-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Icatibant is the only subcutaneous treatment for acute Type I and Type II hereditary angioedema with C1-esterase inhibitor deficiency (HAE-C1-INH) licensed for self-administration in Europe.Aim: To compare the economic impact of two icatibant administration strategies: health professional-administration only (strategy 1) versus including the patient self-administration option (strategy 2). METHODS: Economic evaluation model based on the building of a decision tree. Both strategies are assumed to have equivalent effectiveness. The payer (Spanish National Health System) and the social perspectives were considered. All relevant cost-generating factors were taken into account. The time horizon was one year. Sources of information included scientific evidence, official data and experts' opinion. A deterministic sensitivity analysis was carried out to quantify the underlying uncertainty in the model. RESULTS: From the social perspective, which considers both direct (health care costs) and indirect costs (productivity losses), strategy 2 would result into average savings of [euro sign]121.30 per acute attack compared to strategy 1. For Spain, this would achieve in an annual savings of [euro sign]551,371. The reduction in direct costs accounts for 74% of the savings and lower indirect costs account for the remaining 26%. Savings per acute attack may range from [euro sign]79.50 to [euro sign]169.80; accordingly, the annual savings in Spain may vary between [euro sign]90,319 and [euro sign]2,315,360. CONCLUSION: Costs related to the management of acute HAE attacks with C1 inhibitor deficiency may be substantially reduced through interventions targeting home treatment by training patients to self-administer icatibant.
Health economics review. 02/2013; 3(1):2.
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the adherence to immunosuppressant therapy (IST) and perceived barriers affecting IST adherence and quality of life (QOL) in patients who had received a renal (RT) or liver transplant (LT), a questionnaire was sent to over 9000 RT and LT recipients in Spain. Questionnaire comprised questions about patient's socio-demographic, organ transplant and medication characteristics; IST adherence and patient's perceived barriers to adherence; and patient's QOL using the EuroQol. Data from 1983 RT patients and 1479 LT patients were analyzed. Self-reported adherence to IST in RT (92.6%) and LT (88.5%) recipients was high. Daily medication intake (mean of 2-3 doses/d per patient) was considered a lifestyle restriction in about 25% of transplant recipients and was the most common barrier to adherence perceived by over 30% of RT and LT patients. Overall, high-intensity treatment regimens were associated with poorer QOL (EuroQol <70) compared with low-intensity treatment regimens. Most RT (71.0%) and LT (61.4%) patients would prefer to suppress the evening dose if they were able to. Although high adherence rates to IST were reported in this first large Spanish survey in RT and LT patients, adjustment of daily treatment intensity by less frequent dosing may be an adequate strategy to minimize barriers to adherence and improve QOL.
Clinical Transplantation 10/2011; 26(2):369-76. · 1.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nurses play an important role in the multidisciplinary management of inflammatory bowel disease (IBD), but little is known about this role and the associated resources.
To improve knowledge of resource availability for health care activities and the different organizational models in managing IBD in Spain.
Cross-sectional study with data obtained by questionnaire directed at Spanish Gastroenterology Services (GS). Five GS models were identified according to whether they have: no specific service for IBD management (Model A); IBD outpatient office for physician consultations (Model B); general outpatient office for nurse consultations (Model C); both, Model B and Model C (Model D); and IBD Unit (Model E) when the hospital has a Comprehensive Care Unit for IBD with telephone helpline, computer, including a Model B. Available resources and activities performed were compared according to GS model (chi-square test and test for linear trend).
Responses were received from 107 GS: 33 Model A (31%), 38 Model B (36%), 4 Model C (4%), 16 Model D (15%) and 16 Model E (15%). The model in which nurses have the most resources and responsibilities is the Model E. The more complete the organizational model, the more frequent the availability of nursing resources (educational material, databases, office, and specialized software) and responsibilities (management of walk-in appointments, provision of emotional support, health education, follow-up of drug treatment and treatment adherence) (p<0.05).
Nurses have more resources and responsibilities the more complete is the organizational model for IBD management. Development of these areas may improve patient outcomes.
Journal of Crohn s and Colitis 06/2011; 5(3):211-7. · 2.57 Impact Factor
-
Gastroenterología y Hepatología 05/2011; 34(5):376-7. · 0.73 Impact Factor
-
Paloma Hernández-Sampelayo,
Montserrat Seoane,
Lorena Oltra,
Laura Marín,
Antonio Torrejón,
María Isabel Vera,
Valle García, Pablo Lázaro,
Elizabeth Parody,
Antonio J Blasco,
Francisco Casellas
[show abstract]
[hide abstract]
ABSTRACT: The purpose of quality of care programs is to improve patient outcomes. In programs targeting patients with inflammatory bowel disease (IBD), nurses play a key role.
To know the available scientific evidence on the quality of care in IBD management, at the levels of structure, process and outcome, in relation to nurses.
Systematic search in MEDLINE, EMBASE, Índice Médico Español, Cochrane Library, and grey literature. Inclusion criteria were: 1) documents referring IBD; 2) documents providing relevant information on nurses' involvement in the management of IBD; and 3) an original article.
A total of 284 documents were identified, 15 of which were included: 8 related with structure, 12 with process, and 6 with outcomes. Some documents treated more than one level. At the level of structure, services should incorporate specialist nurses as part of the multidisciplinary team, as well as resources to facilitate patient access to nursing care. Notable at the process level, organizational aspects and nurses' competencies and skills in the management of IBD have been described. Among the outcomes mentioned are clinical outcomes, quality of life, and patient satisfaction attributable to nursing staff. No evidence was found about the association between structure or process issues with patient outcomes. Most of the studies reviewed have methodological limitations.
The available evidence provide useful information for the design of standards of structure and process relating to nurses' management of IBD. The IBD nurses' challenge is to provide evidence that these standards help improve health outcomes in patients.
Journal of Crohn s and Colitis 12/2010; 4(6):611-22. · 2.57 Impact Factor
-
Maider Ibarrola-Villava,
Lara P Fernandez,
Guillermo Pita,
Jerónimo Bravo,
Uxua Floristan,
Elena Sendagorta,
Marta Feito,
José A Avilés,
Manuel Martin-Gonzalez, Pablo Lázaro,
Javier Benítez,
Gloria Ribas
[show abstract]
[hide abstract]
ABSTRACT: The CDKN2A gene is regarded as the major familial malignant melanoma (MM) susceptibility gene. Human pigmentation is one of the main modulators of individual risk of developing MM. Therefore, the genes involved in the determination of skin colour and tanning response are potentially implicated in MM predisposition and may be useful predictors of MM risk in the general population. The human melanocortin-1 receptor gene (MC1R) plays a crucial role in pigmentation and also appears to be important in MM. The OCA2 gene has emerged as a new and significant determinant of human iris colour variation. We present a case-control study in Spanish population including 390 consecutive patients with melanoma and 254 control subjects. Sequence analysis of the entire coding region and genotyping of 5 tag-SNPs in the genomic region of MC1R was performed. We identified 27 variants, two reaching statistical significance [R160W (OR: 4.18, 95% CI: 1.24-14.04, P = 0.02) and D294H (OR: 3.10, 95% CI: 1.37-7.01, P = 0.01)] and we detected two novel non-synonymous changes: V92L and T308M. Odds ratio for carrying two functional variants was 4.25 (95% CI: 2.30-7.84, P = 3.63 x 10(-6)). Haplotypes of the entire MC1R region have been established, and we observed an enrichment of a rare European haplotype similar to African values carrying variants V92M and I155T. In addition, three potentially functional SNPs were selected in p16/CDKN2A and in the promoter region of OCA2/HERC2. Our data for CDKN2A gene did not reach statistically significant results for any of the two studied alleles. We found that the variant allele A > G of OCA2/HERC2 (rs12913832) was associated with pigmentation features: eye, hair and skin colour; P-values = 1.8 x 10(-29), 9.2 x 10(-16), 1.1 x 10(-3), respectively, validating previous results.
Experimental Dermatology 09/2010; 19(9):836-44. · 3.54 Impact Factor
-
Dermatologic Surgery 04/2010; 36(5):687-93. · 1.80 Impact Factor
-
Lara P Fernandez,
Roger L Milne,
Guillermo Pita,
Uxua Floristan,
Elena Sendagorta,
Marta Feito,
Jose A Aviles,
Manuel Martin-Gonzalez, Pablo Lázaro,
Javier Benítez,
Gloria Ribas
Melanoma research 11/2009; 19(5):340-1. · 2.06 Impact Factor
-
Contact Dermatitis 07/2009; 60(6):348-9. · 3.51 Impact Factor
-
Lara P Fernandez,
Roger L Milne,
Guillermo Pita,
Uxua Floristan,
Elena Sendagorta,
Marta Feito,
Jose A Avilés,
Manuel Martin-Gonzalez, Pablo Lázaro,
Javier Benítez,
Gloria Ribas
[show abstract]
[hide abstract]
ABSTRACT: Human pigmentation appears to be one of the main modulators of individual risk of developing malignant melanoma (MM). A large number of genes are known to be involved in rare pigmentary disorders and explain most of the variation in pigmentation phenotypes seen in human populations. This Spanish case-control study included 205 patients with melanoma and 245 control subjects. Thirty-one single nucleotide polymorphisms (SNPs) in genes that had been mainly associated with congenital pigmentation syndromes (ADTB3A, ATRN, CHS1, EDNRB, HPS, KIT, MGRN1, MITF, MLANA, MYO5A, MYO7A, OA1, OCA2, PAX3 and SOX10) were selected. We found that the variant allele of OCA2 R419Q (rs1800407) was associated with increased risk of MM (OR 1.55, 95% CI 1.04-2.31, P = 0.03). This effect on melanoma risk appeared to be stronger among individuals with solar lentigines, or at least 50 nevi. We also describe, for the first time, an association with the variant S1666C (rs2276288) in the MYO7A gene (OR 1.35; 95% CI 1.04-1.76; P = 0.03). Again, this association appeared to be stronger in several phenotypic groups such as individuals with fair skin and those with childhood sunburns. We also found that several variants in the pigmentation genes considered were associated with intermediate phenotypic characteristics. Our findings highlight the potential importance of pigmentation genes in sporadic MM susceptibility.
Experimental Dermatology 04/2009; 18(7):634-42. · 3.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Specific risk factors for complications in pediatric dermatologic surgery have not been studied in previous reports.
Analyze complications of a cohort of children for anesthetic and surgical complications and determine specific risk factors for surgical complications.
Retrospective collection of data from 210 consecutive children having operations over 6 years. Bivariate and logistic regression statistical analysis of complications and risk factors was conducted for single step interventions.
General anesthesia complications were observed in 10.07 percent of the cases: Agitation and stridor were the most common anesthetic complications. Surgical complications were observed in 22.63 percent of the cases. Scar stretching followed by infection were the most prevalent complications. Complication rates, both anesthetic (9.09%) and surgical (13.63%) of multiple step interventions were similar to single step surgery. Intradermal absorbable suture in upper closure (p=0.028) and in limb (p=0.014) location were independently associated with complications.
General anesthesia is safe in pediatric dermatology in the hands of experienced pediatric anesthetists. The most frequent surgical complication was scar stretching. Limb location and use of absorbable continuous intradermal suture in the upper closures should be taken into account as possible risk factors when informing parents and performing these procedures.
Dermatology online journal 01/2009; 15(9):2.
-
[show abstract]
[hide abstract]
ABSTRACT: Occupational airborne contact dermatitis from disinfectants are not frequent. They are usually seen in hospitals, were the exposure is more common. We report a case of a young woman, with an intense eczematous eruption that developed hours after an accidental contact with a cleaning solution.
Contact Dermatitis 12/2006; 55(5):311-2. · 3.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background Treatment in advanced stage mycosis fungoides is often palliative. New approaches, like radioimmunotherapy, are necessary. However, only partial responses or short-term remissions are ohtained with all these methods.Case report: A 37-year-old female had a tumor stage mycosis fungoides and a thyroid carcinoma with lymph node involvement. Both tumors are now in complete remission 9 years after following a combined treatment with I-131 (total dose 250 mCi).Conclusion: Further studies are needed to assess the role of I-131 in the treatment of mycosis fungoides.
Journal of the European Academy of Dermatology and Venereology 07/2006; 7(2):171 - 175. · 2.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The incidence of cutaneous melanoma has increased worldwide in the last 20 years. Research on potential risk factors, both environmental and genetic, has led us to some new and interesting conclusions. Ultraviolet radiation is clearly the main environmental risk factor for melanoma, but its relationship is complex and controversial. With regard to genetic factors, the discovery of two types of genes was a great advance in further understanding the biology of the melanocyte. CDKN2A (p16) is the prototype of the high-penetrance, low-prevalence gene related to melanoma. This gene has been studied in some families in which several members have been diagnosed with melanoma. In the general population with non-familial melanoma, low-penetrance, high-prevalence genes such as MC1R seem to be more interesting. Studies on the MC1R gene have not only shown its importance in skin and hair pigmentation, but also in the development of melanoma. Functional studies on CDKN2A and MC1R have led us to new and important conclusions. The analysis of data from studies on families, twins and control cases, with the collaboration of several countries, will lead us to new discoveries. For the primary and secondary prevention of this tumor, we must promote public health campaigns on the dangers of sun exposure and the identification of individuals at high risk.
Actas Dermo-Sifiliográficas 06/2006; 97(4):229-40.
-
[show abstract]
[hide abstract]
ABSTRACT: Surgical treatment of melanoma is performed by dermatologists and general or plastic surgeons. It is not known whether the type of specialist treating the melanoma results in a different prognosis for these patients.
A retrospective study was carried out on the epidemiological, clinical/histological and evolutional characteristics of all patients diagnosed with melanoma at Hospital Gregorio Marañón over a 10-year period (1994-2003). The differences by hospital department where the patients were treated (dermatology, general surgery and plastic surgery) were noted.
Over 90 % of the patients with melanoma were treated by the Dermatology Department. The thickness of the tumors and the presence of histologic ulceration were significantly higher in the melanomas treated by general and plastic surgeons (p <0.05). The differences in overall average survival (105, 55 and 77 months) and disease-free time (88, 24 and 51.3 months) in the melanomas operated on by dermatologists, general surgeons and plastic surgeons, respectively, were significant (p <0.001).
This study confirms that there are significant differences in the clinical and histological characteristics and the life prognosis of patients with cutaneous melanoma treated by different specialists. The melanomas treated by general or plastic surgeons have usually been developing for a longer time, and therefore are thicker and more often ulcerated than those treated by dermatologists, resulting in a lower survival period. With appropriate medical and surgical training, dermatologists are the most suitable specialists for early diagnosis and treatment.
Actas Dermo-Sifiliográficas 06/2006; 97(4):247-52.
-
[show abstract]
[hide abstract]
ABSTRACT: Tumor cell migration involved in metastases is a tightly regulated, nonrandom process. Chemokines have been identified as critical molecules guiding cell migration. We performed a prospective study to analyze a possible association between the expression of chemokine receptors CXCR3 and CXCR4 by primary melanoma and clinical outcome. Forty primary melanomas were available for analysis; 57% of the tumors expressed CXCR3 and 35% expressed CXCR4 by melanoma cells. At initial diagnosis, 5 patients had subclinical lymph node involvement and after a median follow-up time of 32 months, 2 additional patients developed regional lymph node metastases and 5 patients developed distant metastases. The expression of CXCR4, but not CXCR3, by melanoma cells in primary lesions was significantly associated with the presence of ulceration, increased tumor thickness, a greater risk of developing regional and distant metastases and a higher mortality rate. Our study underscores the value of CXCR4 expression as a useful marker for predicting outcome in patients with localized melanoma. In addition, our findings support that, among chemokine receptors, CXCR4 might be an appropriate therapeutic target for adjuvant therapy in patients at risk for metastatic disease.
International Journal of Cancer 01/2006; 117(5):861-5. · 5.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Numerous plant species and their derivatives can cause skin reactions through a variety of mechanisms: irritative contact dermatitis, allergic contact dermatitis, contact urticaria and photodermatitis. We present a case of irritative contact dermatitis after exposure to the sap of Agave americana. The skin symptoms in this case have only been described on rare occasions; although this condition usually presents with a papulovesicular rash, in this patient it appeared as purpuric lesions in the contact area.
Actas Dermo-Sifiliográficas 11/2005; 96(8):534-6.
-
[show abstract]
[hide abstract]
ABSTRACT: We present two cases of systemic lupus erythematosus (SLE) which began with subacute clinical manifestations. Both cutaneous and systemic lupus are the result of interactions between susceptibility genes and environmental factors such as ultraviolet radiation, giving rise to an anomalous response with hyperreactivity of T and B lymphocytes. Over 50 % of subacute cutaneous lupus cases have or will have SLE, while only 16 to 61 % of SLE cases have acute cutaneous lupus lesions.
Actas Dermo-Sifiliográficas 06/2005; 96(4):248-51.
-
[show abstract]
[hide abstract]
ABSTRACT: Positron emission tomography (PET) imaging is superior to conventional techniques for the evaluation of patients with stage III and stage IV cutaneous melanoma. Several studies have highlighted the advantages of this noninvasive technique for the assessment of lymph node involvement.
To compare PET imaging with sentinel node biopsy for primary staging of cutaneous melanoma and to discuss the technical limitations of PET scanning.
Twenty-five consecutive patients with a histologic diagnosis of melanoma with a Breslow thickness equal or greater to 1 mm underwent a preoperative PET to assess lymph node involvement.
Sentinel node biopsy and PET showed a sensitivity of 100% and 22%, respectively, in the identification of lymph node metastases.
PET is not a sensitive technique for the primary staging of cutaneous melanoma.
Dermatologic Surgery 04/2003; 29(3):245-8. · 1.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hepatitis C virus (HCV) replicates in salivary glands of chronic hepatitis C patients and is released into the saliva, suggesting that HCV may replicate in other exocrine glands. The presence of positive and negative HCV RNA strands was demonstrated by in situ hybridization, and of HCV core protein by immunohistochemistry, in sweat glands and keratinocytes in healthy skin biopsies from 15 patients with chronic hepatitis C and 10 anti-HCV negative patients with chronic liver disease. Positive and negative HCV RNA strands were detected in 9.6 +/- 5.2% and 4.2 +/- 3.8%, respectively, of the epithelial cells of eccrine sweat glands. Core protein was detected in 6.0 +/- 3.93% of these cells. HCV RNA resistant to RNase digestion (encapsidated HCV RNA) was detected in 10/10 sweat samples from HCV-infected patients. Positive and negative HCV RNA strands were detected in 6.7 +/- 2.97% and 3.0 +/- 3.08% of the keratinocytes, respectively. HCV core protein was found in 4.5 +/- 2.76% of these cells. No HCV RNA or HCV core protein was detected in the skin biopsies from the 10 anti-HCV negative patients. In conclusion, HCV replicates in eccrine sweat glands cells and keratinocytes in healthy skin and is released into the sweat.
Journal of Medical Virology 01/2003; 68(4):529-36. · 2.82 Impact Factor
