http://hdl.handle.net/10171/190 Fri, 24 May 2013 20:36:51 GMT 2013-05-24T20:36:51Z http://hdl.handle.net/10171/27505 Title: Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients Author(s) : Lecumberri, R. (Ramón); Marques, M. (Margarita); Diaz-Navarlaz, M.T. (María Teresa); Panizo, E. (Elena); Toledo, J. (Jon); Garcia-Mouriz, A. (Alberto); Paramo, J.A. (José Antonio) Abstract: Despite current guidelines, venous thromboembolism (VTE) prophylaxis is underused. Computerized programs to encourage physicians to apply thromboprophylaxis have been shown to be effective in selected populations. Our aim was to analyze the impact of the implementation of a computer-alert system for VTE risk in all hospitalized patients of a teaching hospital. A computer program linked to the clinical record database was developed to assess all hospitalized patients' VTE risk daily. The physician responsible for patients at high risk was alerted, but remained free to order or withhold prophylaxis. Over 19,000 hospitalized, medical and surgical, adult patients between January to June 2005 (pre-intervention phase), January to June 2006 and January to June 2007 (post-intervention phase), were included. During the first semesters of 2006 and 2007, an electronic alert was sent to 32.8% and 32.2% of all hospitalized patients, respectively. Appropriate prophylaxis among alerted patients was ordered in 89.7% (2006) and 88.5% (2007) of surgical patients, and in 49.2% (2006) and 64.4% (2007) of medical patients. A sustained reduction of VTE during hospitalization was achieved, Odds ratio (OR): 0.53, 95% confidence interval (CI) (0.25-1.10) and OR: 0.51, 95%CI (0.24-1.05) during the first semesters of 2006 and 2007 respectively, the impact being significant (p < 0.05) among medical patients in 2007, OR: 0.36, 95%CI (0.12-0.98). The implementation of a computer-alert program helps physicians to assess each patient's thrombotic risk, leading to a better use of thromboprophylaxis, and a reduction in the incidence of VTE among hospitalized patients. For the first time, an intervention aimed to improve VTE prophylaxis shows maintained effectiveness over time. Wed, 31 Dec 2008 23:00:00 GMT http://hdl.handle.net/10171/27505 2008-12-31T23:00:00Z http://hdl.handle.net/10171/22863 Title: Esclerosis multiple y fatiga Author(s) : Castro, P. (Purificación) de; Abad, A. (A.); Barcena, E. (E.); Rotger, A. (A.); Iriarte, J. (Jorge) Abstract: Fatigue is a frequent symptom in multiple sclerosis, known since the first descriptions of the disease, and it has been the object of special interest in recent years due to the great influence it has on the quality of life of those suffering from the disease. The fatigue of multiple sclerosis has clinical characteristics that differentiate it from the fatigue of other systemic diseases. At the same time, it is highly variable between patients and a clear distinction can be made between three types: astenia, fatigability and the worsening of symptoms with exercise. The physiopathological bases are not fully established, but there is data indicating that astenia is related to immunoactivation and evidence of the relation of fatigability to alterations of the pyramidal tract. Another point of interest in the study of fatigue is how to objectivise and quantify it, as well as the neurophysiological techniques for its evaluation and the measurement scales most frequently employed. The paper also sets out the principal therapeutic tests and considers the relative efficacy of aminopyridine and amantadine in alleviating it. Fri, 31 Dec 1999 23:00:00 GMT http://hdl.handle.net/10171/22863 1999-12-31T23:00:00Z