Daniel Ginard

Hospital Universitari Son Espases, Palma, Balearic Islands, Spain

Are you Daniel Ginard?

Claim your profile

Publications (60)312.81 Total impact

  • Journal of Crohn s and Colitis 02/2014; 8:S283-S284. DOI:10.1016/S1873-9946(14)60637-1 · 3.56 Impact Factor
  • Journal of Crohn s and Colitis 02/2014; 8:S178-S179. DOI:10.1016/S1873-9946(14)60399-8 · 3.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: patient satisfaction with healthcare services provided for inflammatory bowel diseases (IBD) is essential due to high resources use.Objectives: the study aimed to describe patient satisfaction with healthcare services using the CACHE questionnaire and to assess gastroenterologist and nurse perception on patients´ satisfaction.Methods: observational multicentric prospective study in 35 Spanish hospitals. Patients included had Crohn´s disease or ulcerative colitis. The study was approved by the Hospital Universitari Vall d´Hebron Ethics Committee. Scheduled study visits: baseline (patient sociodemographics and clinical data were collected), 2-4 and 6-months. Patient satisfaction with healthcare was assessed by CACHE questionnaire at each visit; it scores from 0-least satisfaction to 100-highest satisfaction.Gastroenterologists and nurses answered once an adapted questionnaire.Results: participating 290 patients (54.2 % males, 41.3 years old), 62 gastroenterologists and 47 nurses. At baseline mean (SD) CACHE score was 81.7 (10.9); satisfaction with clinician care was the highest, patient information the lowest. Scores did not change across study.Gastroenterologist global score was 72.5 (9.8); Staff Care satisfaction was the highest, patient information the lowest. All scores were significantly lower than patients´.Nurses´ global score was 82.2 (8.5), clinician care satisfaction was the highest, centre facilities the lowest. Scores on satisfaction with clinician care, centre facilities, and patient information scored statistically lower than patients´.No relationship was found between patients´ satisfaction and patients characteristics.Conclusions: IBD patients are satisfied with healthcare services provided, even though the information may be improved. Nurses´ perception is similar to that of patients, physicians have a lower perception.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 08/2013; 105(7):385-391. DOI:10.4321/S1130-01082013000700003 · 1.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: : Currently, there is no tool to evaluate satisfaction of patients with inflammatory bowel disease (IBD) with health care services. The objective of this study was to develop and test a new specific instrument to measure satisfaction with health care in patients with IBD. : The questionnaire was developed using a literature review, a focus group with clinical experts, and administration of a provisional version to 20 patients with IBD. The final version of the questionnaire was validated in a longitudinal multicenter study in adult patients with IBD. The instrument's underlying dimension structure was analyzed using factor analysis, and its feasibility, reliability, and validity were assessed. : The final version of the CACHE questionnaire contains 31 items scored on a 5-point Likert-type scale. Scores were standardized to a range from 0 (minimum satisfaction) to 100 (maximum satisfaction). Factor analysis revealed 6 factors (staff care, clinician care, facilities, information, center accessibility, and support received), which explained 56% of variance. Overall, 91% of patients answered all items. Cronbach's alpha for the overall score was 0.93. There were no statistically significant correlations between the overall score and sociodemographic and clinical variables, but there was a statistically significant correlation between the time spent in the waiting room and the item measuring satisfaction with that aspect. There were no statistically significant changes in the overall score between the visits. The effect size was 0.016. : The CACHE questionnaire covers aspects relevant to the assessment of health care quality in patients with IBD and has proved to be feasible, reliable, and valid.
    Inflammatory Bowel Diseases 03/2013; 19(3):559-68. DOI:10.1097/MIB.0b013e31827febd1 · 5.48 Impact Factor
  • Journal of Crohn s and Colitis 02/2013; 7:S180. DOI:10.1016/S1873-9946(13)60446-8 · 3.56 Impact Factor
  • Journal of Crohn s and Colitis 02/2013; 7:S222-S223. DOI:10.1016/S1873-9946(13)60551-6 · 3.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES:The safety of thiopurines and anti-tumor necrosis factor-α (TNF-α) drugs during pregnancy remains controversial, as the experience with these drugs in this situation is limited. Our aim is to assess the safety of thiopurines and anti-TNF-α drugs for the treatment of inflammatory bowel disease (IBD) during pregnancy.METHODS:Retrospective, multicenter study in IBD patients. Pregnancies were classified according to the therapeutic regimens during pregnancy or during the 3 months before the conception: non-exposed group, pregnancies exposed to thiopurines alone (group A), and pregnancies exposed to anti-TNF-α drugs (group B). An unfavorable Global Pregnancy Outcome (GPO) was considered if pregnancy developed with obstetric complications in the mother and in the newborn.RESULTS:A total of 187 pregnancies in the group A, 66 pregnancies in the group B, and 318 pregnancies in the non-exposed group were included. The rate of unfavorable GPO was different among the three groups (31.8% in non-exposed group, 21.9% in group A, and 34.8% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). The rate of pregnancy complications was similar among the three groups (27.7% in non-exposed, 20.9% in group A, and 30.3% in group B). The rate of neonatal complications was different among the three groups (23.3% in non-exposed group, 13.9% in group A, and 21.2% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). In the multivariate analysis, the treatment with thiopurines (odds ratio=0.6; 95% confidence interval=0.4-0.9, P=0.02) was the only predictor of favorable GPO, whereas maternal age >35 years at conception was the only predictor of unfavorable GPO. The treatment with anti-TNF-α drugs was not associated with an unfavorable GPO.CONCLUSION:The treatment with thiopurines and anti-TNF-α drugs does not seem to increase the risk of complications during pregnancy and does seem to be safe for the newborn.Am J Gastroenterol advance online publication, 15 January 2013; doi:10.1038/ajg.2012.430.
    The American Journal of Gastroenterology 01/2013; 108(3). DOI:10.1038/ajg.2012.430 · 9.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antecedentes: El objetivo de este estudio fue estimar los costes directos hospitalarios asociados al manejo clínico y terapéutico de los pacientes con enfermedad de Crohn moderada y grave en la práctica clínica habitual en España. Metodología: Estudio descriptivo, naturalístico, retrospectivo, de carácter multicéntrico y de ámbito nacional. Participaron en el estudio 10 médicos gastroenterólogos de 10 hospitales españoles. La información para el estudio se obtuvo de una revisión de historias clínicas de pacientes con enfermedad de Crohn (EC). Se elaboró un modelo de Markov para estimar el coste directo sanitario por paciente asociado al manejo clínico y terapéutico de la enfermedad de Crohn, desde la perspectiva del Sistema Nacional de Salud (SNS) en un periodo de tres años. Se ha realizado un análisis de sensibilidad para evaluar el impacto en los resultados de cambios en las principales variables. Resultados: Se incluyó a 178 pacientes. La estimación del coste directo sanitario asociado a la EC para un periodo de 3 años fue de 23.168 € por paciente (7.722 € por paciente y año). Los ingresos hospitalarios representaron un 57% del total de los costes asociados a la EC, los costes asociados al tratamiento farmacológico el 33% (27% debido a terapias biológicas (TB) y 6% por terapias convencionales). Los demás costes que incluyen visitas, pruebas e intervenciones quirúrgicas representaron un 10%. La probabilidad de recibir terapia biológica fue la única variable testada que presentó un impacto significativo en el resultado final del modelo. Conclusiones: El coste directo de la EC se debe en su mayor parte a los ingresos hospitalarios y a la intensa utilización de recursos en los estados más graves de la enfermedad. La utilización de mayores dosis de TB en la práctica clínica habitual, en comparación con las de sus fichas técnicas, está directamente relacionada con el aumento de los costes de la EC.
    Pharmacoeconomics - Spanish Research Articles 01/2013; 7(1). DOI:10.1007/BF03320866
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: While most studies have found a negative effect of smoking on Crohn's disease (CD) phenotype, more recent data have failed to reproduce this association, which might be due to a current wider use of thiopurines and biologic therapy. The TABACROHN study aimed at defining the impact of smoking on CD in the largest published series. METHODS: This multicenter cross-sectional study included 1170 CD patients. Patients were classified as nonsmokers, current smokers, or former smokers according to their present smoking status. Clinical data regarding disease characteristics, treatment, and complications were collected. RESULTS: Smokers were more frequently under maintenance treatment when compared to nonsmokers. In addition, current smokers presented higher use of biologic drugs compared to nonsmokers. Tobacco exposure and a higher tobacco load were independent predictors of need for maintenance treatment and stenosing phenotype, respectively. CONCLUSIONS: In the era of early and widespread use of immunosuppressants and biologics, tobacco exposure is an independent predictor of need for maintenance treatment, specifically biologic therapy. The wider use of biologics and immunosuppressants could account for the existence of no major differences in disease behavior and complications between nonsmokers and current smokers. (Inflamm Bowel Dis 2012;).
    Inflammatory Bowel Diseases 01/2013; DOI:10.1002/ibd.22959 · 5.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND AIMS: The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction. METHODS: Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care. RESULTS: A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p<0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations. CONCLUSIONS: The level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented.
    Journal of Crohn s and Colitis 11/2012; DOI:10.1016/j.crohns.2012.10.003 · 3.56 Impact Factor
  • R. Queiro, D. Ginard
    [Show abstract] [Hide abstract]
    ABSTRACT: Although ustekinumab is currently licensed for the treatment of psoriasis, in view of the innovative mechanism of action of this biologic agent, it is reasonable to hypothesize that it will, in the near future, be approved for other indications, such as the treatment of psoriatic arthritis and Crohn disease.Interactions between genetic, environmental, and immunological factors play a key role in the pathogenesis of both psoriasis and psoriatic arthritis. The IL-23/TH17 axis is one of the main pathogenic pathways in these diseases, and there is ample evidence to support the use of pharmacologic agents targeting this pathway. Ustekinumab, a human monoclonal antibody that binds to the p40 subunit shared by IL-12 and IL-23, is currently the only agent capable of modulating the IL-23/TH17 pathway. While there is some evidence supporting the use of ustekinumab in the treatment of psoriatic arthritis, more data on safety and efficacy are required.Crohn disease is a chronic inflammatory disease of unknown etiology that affects the digestive tract. It is treated with corticosteroids, immunosuppressants, and anti-TNF agents. Alternative treatments, such as ustekinumab, however, are needed for patients who do not respond to conventional therapy. The results of 2 recent phase IIb studies showed that ustekinumab induced and maintained clinical response in patients with Crohn disease; most of those who responded well had previously been unsuccessfully treated with infliximab and had elevated C reactive protein levels at the time of treatment. Many issues remain to be resolved, including the establishment of an optimal dose and administration route. Further studies are needed to evaluate the efficacy of ustekinumab in Crohn disease and to determine the best treatment regimen.The present chapter reviews the current evidence on the potential usefulness of ustekinumab in the treatment of psoriatic arthritis and Crohn disease.
    Actas Dermo-Sifiliográficas 10/2012; 103:65–72. DOI:10.1016/S0001-7310(12)70011-X
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Tobacco smoking has a significant impact on the development of Crohn's disease (CD) and its clinical course, making smoking cessation one of the main goals in CD therapeutic strategy. Aims: To evaluate the effectiveness of an advice-based smoking cessation strategy among CD patients. Methods: We have performed a prospective multicenter study which enrolled 408 CD smokers. At inclusion all patients were instructed about the risks of smoking and subsequently followed every 3 months. Each center used additional smoking cessation strategies based on available resources. Urinary cotinine and exhaled carbon monoxide levels were evaluated in a subgroup of patients. Results: Median study follow up was 18 months. 31% of the patients achieved complete smoking cessation and 23% were smoking-free at the end of their follow up with 8% of smoking relapse. Most patients not achieving smoking cessation did not change their smoking habit with only 5% presenting a decrease in tobacco load. 63% of patients willing to quit smoking received help from another specialist, most frequently the pulmonologist (47%). Surprisingly, most patients (88%) tried to quit smoking with no pharmacological therapy and bupropion, varenicline and nicotine replacement treatment were used in few patients. Urinary cotinine and exhaled CO levels tested in a subgroup of patients proved to have a good correlation with the self-reported smoking habit. No predictors of successful smoking cessation were identified. Conclusion: Our results underline that an anti-tobacco strategy mostly based on CD patients´s education and counseling is feasible and effective in helping patients reach complete abstinence.
    Journal of Crohn s and Colitis 05/2012; 7(3). DOI:10.1016/j.crohns.2012.04.011 · 3.56 Impact Factor
  • Journal of Crohn s and Colitis 02/2012; 6:S109-S110. DOI:10.1016/S1873-9946(12)60272-4 · 3.56 Impact Factor
  • Journal of Crohn s and Colitis 02/2012; 6:S114. DOI:10.1016/S1873-9946(12)60283-9 · 3.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several small, prospective, open studies suggest that leukocytapheresis might be efficient in patients with steroid-dependent ulcerative colitis (UC). To evaluate the short- and long-term effectiveness of leukocytapheresis for the management of steroid-dependent UC in clinical practice. A Web-based, nationwide database specifically designed to record the efficacy and safety data of leukocytapheresis therapy in UC was available from September 2007 in Spain. Clinical data were collected at treatment baseline, 1 month after the last apheresis session (initial efficacy), and 6 and 12 months thereafter (long-term efficacy). Remission was defined as a Mayo Clinic index ≤2 together with complete steroid withdrawal and response as a decrease of ≥3 from the baseline score. A total of 142 steroid-dependent UC patients were included in the registry, most of them treated with the Adacolumn™ system. In 69% of patients thiopurine therapy failed to achieve steroid-free clinical remission. Initial clinical remission was obtained in 37% of cases. The initial corticosteroid dose, the number and frequency of apheresis sessions, or the previous failure of thiopurines and/or infliximab did not influence the initial remission rate, but a greater decrease in CRP levels was associated with a higher probability to obtain initial remission. At 6 and 12 months, 41 and 36% of patients were in clinical remission, respectively. Only one serious adverse effect was recorded. In clinical practice, apheresis allows long-term steroid-free clinical remission in up to one third of steroid-dependent UC patients, even in those with prior failure of thiopurines.
    Journal of Gastroenterology 11/2011; 47(4):359-65. DOI:10.1007/s00535-011-0499-2 · 4.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Low thiopurine-methyl-transferase (TPMT) activity and high 6-thioguanine-nucleotide (6TGN) concentrations have been linked to therapeutic success in inflammatory bowel disease patients treated with thiopurines; however, this has not been implemented in clinical practice. To identify a therapeutic threshold value for TPMT or 6TGN concentrations, and their capability to predict treatment safety and efficacy. Prospective multicentre study including steroid-resistant/dependent patients starting thiopurines. The TPMT activity was determined at inclusion (>5 U/mL required). Azathioprine metabolites [6TGN, 6-methyl-mercaptopurine ribonucleotides (6MMP), and 6TGN/6MMP and 6TGN/TPMT ratios] were periodically monitored during steroid tapering and after withdrawal for 6 months or until a new flare occurred. A total of 113 patients were analysed (62% clinical response). Areas under the receiver operating characteristic (ROC) curve (AUC) relating clinical response and metabolite levels at 2, 4 and 6 months after steroid withdrawal were less than 0.7. The AUCs relating final response and initial TPMT activity or metabolite concentrations at 2, 4, 8 and 16 weeks after starting thiopurines were less than 0.7. No cut-off point with worthwhile sensitivity/specificity was found. Eight (7%) patients developed thiopurine-related toxicity that could not be linked to TPMT activity or 6TGN levels. Our results do not support determination of TPMT activity or 6TGN concentrations to predict treatment outcome, and no useful serum metabolites threshold value to adjust the drug's dose was identified.
    Alimentary Pharmacology & Therapeutics 07/2011; 34(5):544-54. DOI:10.1111/j.1365-2036.2011.04756.x · 4.55 Impact Factor
  • Gastroenterology 01/2011; 140(5). DOI:10.1016/S0016-5085(11)61172-4 · 13.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Few data are available on the prevalence of erosive and severe esophagitis in Western countries. To retrospectively determine the prevalence and the factors predicting erosive esophagitis and severe esophagitis in a large series of endoscopies in Spain. Retrospective observational study. A multivariate analysis was performed to determine variables predicting severe esophagitis. Databases of 29 Spanish endoscopy units. Patients submitted to a diagnostic endoscopy during the year 2005. Retrospective review of the databases. Esophagitis severity (graded according to the Los Angeles classification) and associated endoscopic findings. Esophagitis was observed in 8.7% of the 93,699 endoscopies reviewed. Severe esophagitis (LA grade C or D) accounted for 22.5% of cases of the disease and was found in 1.9% of all endoscopies. Incidences of esophagitis and those of severe esophagitis were 86.2 and 18.7 cases per 100,000 inhabitants per year respectively. Male sex (OR 1.89) and advanced age (OR 4.2 for patients in the fourth age quartile) were the only variables associated with severe esophagitis. Associated peptic ulcer was present in 8.8% of cases. Retrospective study, no data on individual proton pump inhibitors use. Severe esophagitis is an infrequent finding in Spain. It occurs predominantly in males and in older individuals. Peptic ulcer disease is frequently associated with erosive esophagitis.
    PLoS ONE 01/2011; 6(10):e25051. DOI:10.1371/journal.pone.0025051 · 3.53 Impact Factor
  • Source
    Gastroenterology 01/2011; 140(5). DOI:10.1016/S0016-5085(11)61065-2 · 13.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Beclometasone dipropionate (BDP) is a relatively new topically acting oral steroid to treat mild to moderately active ulcerative colitis (UC). We estimate that 20,000 patients have received oral BDP in Spain in the last two years. Our aim was to evaluate the efficacy and safety of oral BDP in clinical practice. Retrospective and multicenter study that included 434 patients with active UC treated with BDP. The partial Mayo Clinic score (pMS, 0-9) was used to measure disease activity. Remission was defined as post-treatment pMS of 0 or 1; response as a decrease in pMS of 3 points or 2 points and >30%, and failure as lack of remission or response. BDP dose was 5 mg/day in 88% of patients and mean treatment duration was 6.2 weeks. BDP achieved remission in 44.4%, response in 22.3% and failed in 33.2% of patients. Mean pMS decreased from 4.9 ± 1.3 to 2.4 ± 2.3 (p<0.0001). Remission rate was higher in mild and moderate than in severe UC (p<0.043) and tended to be higher in left-sided and extensive UC than in proctitis (p<0.06). Failure was less frequent in patients treated for >4 weeks (p<0.02). Mild adverse events were reported in 7.6% of patients. BDP induces response or remission in two thirds of active UC patients, with a good safety profile. Patients with mild to moderate, left-sided or extensive UC, receiving BDP for more than 4 weeks are most likely to benefit from this treatment.
    Journal of Crohn s and Colitis 12/2010; 4(6):629-36. DOI:10.1016/j.crohns.2010.07.003 · 3.56 Impact Factor