Biomedical subjects

Antonio Escobar

Publications and source records attributed to Antonio Escobar.

6 recordsLinked to original sources

PubMed2005

Development and validation of an in-patient satisfaction questionnaire.

OBJECTIVE: To develop a psychometrically sound, hospital patient satisfaction questionnaire to be administered to patients discharged from medical and surgical services. DESIGN: Cross-sectional survey in Spanish. SETTING: Four acute care general hospitals of the Basque Health Service. STUDY PARTICIPANTS: Random samples of 650 discharged patients from each hospital during February and March 2002. A total of 1910 patients responded to the questionnaire (73.5%). MAIN OUTCOME MEASURES: Overall perceived quality of health care and perceived health improvement. RESULTS: No sociodemographic differences were found between respondents and non-respondents. Six dimensions were identified from the factor analysis, explaining 50% of the variance. All items, except two, revealed loadings above 0.4. Cronbach's alpha exceeded 0.7 for all dimensions, except privacy. Comfort was the dimension with the lowest level of patient satisfaction, whereas privacy was the most satisfactory. The interscale correlations never exceeded the internal consistency of each scale. The analysis of the dimensions with two items of global assessment showed a positive correlation. CONCLUSIONS: The results obtained from the development and validation of the questionnaire provide evidence of its psychometric properties, although it would be useful to carry out further analyses to assess time-based properties of reliability. We found a positive relation between the degree of patient satisfaction and overall evaluation of the quality of health care, providing evidence of the ability of the questionnaire to correlate with other concepts. The in-patient satisfaction questionnaire could become a useful instrument in quality-of-care assessment.

Cross-Sectional Studies↗

PubMed2005

Appropriateness of total hip joint replacement.

OBJECTIVE: To evaluate the appropriateness of the use of total hip joint replacements. DESIGN: Observational study of consecutive patients with a diagnosis of hip osteoarthritis and who had undergone total hip arthroplasty over a 1-year period from seven hospitals. MAIN MEASURES: The appropriateness of the use of hip replacement was judged by explicit criteria developed by a panel of experts using RAND methodology. The length of hospital stay during the admission and complications were recorded 6 months post-operatively. Patients were also surveyed 6 months after discharge to determine whether they believed they had recovered or their satisfaction with the intervention. Appropriateness results of this study were compared with a previous study performed with the same criteria 4 years previously. RESULTS: In total, 784 patients participated in the study. Indications for surgery were considered necessary in 52.2% of cases, appropriate in 21.3%, uncertain in 21.4%, and inappropriate in 5.1%. Differences were found in the rates of appropriateness exclusively from one hospital. At 6 months after discharge, differences between centres were found for the proportion of patients that reported they had recovered from surgery (range 57.7-24.8%) and in the length of hospital stay during admission (range 10-16 days). Improvement in the appropriateness rates were found for all participant hospitals during both periods. CONCLUSIONS: We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable.

Aged↗

PubMed2003

[A randomized clinical trial to compare the effectiveness of indinavir, ritonavir and saquinavir].

BACKGROUND AND OBJECTIVE: HIV protease inhibitors (PI) were licensed without a direct evidence of their relative efficacy. PATIENTS AND METHOD: 137 patients attending our clinics between November 1997 and March 1998, to whom treatment with a PI was recommended, were randomized to receive indinavir (IDV), saquinavir (SQV) or ritonavir (RTV). Main outcome variables were one-year mean changes in HIV-RNA plasma concentrations and CD4 cells counts and proportion of patients with HIV viral load below level of detection. RESULTS: Mean HIV viral load reductions were 0.95 for SQV, 0.72 for IDV and 0.65 for RTV (p = 0.44), equaling losses and changes to failures. In a standard intent-to-treat analysis, mean changes in viral load were 1.16, 1.01 and 1.50 (p = 0.21), respectively. The proportion of patients with undetectable viral load was 50%, with no differences between treatment arms. CONCLUSIONS: No differences were observed in the effectiveness of SQV, IDV and RTV.

Adult↗

PubMed2003

Development of explicit criteria for total knee replacement.

OBJECTIVES: To develop and test an appropriateness of indications tool for total knee replacement (TKR) in patients with osteoarthritis. METHODS: Criteria were developed using a modified Delphi panel judgment. Another panel rated the same indications, and the results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. A classification tree was developed. RESULTS: The procedure was considered appropriate in 167 (26.8%) scenarios, and there was agreement on 112 (67.1%) of them. When the rates of the main panel were compared with those of a second panel, the result was a kappa statistic of 0.75. The test-retest kappa for the main panel was 0.78. Neither in the first case nor in the second was there an instance in which a scenario classified as appropriate shifted to inappropriate or vice versa. The regression models showed that symptomatology and radiology were the variables that explained most of the variability of appropriateness as determined by panelists. In the classification tree performed, the probability of misclassification was 3.8% with 150 scenarios, of the 156 analyzed and classified correctly. CONCLUSIONS: The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this algorithm as an aid in formulating clinical practice guidelines and to promote the appropriateness of TKR.

Algorithms↗

PubMedDate not supplied

[Prioritization of patients on the waiting list for hip and knee replacement: the patients' views].

OBJECTIVE: To identify patients' views on the criteria used to prioritize patients on the waiting list for total hip or knee prostheses. This study is part of a wider project whose objective is to design an instrument to prioritize patients on the waiting list for both procedures. MATERIAL AND METHODS: We performed a descriptive study with qualitative methodology that provides valuable information on how to improve various aspects of clinical practice and detect solutions that could be useful in decision making. There were 4 focus groups; 2 before the design of the instrument and 2 after. These focus group were composed of patients on the waiting list for knee or hip replacement. RESULTS: Thirty-one patients agreed to participate in the focus groups. All the patients were dissatisfied with the current waiting lists. The most salient factors discussed in meetings were pain, functional capability, and the repercussions of these on the patient's social role. CONCLUSIONS: Although the instrument is designed to be used by health professionals, patients' participation in its design and evaluation allows them to feel more involved in the healthcare process and provides information that more accurately reflects their experiences. The use of this information by health professionals will improve resource optimization and the response to patient needs.

Arthroplasty, Replacement, Hip↗

PubMedDate not supplied

[Retroperitoneal endoscopic nephrectomy].

OBJECTIVES: Nephrectomy is probably the most widely accepted procedure for the application of laparoscopic techniques in urology. The great advantages of laparoscopy over conventional approaches have justified its indication for different renal extirpative procedures: atrophy, renal carcinoma, transitional cell carcinoma, polycystic kidney disease, living kidney donation for transplantation and partial nephrectomies. The objective of this article is to describe the techniques and advantages of laparoscopic nephrectomy through a retroperitoneoscopic approach, demonstrating that it is an effective option for the majority of cases in which extraction of the kidney is required. METHODS: Between January 1991 and January 2001 107 patients with different renal conditions were treated at the Instituto Docente de Urología (IDU) using transperitoneal (36 patients) or retroperitoneal (71 patients) laparoscopic access. Indications for laparoscopic approach included atrophy, living donation, renal carcinoma, urothelial tumour, polycystic kidney disease and partial nephrectomy. RESULTS: Nephrectomy trough a transperitoneal approach was completed in 33 (91.6%) of 36 patients, being necessary to convert to conventional surgery in the remaining 3 cases (8.3%). Retroperitoneoscopic approach was successful in all cases (100%). CONCLUSIONS: The retroperitoneoscopic approach is a simple procedure that allows its implementation in the majority of patients in which there is an indication for nephrectomy. Retroperitoneoscopy provides a rapid recovery, minimal analgesic needs, and a short hospital stay. Finally, retroperitoneoscopic approach represents a logical evolution for conventional flank incisions, providing familiarity with surgical field landmarks and management to those urologists that incorporate this new technical modality.

Humans↗