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Crespo J, Carballo Álvarez F, Alberca de Las Parras F, Fernández Rodríguez CM, Vera Mendoza MI, Gómez M, Elola Somoza FJ. Digestive units in the National Health System of the 21st century. Organizational and management standards for a patient-centered service. Rev Esp Enferm Dig 2021; 112:144-149. [PMID: 31960697 DOI: 10.17235/reed.2020.6778/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Spanish Society of Digestive Pathology has set a consensus document on the standards and recommendations for gastroenterology units (GU). These standards are considered as relevant in the organization and management of the unit to develop their activities with efficiency and quality. Four key groups of processes have been identified: a) care for the acutely ill adult patient; b) outpatient digestive endoscopy; c) in-hospital support to other services and outpatient clinics; and d) management of patients with chronic complex digestive pathology. Standards for organization and management of the unit were classified within the group of support processes, and training and research as strategic processes. Standards have also been developed for some functional and monographic units such as endoscopy, hepatology and inflammatory bowel disease; as well as for certain procedures including endoscopic retrograde cholangiopancreatography, colonoscopy and gastroscopy. The standards will be set for other units and procedures as they are developed. The standards developed must be reviewed within a maximum period of five years.
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Affiliation(s)
- Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, 39002
| | | | | | | | | | - Marcos Gómez
- Servicio de Cirugía General y Digestiva, Hospital Universitario Marqués de Valdecilla
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Gutiérrez García ML, Gómez Perosanz R, Acedo Sanz JM, Delgado-Iribarren García-Campero A, Claudio Domínguez I, Domenech Gómez-Imaz A, Pérez Encinas M, de la Fuente Hermosín I, Fabero Jimenez A, Fernández Rodríguez CM. Coordinated assistance plan for the elimination of hepatitis C virus at the centro de ayuda integral al drogodependiente (CAID (Comprehensive Care Centre for Drug Addicts)). Gastroenterol Hepatol 2020; 44:214-220. [PMID: 33162188 DOI: 10.1016/j.gastrohep.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The drug-injecting population has a high prevalence of hepatitis C virus (HCV) and high risk of transmission. It is a priority to establish an agile diagnostic and treatment plan. OBJECTIVES 1) Assess the effectiveness of a new coordinated care plan of referral from the Comprehensive Care Centre for Drug Addicts (CAID) to specialised care and 2) Determine the prevalence of HCV, clinical characteristics, effectiveness and safety of treatment in this population. METHODS 1,300 serologies requested by the CAID between 1998 and 2018 were retrospectively analysed, the seroprevalence of HCV was calculated and the efficiency of the traditional CAID-specialised care referral system was evaluated. A care plan was designed and coordinated among specialists involved in diagnosis and treatment. Since October 2018, 11 patients have been included in the new plan and the performance of both referral systems was compared. RESULTS With the traditional system, 48.2% (83/172) of the patients were lost. 14.5% (172/1,300) presented positive HCV serology, compared to the general population OR = 19; 95% CI 14.3-25. The prevalence of active infection was 80.3% (90/112). The prevalence of active infection was 80.3% (90/112). Of the 11 patients referred by the new plan, 76.9% (8/11) had active infection and 100% (8/8) were treated with Direct Antiviral Agents successfully. CONCLUSIONS The new coordinated CAID-specialised care plan presents high effectiveness in comparison with the traditional referral system. The seroprevalence and prevalence of active infection in the CAID population is very high. Treatments with Direct Antiviral Agents are effective and safe.
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Affiliation(s)
| | - Raquel Gómez Perosanz
- Servicio de Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | | | | | | | | | | | - Aurora Fabero Jimenez
- Dirección de Continuidad Asistencial, Hospital Universitario Fundación Alcorcón, Madrid, España
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Herrero JI, Ampuero J, Fernández Rodríguez CM. Reflex testing. A key tool for the elimination of hepatitis C. Rev Esp Enferm Dig 2020; 112:513-514. [PMID: 32611193 DOI: 10.17235/reed.2020.7201/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatitis C is a major cause of liver cirrhosis and hepatocellular carcinoma, as well as the primary indication for liver transplant in Europe. The highly effective direct-acting antivirals currently available make it possible to achieve the hepatitis C elimination targets set by the World Health Organization. For this, population screening and reflect testing are fundamental strategies.
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Affiliation(s)
| | - Javier Ampuero
- Aparato Digestivo, Hospital Universitario Virgen del Rocío
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Jiménez Galán G, Alia Alia C, Vegue González M, García Berriguete RMª, Fernández González F, Fernández Rodríguez CM, González Fernández M, Gutiérrez García ML, Losa JE, Velasco M, Moreno L, Hervás R, Delgado-Iribarren A, Palacios García-Cervigón G. The contribution of telemedicine to hepatitis C elimination in a correctional facility. Rev Esp Enferm Dig 2020; 111:550-555. [PMID: 31215210 DOI: 10.17235/reed.2019.6152/2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND micro-elimination has been recently proposed as an efficient strategy to achieve global hepatitis C virus (HCV) elimination. The Spanish Health Ministry Strategic Plan for hepatitis C infection highlighted intervention in prisons as a priority action. However, there are important barriers associated with the specialized care provision to the penitentiary population. AIMS to assess the contribution of telemedicine for HCV elimination in a correctional facility in Spain. METHODS an open label program of HCV elimination via telemedicine was started on February 3rd, 2015 in a large penitentiary of 1,200 inmates, as an alternative to referring patients to specialists. An anonymous satisfaction survey was performed among a random sample of inmates and all participating doctors. RESULTS the prevalence of HCV viremia prior to program initiation was 12.4%. One hundred and thirty-one patients received DAA HCV treatment during the period 2015-2018; 42.74% had a HCV-HIV co-infection. Overall, 97% achieved a sustained virological response (SVR). A second regime of DAA successfully rescued non-responder patients and the HCV prevalence was zero at the end of the program. Satisfaction was high or very high according to 67% of inmates and all participating doctors. CONCLUSION telemedicine is an effective tool for HCV elimination in penitentiary correctional facilities where referral to specialists is difficult. The extensive use of this technology should be recommended in this setting in order to facilitate equitable access to specialized care.
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Affiliation(s)
- Germán Jiménez Galán
- Servicio Medico, Centro Penitenciario Madrid IV, Centro Penitenciario de Navalcarnero, España
| | - Carlos Alia Alia
- Servicio Medico, Centro Penitenciario Madrid IV, Centro Penitenciario de Navalcarnero, España
| | - Milagros Vegue González
- Servicio Medico, Centro Penitenciario Madrid IV, Centro Penitenciario de Navalcarnero, España
| | | | | | | | | | | | - Juan Emilio Losa
- Unidad de infecciosas. Medicina Interna, Hospital Universitario Fundación Alcorcón, Spain
| | - María Velasco
- Unidad de Infecciosas. Medicina Interna, Hospital Universitario Fundacion Alcorcon, Spain
| | - Leonor Moreno
- Medicina Interna, Hospital Universitario Fundación Alcorcón, Spain
| | - Rafael Hervás
- Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Spain
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Fernández Rodríguez CM, Aller R, Gutiérrez García ML, Ampuero J, Gómez-Camarero J, Martín-Mateos RMª, Burgos-Santamaría D, Rosales JM, Aspichueta P, Buque X, Latorre M, Andrade RJ, Hernández-Guerra M, Romero-Gómez M. Higher levels of serum uric acid influences hepatic damage in patients with non-alcoholic fatty liver disease (NAFLD). Rev Esp Enferm Dig 2020; 111:264-269. [PMID: 30810330 DOI: 10.17235/reed.2019.5965/2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND recent evidence suggests a causal link between serum uric acid and the metabolic syndrome, diabetes mellitus, arterial hypertension, and renal and cardiac disease. Uric acid is an endogenous danger signal and activator of the inflammasome, and has been independently associated with an increased risk of cirrhosis. AIM AND METHODS six hundred and thirty-four patients from the nation-wide HEPAMET registry with biopsy-proven NAFLD (53% NASH) were analyzed to determine whether hyperuricemia is related with advanced liver damage in patients with non-alcoholic fatty liver disease (NAFLD). Patients were divided into three groups according to the tertile levels of serum uric acid and gender. RESULTS the cohort was composed of 50% females, with a mean age of 49 years (range 19-80). Patients in the top third of serum uric acid levels were older (p = 0.017); they had a higher body mass index (p < 0.01), arterial blood pressure (p = 0.05), triglyceridemia (p = 0.012), serum creatinine (p < 0.001) and total cholesterol (p = 0.016) and lower HDL-cholesterol (p = 0.004). According to the univariate analysis, the variables associated with patients in the top third were more advanced steatosis (p = 0.02), liver fibrosis (F2-F4 vs F0-1; p = 0.011), NASH (p = 0.002) and NAS score (p = 0.05). According to the multivariate logistic regression analysis, the top third of uric acid level was independently associated with steatosis (adjusted hazard ratio 1.7; CI 95%: 1.05-2.8) and NASH (adjusted hazard ratio 1.8; CI 95%: 1.08-3.0) but not with advanced fibrosis (F2-F4) (adjusted hazard ratio 1.09; CI 95%: 0.63-1.87). CONCLUSION higher levels of serum uric acid were independently associated with hepatocellular steatosis and NASH in a cohort of patients with NAFLD. Serum uric acid levels warrants further evaluation as a component of the current non-invasive NAFLD scores of histopathological damage.
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Affiliation(s)
| | - Rocío Aller
- Digestivo, Hospital Clínico Universitario de Valladolid, España
| | | | - Javier Ampuero
- UNIT for the clinical Management of Digestive Dise, Virgen del Rocio University Hospital CIBEReh
| | | | - Rosa M ª Martín-Mateos
- Gastroenterologia, Hospital Universitario Ramon y Cajal. Universidad de ALcala de Henares. CIBERehd
| | - Diego Burgos-Santamaría
- Gastroenterologia, Hospital Universitario Ramon y Cajal. Universidad de ALcala de Henares. CIBERehd, España
| | | | - Patricia Aspichueta
- Biocruces Health Research Institute, University of Basque Country UPV/EHU, Bizkaia, Spain
| | - Xabier Buque
- Biocruces Health Research Institute, University of Basque Country UPV/EHU, Bizkaia, Spain
| | - Mercedes Latorre
- Unidad de hepatología, Consorcio Hospital General Universitario de Valencia
| | - Raúl J Andrade
- Unidad Aparato Digestivo. Complejo Hospitalario de Especialidades Virgen de la Victoria, Málaga
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Gutiérrez García ML, Manzano Alonso ML, Ferrer Rosique JÁ, Muñoz Gómez R, Alonso López S, Fernández Álvarez I, Fernández Rodríguez CM. Hepatitis B virus in patients with chronic hepatitis C treated with direct antiviral agents. Rev Esp Enferm Dig 2020; 111:129-133. [PMID: 30421955 DOI: 10.17235/reed.2018.5667/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION cases of hepatitis B virus (HBV) reactivation have been reported in patients with hepatitis C virus (HCV) treated with direct antiviral agents (DAA). OBJECTIVES AND METHODS the main objectives of the present study are: a) to determine the prevalence of HBV/HCV coinfection in HCV patients treated with DAAs in the Autonomous Community of Madrid (CM) and also to determine the incidence and clinical relevance of HBV reactivation; and b) to determine the HBV screening rates in HCV patients in our region. For that purpose, 1,337 HCV patients were consecutively treated with DAAs in two hospitals located in South CM between January 2015 and June 2017. RESULTS nine of the 1,337 (0.67%) participants were HBsAg positive and 356 (26.6%) had previous HBV infection markers. Two of the four (50%) HBsAg positive patients with untreated HBV developed a virological reactivation, but not a biochemical reaction. Of the 356 patients with previous HBV infection markers, all had normal transaminases at the end of treatment and during follow-up. The HBV screening rate amounted to 92.9% of the cohort. CONCLUSIONS the prevalence of HBV (HBsAg positive) infection in patients with chronic hepatitis C in the southern area of the CM is low. HBV reactivation in HBsAg positive patients treated with DAAs is common, although without clinical relevance. In our region, there is a high rate of HBV screening in patients with HCV that are likely treated with DAAs.
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Fernández Rodríguez CM. Disruptive therapeutic innovation and the opportunity to eliminate a chronic disease - The issue of chronic hepatitis C in Spain. Rev Esp Enferm Dig 2018; 109:807-808. [PMID: 29168643 DOI: 10.17235/reed.2017.5384/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Public funding decisions must be guided by criteria of scientific evidence, cost-effectiveness and economic evaluation. As an increase in health-effectiveness provided by therapeutic innovations can also substantially raise the cost, the cost-effectiveness analysis estimating this increase in the cost per unit of health gained compared to the previous technologies should be part of the economic evaluation. The measure of effectiveness most frequently used in health economic evaluations is the Quality Adjusted Life Year (QALY). Data from a Markov analysis presented by Turnes et al. in the last issue of this journal comparing two scenarios, pre-DAA and post-DAA in Spain is discussed in this document.
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Fernández Rodríguez CM, Fernández Pérez C, Bernal JL, Vera I, Elola J, Júdez J, Carballo F. RECALAD. Patient care at National Health System Digestive Care Units - A pilot study, 2015. Rev Esp Enferm Dig 2017; 110:44-50. [PMID: 29284269 DOI: 10.17235/reed.2017.5316/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. MATERIAL AND METHODS A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). RESULTS Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities. CONCLUSIONS The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement.
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Affiliation(s)
| | | | | | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda
| | - Javier Elola
- Director, Fundacion Instituto para la Mejora de la Asistencia Sanitaria, España
| | - Javier Júdez
- Gestion del conocimiento, Fundacion SEPD, España
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Fernández Rodríguez CM, Alonso López S. [Treatment optimization in chronic hepatitis C virus infection]. Gastroenterol Hepatol 2009; 33:119-25. [PMID: 19804920 DOI: 10.1016/j.gastrohep.2009.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 07/09/2009] [Indexed: 10/20/2022]
Abstract
The treatment duration that obtains the optimal risk-benefit ratio in chronic hepatitis C infection is guided by viral kinetic data in weeks 4 and 12. Rapid virological response (RVR) and early virological response (EVR) have high positive and negative predictive value, respectively. Patients with genotype-1, RVR, without significant fibrosis and low baseline viral load (<600,000UI/ml) can receive treatment for 24 weeks without loss of efficacy, while the absence of EVR in these patients is a criterion for treatment interruption. Data on prolonging treatment to 72 weeks in patients with genotype 1 and a decrease of >2log in viremia without negativization of viremia in week 12 are contractictory. In patients with genotypes 2 and 3, 24-week treatment is superior to 16-week treatment, although 16-week treatment can be evaluated in patients with genotype 3 and RVR. In patients with genotype 2 and RVR, rates of RVR in 14-week treatment are similar to those in 24-week treatment, while in patients without RVR, treatment should be continued to 24 weeks. Key factors in treatment optimization are the weight-adjusted dose of ribavirin and therapeutic adherence.
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