[Clinical practice guideline for irritable bowel syndrome].
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Clinical Trials as Topic↗
Biomedical subjects
Xavier Bonfill
Publications and source records attributed to Xavier Bonfill.
Relationship between the method of detection and prognostic factors for breast cancer in a community with a screening programme.
OBJECTIVES: To analyse and compare the prognostic factors of breast cancer in the target population of our community-screening programme as a function of the method of detection and to analyse the differences in the prognostic factors as a function of the patient's age and the screening episode. SETTING: A Breast Cancer-Screening Programme (BCSP) in Northeast Spain. METHODS: Observational study of all primary malignant breast lesions diagnosed in a woman between 50 and 69 years of age between 18 October 1995 and 31 December 2002. The 16 centres that women from the target population might have attended were contacted. RESULTS: A total of 225 (37.2%) of the lesions included were diagnosed through the BCSP, 59 (9.7%) interval cancers were detected, and 321 (53.1%) were detected through other circuits. Node involvement was significantly lower in the lesions detected at screening (32%) in comparison to the interval cancers (41.8%) and those detected through other circuits (47.5%). A significantly larger percentage of the interval tumours (28.6%) and the lesions diagnosed outside the BCSP (22.1%) scored >5.4 on the Nottingham Prognostic Index (NPI) than those diagnosed within the programme (10.9%). The relation between the NPI and the detection method was only statistically significant in the 65-69-year-old age group. The NPI score of the tumours detected by the BCSP showed a statistically significant association with age. CONCLUSION: This analysis has shown notable differences in some prognostic factors for breast cancer according to the method of detection. Association between age and the a priori prognosis of the malignant lesions arises.
Aged↗
[Meta-analyses (QUOROM)].
The increase in the number of published systematic reviews and meta-analyses over the last few years has highlighted the need to establish guidelines for their publication, in order to facilitate their interpretation and use. The Quality of Reporting of Meta-analyses Conference, which took place in 1996, resulted in the QUOROM statement, consisting of a checklist and flow diagram. The checklist is composed of 18 items to encourage authors to provide essential information to readers about the methods and results of the meta-analysis. The flow diagram of randomized clinical trials (RCT) helps to provide information about the number of RCTs identified, included and excluded in the meta-analysis and the reasons for excluding them. Both tools provide standards for improving the quality of reporting of meta-analyses to make them rigorous, useful and reliable.
Authorship↗
Neuroreflexotherapy for nonspecific low back pain: a systematic review.
STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effectiveness of neuroreflexotherapy (NRT) for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few of the alternatives for the management of LBP have a firm base of evidence for their effectiveness. Recently, a new intervention known as NRT has been developed in Spain and has been reported to have favorable results. METHODS: Searches were undertaken according to Cochrane Collaboration guidelines, and randomized controlled trials that evaluated NRT as treatment for patients with nonspecific LBP were included. A qualitative synthesis and an assessment of methodological quality were undertaken. RESULTS: Three randomized controlled trials were included, with 125 and 148 subjects in control and intervention groups, respectively. NRT was compared with sham in two trials and standard care in one. Individuals receiving active NRT showed significantly better outcomes for pain, mobility, disability, medication use, consumption of resources, and costs. No major side effects were reported by those receiving active NRT. CONCLUSIONS: NRT appears to be a safe and effective intervention for nonspecific LBP. This conclusion is limited to three trials conducted by a small number of experienced clinicians. Further trials in other settings are needed to determine whether these favorable results can be generalized.
Acute Disease↗
Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial.
BACKGROUND: Control of oral anticoagulant treatment has been reported to be suboptimal, but previous studies suggest that patient self-management improves control. OBJECTIVE: To compare the quality of control and the clinical outcomes of oral anticoagulant treatment in self-managed patients versus patients following conventional management. DESIGN: Randomized, controlled trial. SETTING: University-affiliated hospital in Spain. PATIENTS: 737 patients with indications for anticoagulant treatment. INTERVENTION: The self-management group (n = 368) received simple instructions for using a portable coagulometer weekly and self-adjusting treatment dose. The conventional management group (n = 369) received usual care in an anticoagulation clinic (monthly measurement and control of international normalized ratio [INR], managed by hematologists). MEASUREMENTS: Percentage of INR values within the target range and major related complications. RESULTS: The median follow-up period was 11.8 months (range, 0.3 to 16.9 months). The unadjusted percentages of in-range INRs were 58.6% in the self-management group and 55.6% in the conventional management group (difference, 3.0 percentage points [95% CI, 0.4 to 5.4 percentage points]). Twenty-seven patients (7.3%) in the conventional management group and 8 (2.2%) in the self-management group had major complications related to anticoagulant treatment. The unadjusted risk difference for major complications between groups was 5.1 percentage points (exact 95% CI, 1.7 to 8.5 percentage points). Fewer patients had minor hemorrhages in the self-management group (14.9%) than in the conventional management group (36.4%). Fifteen patients (4.1%) in the conventional management group and 6 (1.6%) in the self-management group died (unadjusted risk difference, 2.5 percentage points [exact 95% CI, 0.0 to 5.1 percentage points]). LIMITATIONS: The trial was performed at only 1 center and was not blinded. The dropout rate in the intervention group was 21%. CONCLUSIONS: Compared with conventional management by an anticoagulation clinic, self-management of oral anticoagulant treatment achieved a similar level of control. Of note, major complications and minor hemorrhages were less common in the self-management group.
Acenocoumarol↗
Genetic counseling program in familial breast cancer: analysis of its effectiveness, cost and cost-effectiveness ratio.
Women with a family history of breast cancer are at increased risk for developing this neoplasm. Starting surveillance more frequently at a younger age than the general population and the possibility of undergoing genetic testing are options for their medical management. We analyzed the benefits and costs of our clinical program in familial breast cancer (FBC) and carried out a cost-effectiveness analysis of such procedure. The benefits and costs of performing genetic counseling and a screening program in FBC based on 143 high-risk families registered in our database between June 1995 and December 2001 were analyzed. A decision tree was constructed to estimate the survival benefit and cost-effectiveness of the clinical genetic counseling program compared with the strategy of not performing any screening protocol. We estimated that the prevalence of a BRCA mutation in an unaffected relative of our high-risk cohort was 10% and that 53% of the mutations are found in the BRCA1 gene. We assigned a 58.5% lifetime risk of breast cancer for a 30-year-old mutation carrier according to the SEER data. The effectiveness of the screening was obtained from our experience and data for estimating survival were derived from other studies with longer follow-up. We used our local payment data to calculate the costs of the program. A mutation in the BRCA1 or BRCA2 genes was identified in 20% of the probands. Seventy primary breast cancer cases were recorded since the onset of the program. Thirty percent of the tumors were diagnosed through the screening program and 71% of them were lymph node-negative compared to 49% of the tumors diagnosed outside the program (p=0.1). The cost-effectiveness ratio of our FBC genetic counseling and screening program was 4,294 euros per life-year gained. The model was sensitive to the prevalence of mutation carriers, the lifetime risk of breast cancer and the effectiveness of the screening. In our setting and according to our model, this analysis suggests that a program of genetic testing and screening for breast cancer in a high-risk population may be cost-effective. These results need to be confirmed as more effective interventions for cancer prevention and screening are being implemented.
Aged↗
[In-patient treatment decisions].
BACKGROUND AND OBJECTIVE: The aim of this study was to identify the extent to which treatment decisions for medical in-patients in three hospitals in Catalunya are supported by published evidence. PATIENTS AND METHOD: In a retrospective, cross-sectional study, main diagnosis-treatment pairs (DTPs) were identified for 980 hospital discharges. The Cochrane library and MEDLINE from 1966 to 1998 were searched for systematic reviews or, in their absence, randomized controlled clinical trials (RCT) that supported the treatment given for each diagnosis. The level of evidence found for each DTP was classified. Descriptive analyses for patients and different DTP were performed. RESULTS: A systematic review or RCT (level I) was found for 65.4% of the 980 patients. In 32.6% of cases, there was only non-experimental or consensus evidence (level II) and in 2% there was no good evidence for the treatment given (level III). An analysis of the 598 unique pairs reduced the percentage of cases supported by level I evidence (55.7) with a proportionate increase in level II (41%). There were some differences in the proportion of cases in each evidence level by diagnostic group. CONCLUSIONS: For about two thirds of patients and a half therapeutic decisions in these three centres, there was a published RCT or a systematic review, with variations according to diagnostic groups. More robust and objective instruments are needed to assess the degree to which scientific evidence is applied in clinical practice.
Cross-Sectional Studies↗
[Clinical practice guidelines: high-quality and useful].
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Evidence-Based Medicine↗