Search

Background: The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives: A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods: Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value < 0.05). Finally, the results were discussed in a deliberative process (phase C). Results: Thirty-one criteria were initially defined (phase A) and grouped into 5 categories: efficacy/effectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value < 0.001), percentage of patients with an improvement of ≥ 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions: From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability.

Background Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients. Methods A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors. Results By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (−1.7 s), OLST (7.1 s), STS-10 (−5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study. Conclusion An intradialytic non-immersive VR exercise programme improves patient physical function.

Background and Aims It is recommended intradialysis exercise implementation in the first part of the HD session to avoid hemodynamic instability or cramping, but the time restriction to exercise worsens clinical feasibility of exercise as a routine. Exercise using non-immersive virtual reality is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on hemodynamic control. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), episodes of hypotension and episodes of clinical instability are monitored throughout the session. The intervention has already begun and will continue for twelve months. The control analysis is performed during the three months at rest prior to starting the intervention (Rest) and then the intervention begins, every three months. Now we present the results at thirth month with exercise (Exercise) . An mixed ANOVA of repeated measures is used to assess the effect of the intervention. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. The mean baseline (SD) was Body Mass Index 26.2 (5.5) kg/m2, Overhydration 2.1 (1.3) liters, Kt/V was 1.65 (SD 0.21), Serum Albumin 3.84 (0.29) mg/dl and Hemoglobin 11.81(1.27) g/dl . Analysis by time Rest versus Exercise showed as mean (SD): HR 64 (8) vs 64 (7) bpm, SBP 143 (18) vs 141 (18) mmHg and DBP 61 (10) vs 60 (11) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Rest vs Exercise were HR – 1.34 (5.7) vs -0.9 (5.9) bpm, SBP 1.2 (12) vs 2.65 (16) mmHg and DBP 2.65 (5.8) vs 1.09 (7.1) mmHg, no significant differences. Analysis by groups Start versus End showed as means (CI95%): HR 66 (62,69) vs 63 (59,67) bpm, SBP 145 (136,154) vs 136 (126,146) mmHg and DBP 63 (58,68) vs 56 (50,62) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Start group vs End group neither showed significant differences. There were no differences between the groups regarding episodes of hypotension or clinical instability. Conclusion Performing intradialysis with virtual reality is well tolerated at any time during the session. This result improves the opportunities to implement exercise in hemodialysis.

Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group–time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.

Background and Aims Exercise using non-immersive virtual reality (VR) is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. There is controversy about the effect of intradialysis exercise on the dialysis dose. Furthermore, theoretical models also indicate that intradialytic exercise at the end of session may be beneficial in postdialysis rebound. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on postdialysis rebound and dialysis dose. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Dialysis dose was measured through the monocompartimental Kt/V, and the potassium, urea, phosphorus and creatinine rebound was calculated after both baseline and exercise sessions at 17 weeks. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive VR game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. An mixed ANOVA of repeated measures was used to assess the effect of the intervention. Patients exercised for 17 weeks. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. There were no significant differences in rebound urea, creatinine, potassium and phosphorus 30 minutes after finishing dialysis. The mean baseline Kt/V was 1.65 (SD 0.21) and with exercise 1.75 (SD 0.25). The mixed ANOVA analysis showed a significant time effect with an increase in Kt/V (mean 0.10, 95% CI 0.02-0.19, p 0.018) from exercise session vs baseline. No group per time significant interaction was found, so that there was no difference in the dialysis dose between Start and End group. Conclusion Intra-dialysis exercise with virtual reality can improve the dose of dialysis, no matter the timing of the exercise is performed.

Este artículo se encuentra disponible en la siguiente URL: https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0243917 The aim of the present clinical trial is to evaluate the effectiveness of neuromuscular versus classical strength-resistance training as part of a cardiac rehabilitation programme in patients following acute coronary syndrome. The study is designed as a double-blinded, randomised, and controlled clinical trial. Thirty participants suffering from acute coronary syndrome who meet our inclusion criteria will be recruited by a private tertiary hospital. The intervention group will follow 20 sessions of a cardiac rehabilitation programme divided into two parts: aerobic training and neuromuscular strength-resistance training. The control group will complete the same aerobic training as well as a classical strength-resistance training workout programme. The primary outcome of the study will be the mean difference in change from baseline in the Incremental Shuttle Walking Test. The secondary outcomes will be the cardiorespiratory fitness of the patients (assessed by means of the Chester Step Test), lower-limb performance (assessed with the 30-Second Chair Stand Test and Single- Leg Squat Test), lower-limb strength (hip flexor handheld dynamometry), sexual dysfunction assessment (Sex Health Inventory for Men) and quality of life (EQ-5D-5L). This work will provide evidence for the effectiveness of a neuromuscular versus a classic strength-training programme in terms of cardiorespiratory fitness, lower-limb performance capacities and quality of life, in cardiac patients. The data obtained could lead to more effective and functional workouts which, in turn, may enhance the speed at which these patients can return to their everyday activities of life and improve the efficiency of their movement patterns and heart responses. Furthermore, patients may find neuromuscular workout routines more motivating and engaging, thus encouraging them to adopt healthier lifestyle patterns.

Sin financiación 4.531 JCR (2019) Q1, 6/24 Transplantation 1.857 SJR (2019) Q1, 6/70 Nephrology No data IDR 2019 UEV

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients (≥0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.

Fundamento y objetivo Los problemas relacionados con los medicamentos (PRM) son problemas de salud que se producen como consecuencia de fallos de la farmacoterapia del paciente y que interfieren con los resultados esperados de salud. El objetivo de este trabajo es conocer los problemas de salud mas frecuentes que constituyen PRM. Pacientes y metodo La entrevista con el paciente junto con la evaluacion de la historia clinica son las principales fuentes de informacion para evaluar e identificar PRM. Se utilizo un cuestionario validado como instrumento para la entrevista y la CIE-9 para la clasificacion de los problemas de salud encontrados. Resultados Se entrevisto a un total de 2.556 pacientes durante 1 ano en el servicio de urgencies hospitalario, de los que se estudiaron 2.261 tras las exclusiones. Las enfermedades osteoarticulares, los signos y sintomas mal definidos y las lesiones y envenenamientos son los problemas mas relacionados con la aparicion de PRM. Los PRM de necesidad y efectividad mantienen un perfil similar. Los PRM de seguridad se asociaron mas a signos y sintomas mal definidos y lesiones y envenenamientos asi como a alteraciones nerviosas, digestivas y sanguineas. Conclusiones Los PRM mas frecuentes que son causa de consulta en un servicio de urgencies hospitalario son los osteoarticulares, seguidos de los signos y sintomas mal definidos. Se observan diferencias en los diagnosticos entre las distintas dimensiones de PRM y sus tipos.