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S Lorenzo

Publications and source records attributed to S Lorenzo.

11 recordsLinked to original sources
PubMed1999

[The variability in the care for diabetic and hypertensive patients as a function of the styles of a physician's practice].

OBJECTIVES: To analyse the variability of certain indicators of the procedure and outcome of medical care in the clinical records of diabetic and hypertense patients, and their relationship with the doctor's style of practice. DESIGN: An observational, descriptive study. SETTING: Seven health centres in the public network. PARTICIPANTS: 40 primary care doctors (all the doctors). MEASUREMENTS AND MAIN RESULTS: By means of stratified systematic random sampling, 20 clinical histories for each doctor were chosen (10 for patients diagnosed with diabetes mellitus and 10 with hypertension). The deviation ratio was used as the measurement of variability. Doctors' styles of medical practice were evaluated through the Australia questionnaire. Great variability was found in the frequency with which the different indicators of the two pathologies were recorded (deviation ratio: weight > 90.02% in DM, 81.37% in HT; height > 84.01% in DM, 77.10% in HT), and in the absolute figures (patients with HT, wide variability in all outcome indicators; patients with DM, in last figures, total and HDL cholesterol, and HbA1c). The styles of practice were shown to be related to the frequency of appearance of some indicators in the clinical records and with the quality of particular outcome indicators. The age of the doctor correlated significantly, and negatively, with the recording of almost all the indicators and their quality. CONCLUSIONS: Variability of medical practice in the care of the chronically ill seen in primary care does exist. The use of clinical practice guides is emphasised.

Adult↗
PubMed1997

Assessing the impact of mental health programs upon community: the perspectives of primary caregivers and consumers.

Since 1985, there has been a significant movement in Spanish mental health services away from provision of care in psychiatric hospitals and toward a community mental health model (CMMH). This reform has ushered in changes not only for the patients but also for both their relatives and their primary caregivers. However, no survey has ever been carried out to obtain these parties' perceptions of the CMMH. Two studies have now been designed to describe the acceptability of the CMMH to these two key groups. The goals of the two projects were, firstly, to assess the opinions of primary care professionals about CMMH and, secondly, to sample the opinions of the patients' relatives regarding mental health care. In the first survey, 884 primary caregivers (general practitioners (GPs), pediatricians, nurses and social workers) filled out a 14-item questionnaire with a five-point response scale. Several aspects of care were evaluated: accessibility, referral facilities, therapeutic support, training or teaching activities, communication between primary care and mental health professionals for their mutual collaboration, and appropriateness of resources. Most of the primary caregivers reported that the community psychiatric model improved accessibility, treatment and communication between the different levels. Nurses and pediatricians reported dissatisfaction with the CMMH. In the second survey, the satisfaction of patients' relatives with the services provided by the therapists was assessed, using the Satisfaction with Therapist Questionnaire (STQ). The STQ consists of 15 items with a three-point response scale. Amount and adequacy of the information provided, accessibility, and style of conducting the appointment were assessed as measures of satisfaction. A sample of relatives of schizophrenic patients was surveyed by mail (76 relatives answered, a response rate of 31.13%). In summary, relatives were satisfied with therapists' competence but dissatisfied with their communication skills.

Adult↗
PubMed1995

A European project assessing the appropriateness of hospital utilization: background, objectives and preliminary results. The Project Steering Group and the Coordinating Center.

This paper presents the background, objectives and preliminary results of a coordinated European Project involving researchers in seven countries aimed at harmonizing methods to assess inappropriate use of hospital care and qualifying its determinants. After briefly reviewing the philosophy of the European Union "Concerted Action" program in the context of current attempts at reforming the way health care is financed and delivered in several member states, the paper presents results obtained so far. Besides a method workshop where the approaches and methodologies used were compared, during the first year the following tasks have been undertaken: (a) identification and appraisal of a few dozen empirical studies conducted in various countries; (b) qualitative comparison of the instruments used to assess appropriateness; (c) initial development of a common list of reasons for inappropriate hospital use of potential relevance in European health care systems. While the project has already undoubtedly indicated the great potential of European collaboration in health services research, the large number of unpublished studies traced indicates--among other things--the need to create channels through which results of this type of research can be disseminated.

Algorithms↗
PubMed1995

An overview of Spanish studies on appropriateness of hospital use.

This paper is an overview of hospital utilization review in Spain. Most of the hospital utilization studies have used the Appropriateness Evaluation Protocol as the review instrument. The studies, mainly retrospective, started in the late 1980s and used different adaptations of the medical-surgical version of the protocol. The level of inappropriate use detected ranges between 2.1 and 44.8% for admissions, and from 15 to 43.9% for inappropriate days of stay. The variability in the detected degree of inappropriateness may be due to the differences in the review instrument, the use of the override option, the patients included in the study, or the setting. The determinants of inappropriate hospitalization in Spain are mainly related to access to the different levels of care and to the conservative attitude of the physicians. Future utilization review in Spain should be followed by the development of specific interventions to correct the current pattern of overutilization.

Bias↗
PubMed1989

The human immunodeficiency virus long terminal repeat is preferentially expressed in Langerhans cells in transgenic mice.

Four lines of transgenic mice containing the HIV LTR linked to the bacterial gene encoding chloramphenicol acetyltransferase (CAT) were constructed. In each line, a characteristic tissue pattern of CAT expression was observed with detectable levels present in the eye, heart, spleen, thymus, and tail. Low levels of CAT were present in circulating lymphocytes, but CAT activity in these cells could be augmented following treatment with the mitogen phytohemagglutinin (PHA). Likewise, CAT expression was present at only low levels in circulating monocytes, but higher levels of CAT were observed in macrophages grown in the presence of various cytokines (CSF-1, GM-CSF, IL-1 alpha, IL-4, and IL-2). Furthermore, Langerhans cells recovered from skin showed higher levels of CAT activity than those observed in other cells of monocyte-macrophage lineage. These results indicate that LTR-CAT expression in cells of monocyte-macrophage lineage may increase in proportion to the degree of differentiation of these cells. These animals may be useful in the study of cell-specific determinants of LTR-directed gene activity and may serve to identify exogenous cofactors that promote the progression of HIV-related disease in vivo.

Animals↗