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Baltaxe E, Cano I, Herranz C, Barberan-Garcia A, Hernandez C, Alonso A, Arguis MJ, Bescos C, Burgos F, Cleries M, Contel JC, de Batlle J, Islam K, Kaye R, Lahr M, Martinez-Palli G, Miralles F, Moharra M, Monterde D, Piera J, Ríos J, Rodriguez N, Ron R, Rutten-van Mölken M, Salas T, Santaeugenia S, Schonenberg H, Solans O, Torres G, Vargiu E, Vela E, Roca J. Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols. BMC Health Serv Res 2019; 19:370. [PMID: 31185997 PMCID: PMC6560864 DOI: 10.1186/s12913-019-4174-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). METHODS The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. DISCUSSION The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection. TRIALS REGISTRATION NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).
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Affiliation(s)
- Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carmen Herranz
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,CAPSBE. Consorci d'Atenció Primaria de Salut. Barcelona Esquerra, Barcelona, Spain
| | - Anael Barberan-Garcia
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carme Hernandez
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Albert Alonso
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - María José Arguis
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Bescos
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Felip Burgos
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montserrat Cleries
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Joan Carles Contel
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Jordi de Batlle
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
| | | | - Maarten Lahr
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Graciela Martinez-Palli
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Felip Miralles
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Montserrat Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - David Monterde
- Institut Català de la Salut, Serveis Centrals, Barcelona, Catalonia, Spain
| | - Jordi Piera
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - José Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Rodriguez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Reut Ron
- Assuta Medical Centers, Tel Aviv-Yafo, Israel
| | - Maureen Rutten-van Mölken
- School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tomas Salas
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Sebastià Santaeugenia
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia, 08500, Vic, Spain
| | - Helen Schonenberg
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Oscar Solans
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Gerard Torres
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Eloisa Vargiu
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Emili Vela
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
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Cano I, Dueñas-Espín I, Hernandez C, de Batlle J, Benavent J, Contel JC, Baltaxe E, Escarrabill J, Fernández JM, Garcia-Aymerich J, Mas MÀ, Miralles F, Moharra M, Piera J, Salas T, Santaeugènia S, Soler N, Torres G, Vargiu E, Vela E, Roca J. Protocol for regional implementation of community-based collaborative management of complex chronic patients. NPJ Prim Care Respir Med 2017; 27:44. [PMID: 28710482 PMCID: PMC5511202 DOI: 10.1038/s41533-017-0043-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/22/2017] [Accepted: 05/31/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain.
| | - Ivan Dueñas-Espín
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Carme Hernandez
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain
| | - Jordi de Batlle
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain
- Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Jaume Benavent
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Juan Carlos Contel
- Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain
| | - Joan Escarrabill
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miquel Àngel Mas
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - Felip Miralles
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Montserrat Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Jordi Piera
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - Tomas Salas
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | | | - Nestor Soler
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain
| | - Gerard Torres
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain
- Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Eloisa Vargiu
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Emili Vela
- CatSalut, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Majadahonda (Madrid), Spain.
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Dueñas-Espín I, Vela E, Pauws S, Bescos C, Cano I, Cleries M, Contel JC, de Manuel Keenoy E, Garcia-Aymerich J, Gomez-Cabrero D, Kaye R, Lahr MMH, Lluch-Ariet M, Moharra M, Monterde D, Mora J, Nalin M, Pavlickova A, Piera J, Ponce S, Santaeugenia S, Schonenberg H, Störk S, Tegner J, Velickovski F, Westerteicher C, Roca J. Proposals for enhanced health risk assessment and stratification in an integrated care scenario. BMJ Open 2016; 6:e010301. [PMID: 27084274 PMCID: PMC4838738 DOI: 10.1136/bmjopen-2015-010301] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. SETTINGS The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). PARTICIPANTS Responsible teams for regional data management in the five ACT regions. PRIMARY AND SECONDARY OUTCOME MEASURES We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. RESULTS There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. CONCLUSIONS The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require prospective evaluation.
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Affiliation(s)
- Ivan Dueñas-Espín
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS), CIBERES, Universitat de Barcelona, Barcelona, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra, CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Emili Vela
- CatSalut, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Steffen Pauws
- Royal Philips Netherlands BV acting through Philips Research, Eindhoven, The Netherlands
| | - Cristina Bescos
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS), CIBERES, Universitat de Barcelona, Barcelona, Spain
| | | | - Joan Carles Contel
- Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | | | - Judith Garcia-Aymerich
- Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra, CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Maarten M H Lahr
- Department of Epidemiology, Health Technology Assessment, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Magí Lluch-Ariet
- Eurecat, Barcelona, Catalonia, Spain
- Networking Department, Technical University of Catalonia (UPC), Barcelona,Spain
| | - Montserrat Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - David Monterde
- Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Joana Mora
- Kronikgune—Centro de Investigación en Cronicidad, Basque Country, Bilbao, Spain
| | | | - Andrea Pavlickova
- NHS 24, Scottish Centre for Telehealth and Telecare (SCTT), Edinburgh, UK
| | - Jordi Piera
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - Sara Ponce
- Kronikgune—Centro de Investigación en Cronicidad, Basque Country, Bilbao, Spain
| | | | - Helen Schonenberg
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center (CHFC), Universität Würsburg, Würsburg, Germany
| | - Jesper Tegner
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Filip Velickovski
- Eurecat, Barcelona, Catalonia, Spain
- ViCOROB, Universitat de Girona, Girona, Spain
| | | | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS), CIBERES, Universitat de Barcelona, Barcelona, Spain
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Durigon GS, Oliveira DBL, Vollet SB, Storni JG, Felício MCC, Finelli C, Piera J, Magalhães M, Caldeira RN, Barbosa ML, Durigon EL, Berezin EN. Hospital-acquired human bocavirus in infants. J Hosp Infect 2010; 76:171-3. [PMID: 20619493 PMCID: PMC7114665 DOI: 10.1016/j.jhin.2010.04.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 04/23/2010] [Indexed: 11/06/2022]
Abstract
Human bocavirus (HBoV) is a respiratory pathogen that affects young children. We screened 511 nasopharyngeal aspirates for hospital-acquired HBoV from infants hospitalised with respiratory infection from January to December 2008. Among 55 children with HBoV infection, 10 cases were hospital-acquired. Compared with the community-acquired cases, coinfection with other respiratory viruses in these patients was uncommon. HBoV should be considered for inclusion in screening protocols for nosocomial childhood respiratory infections, especially in intensive care units.
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Affiliation(s)
- G S Durigon
- Department of Paediatrics, Santa Casa de Misericórdia Hospital, São Paulo, Brazil.
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Campistol JM, Esforzado N, Martínez J, Roselló L, Veciana L, Modol J, Casellas J, Pons M, de Las Cuevas X, Piera J, Oliva JA, Costa J, Barrera JM, Bruguera M. Efficacy and tolerance of interferon-alpha(2b) in the treatment of chronic hepatitis C virus infection in haemodialysis patients. Pre- and post-renal transplantation assessment. Nephrol Dial Transplant 1999; 14:2704-9. [PMID: 10534516 DOI: 10.1093/ndt/14.11.2704] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection represents an important problem for the dialysis population due to its high prevalence and the long-term development of chronic liver disease, particularly following renal transplantation. METHODS In order to assess the efficacy and tolerance of interferon (IFN) in the treatment of chronic hepatitis C in haemodialysis (HD) patients and their clinical course following renal transplantation, a multicentre, randomized, open-label study was conducted to compare IFN therapy vs a control group. RESULTS Nineteen HCV RNA-positive patients received 3 x 10(6) U of IFN s.c., three times a week (post-HD), and 17 HCV RNA-positive patients were assigned to the control group. Tolerance to IFN therapy was good in nine patients, while treatment was discontinued in the other 10 due to the occurrence of side effects. HCV RNA was negative at the end of treatment in 14 out of 19 patients (74%) receiving IFN and in one patient (5%) in the control group. Six out of the 14 patients who initially responded to IFN therapy had a virological relapse (43%). Eight patients (42%) remained HCV RNA-negative, three of them until the day that renal transplantation (RT) was performed (7, 12 and 27 months, respectively), as did five patients on HD during the follow-up (27+/-5 months). Eight out of the nine patients (89%) who completed therapy were HCV RNA-negative at the end of treatment, and seven of them (78%) remained HCV RNA-negative during the follow-up on dialysis (21+/-8 months). Mean transaminase (ALT) values were significantly decreased following IFN therapy, while no changes were observed during the follow-up period in the control group. Fifteen patients (10 in the treatment group and five in the control group) underwent RT. Three patients in the treatment group were HCV RNA-negative at RT, and one of them had a virological relapse 20 months after RT, while the other two remained HCV RNA-negative at 3 months and 24 months after RT, respectively. In contrast to the control group, transaminase (ALT) remained within normal limits in all patients in the treatment group. Finally, during the post-RT follow-up, the transaminase mean values were significantly lower in treated patients vs patients in the control group (P<0.05). CONCLUSIONS It is concluded that the biochemical and virological response to IFN therapy is good in HD patients. In addition, IFN therapy appears to exert a beneficial effect on the course of liver disease following RT, regardless of the virological response. Despite the fact that IFN therapy was discontinued in 10 out of the 19 patients due to the occurrence of side effects, these disappeared following discontinuation of therapy. Therefore, IFN therapy is advisable for HCV-infected dialysis patients who are candidates for RT.
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Affiliation(s)
- J M Campistol
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
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Tresserra F, Grases PJ, López-Marín L, Piera J, Mestre J. Crystalloids in smears from thyroid nodular hyperplasia. Acta Cytol 1999; 43:513-5. [PMID: 10349393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bernà L, Piera J, Rodríguez-Espinosa J, Caixàs A, Puig-Domingo M, Farrerons J, Galofré M, Rousaud F, Matías-Guiu X, Estorch M, Carrió I. [Isotopic study with double phase 99mTc-sestamibi in the localization of parathyroid gland lesions]. Med Clin (Barc) 1999; 112:201-5. [PMID: 10191481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The use of preoperative imaging in patients with hyperparathyroidism remains controversial. The aim of this study is to assess the usefulness of the double-phase 99mTc-sestamibi scintigraphy in the diagnosis of abnormal parathyroid glands in patients with primary hyperparathyroidism. PATIENTS AND METHODS We studied 60 patients presenting with primary hyperparathyroidism who were referred to surgery; four of them had been unsuccessfully operated. 99mTc-sestamibi scintigraphy were performed in all patients previously to surgery. Scintigraphic technique: planar imaging of the neck and thorax was done in the anterior view at 15 and 150 min postinjection of 740 MBq (20 mCi) of 99mTc-sestamibi. RESULTS Surgery found 57 adenomas (2.59 [SD, 5.84] g; range 0.160-40), 6 hyperplastic glands (0.34 [SD, 0.26] g) and one carcinoma 8.2 g. The 99mTc-sestamibi was able to localize correctly 60 out of 64 lesions (55/57 adenomas, 4/6 hyperplastic glands and 1/1 carcinoma) (global sensitivity of 94%, adenomas sensitivity of 96%, positive predictive value of 97% and specificity of 98%). Isotopic imaging detected the abnormal tissue in all patients who had undergone unsuccessful previous surgery. PTH (4 [SD, 1.51] pmol/l) and calcium postoperative serum levels (2.13 [SD, 0.22] mmol/l) showed curation of all patients. CONCLUSION Double phase parathyroid scintigraphy with 99mTc-sestamibi is the method of choice to localize abnormal parathyroid glands.
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Affiliation(s)
- L Bernà
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Bercelona
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Caixàs A, Bernà L, Hernández A, Tébar FJ, Madariaga P, Vegazo O, Bittini AL, Moreno B, Faure E, Abós D, Piera J, Rodríguez JM, Farrerons J, Puig-Domingo M. Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism. Surgery 1997; 121:535-41. [PMID: 9142152 DOI: 10.1016/s0039-6060(97)90108-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Until now, preoperative parathyroid imaging has been considered unnecessary because currently available techniques do not provide any better results than an expert surgeon. We conducted a multicenter prospective study evaluating the capability of technetium 99m sestamibi scintigraphy in the preoperative identification of pathologic glands. METHODS Ninety-three patients with hyperparathyroidism, seven of them reoperative cases, were studied. In addition, 20 age-matched normocalcemic control subjects were also studied. RESULTS Surgical confirmation of scintigraphic images was obtained in 91 of 93 cases (sensitivity, 97.8%). In all reoperative cases (n = 7), in all cases of ectopic glands (whether operated or not; n = 6), and in all patients with a single-gland disease (n = 70), topographic identification of the pathologic gland was correct in 100%. In multiple-gland disease (n = 23), involvement of more than one gland was visualized in only 61% of the patients; however, in 91% of patients, at least one gland was localized. Surgical success-defined as postoperative normocalcemia-with this approach was 100%. All scans of normocalcemic control subjects were negative. Of 31 patients in whom a multinodular goiter coexisted, seven presented a significant radionuclide background at 120 minutes' scan. False-positive images were found together with those corresponding to the pathologic glands in only three cases. CONCLUSIONS 99mTc-sestamibi is a highly reliable, sensitive, and specific technique for imaging of pathologic glands in hyperparathyroidism, especially in single-gland disease. It may be considered as a first line single-procedure when a preoperative topographic diagnosis is required.
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Affiliation(s)
- A Caixàs
- Hospital de Sant Pau, Autonomous University of Barcelona, Spain
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Bernà L, Caixàs A, Piera J, Gómez G, Matías-Guiu X, Estorch M, Puig M, Carrió I. Technetium-99m-methoxyisobutylisonitrile in localization of ectopic parathyroid adenoma. J Nucl Med 1996; 37:631-3. [PMID: 8691254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Preoperative localization of ectopic parathyroid lesions is crucial for the correct treatment of patients with primary hyperparathyroidism. Invasive and noninvasive procedures, including selective venography, ultrasound, CT and MRI provide limited sensitivity in the detection of ectopic lesions. We report three patients in whom 99mTc-MIBI scintigraphy accurately detected ectopic parathyroid adenomas and was instrumental in the cure for these patients. Technetium-99m-MIBI scintigraphy provides a simple and accurate noninvasive test for the detection of ectopic parathyroid adenomas.
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Affiliation(s)
- L Bernà
- Department of Nuclear Medicine, Hospital de Sant Pau, Barcelona, Spain
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Caixàs A, Bernà L, Piera J, Rigla M, Matías-Guiu X, Farrerons J, Puig-Domingo M. Utility of 99mTc-sestamibi scintigraphy as a first-line imaging procedure in the preoperative evaluation of hyperparathyroidism. Clin Endocrinol (Oxf) 1995; 43:525-30. [PMID: 8548935 DOI: 10.1111/j.1365-2265.1995.tb02915.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The use of preoperative imaging in patients with hyperparathyroidism remains controversial. Many of the available techniques are insufficiently sensitive and specific to justify their routine use. We have evaluated the sensitivity and specificity of 99mTc-sestamibi scintigraphy in the management of patients with different forms of hyperparathyroidism. DESIGN Preoperative imaging evaluation was carried out by scintigraphic detection of pathological parathyroid glands using 99mTc-sestamibi as a radiotracer; confirmation of scan findings was obtained surgically. PATIENTS A group of 25 patients with primary (n = 21) or secondary (n = 4) hyperparathyroidism were studied. All were considered for surgical treatment. MEASUREMENTS In all cases parathyroid imaging was carried out by 99mTc-sestamibi scintigraphy together with at least one other imaging technique which included CT-scan, ultrasonography, MRI or 201TI/99mTc subtraction scintigraphy. Blood tests included measurements of total calcium and PTH. RESULTS 99mTc-sestamibi scintigraphy correctly localized 20 out of 21 adenomas, giving a sensitivity of 95.2%, markedly higher than that obtained with the other imaging techniques (ultrasonography 75%, 201TI/99mTc subtraction scintigraphy 57.1%, CT-scan 41.7% and MRI 33%). Of a total of 17 glands identified surgically as hyperplastic and confirmed by pathological examination, 99mTc-sestamibi scintigraphy showed a positive image in 10, corresponding always to the larger abnormal glands (sensitivity 58.8%, higher than that observed with the other techniques). No false positive images were obtained with 99mTc-sestamibi. All the ectopic adenomas (n = 3) were identified preoperatively, which contributed significantly to the surgical approach. CONCLUSION In patients with hyperparathyroidism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it shows a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands; the benefit of localizing parathyroid tissue prior to surgery in cases of ectopic adenomas clearly indicates that when an imaging procedure is required, this technique may be of great help in the management of hyperparathyroidism.
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Affiliation(s)
- A Caixàs
- Department of Endocrinology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Spain
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Ampudia X, Puig M, Matías X, Soldevila J, Piera J, de Leiva A. [Thyroid lymphoma: a clinico-pathological study]. Rev Clin Esp 1992; 190:249-53. [PMID: 1579696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Five cases of primary lymphoma of the thyroid followed at our hospital during the last decade are reviewed. The clinical and pathological characteristics are analysed and the therapeutical approach described. The age at the diagnosis ranged between 26 and 76 years, with a female versus male predominance (4 out of 5 cases). The commonest clinical feature at presentation was goiter of rapid growth accompanied by compressive symptoms. The pathologic study showed a centrocytic-centroblastic pattern in 3 cases and an immunoblastic lymphoma in the other 2 cases. Associated Hashimoto's thyroiditis was found in 4 of the patients, and extra-thyroid extension in 2 cases. An immunohistochemical study with different cell membrane markers was performed. The treatment included surgery alone in one case, chemotherapy in one case and radiotherapy in another; combined treatment (surgery plus radiotherapy) was performed in two cases. At present the average follow up period is 4.5 years with a patient having died of an unrelated cause among the five cases.
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Affiliation(s)
- X Ampudia
- Servicio de Endocrinología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
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12
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Serra J, Garriga J, Escuder J, Alonso M, Piera J, Puig la Calle J. [Leiomyoma of the rectum. A diagnostic and therapeutic dilemma]. J Chir (Paris) 1987; 124:450-3. [PMID: 3320072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case is reported of leiomyoma of rectum, a rare tumor since it is detected in 2 of 3000 rectal tumors. It occurs principally in patients between 40 and 50 years. The tumor is submucosal, is difficult to diagnose and biopsy is often valueless since it does not involve the tumor mass. The interest of the present case is that trans-rectal ultrasound imaging of the leiomyoma was performed. Differential histologic diagnosis between benign and malignant forms is a dilemma, these tumors being of slow growth with a marked tendency for recurrence and malignant degeneration. Treatment should always be surgical, with local resection if histology has excluded malignancy, followed by periodic surveillance. Radical surgery is indicated in malignant forms or for local recurrence of benign tumors.
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Affiliation(s)
- J Serra
- Service de Chirurgie Générale et Digestive, Hôpital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Espagne
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Abstract
Three cases of thyroidal hemiagenesis have been reported. The patients were euthyroid and presented with adenomatous goiters; one uninodular and the others multinodular in the contralateral lobe. In two cases the diagnosis was established by the thyroid stimulation test and confirmed at operation. In one case, this test was not performed and the hemiagenesia was discovered at routine surgical exploration of the scintigraphically absent lobe. From our cases and review of the literature we have concluded that the anomaly is usually discovered while searching for a contralateral pathologic abnormality, a thyroid stimulation test is essential for a preoperative suspicion, it occurs more frequently among women and in the left lobe, and ours are the first cases reported from Spain.
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Estivill X, Zurita L, Santesmasses A, Piera J, Segura J, Félez J. [Acquired factor X deficiency in primary amyloidosis]. Med Clin (Barc) 1984; 83:223. [PMID: 6482586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Artigas V, Piera J, Soldevila J, Farrerons FJ. [Review of a series of 28 cases of thyroid gland cancer]. Lyon Chir 1969; 65:279-85. [PMID: 5399043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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