Professionals should be trained in health education and communication techniques to contribute to the patient's self-management and motivation for diet adherence. Controlled and randomised clinical studies involving predialysis stages should be performed to investigate the impact of the assessment and control of barriers to diet adherence.
artículos originales0 Factores determinantes y coste económico del absentismo de pacientes en consultas externas de la agencia sanitaria costa del sol Determinants and economic cost of patient absenteeism in outpatient departments of the Costa del Sol Health Agency M.l. Jabalera Mesa 1 , J.M. Morales asencio 2 , F. rivas ruiz 3 resuMen Fundamento. Identificar los factores de la persona, el proceso y el contexto que influyen en el cumplimiento de las citas de consultas externas en la Agencia Sanitaria Costa del Sol, describiendo el perfil del paciente que no acude a su cita, los motivos del absentismo y realizando una estimación del coste económico. Método. Estudio observacional, multicéntrico de casos y controles, mediante encuesta a pacientes citados en consultas ambulatorias durante 2013 y 2014 y análisis de costes por consultas. resultados. Participaron en el estudio 882 pacientes (294 casos y 588 controles). El olvido (29,6%; n=87) y el fallo en la comunicación (16%; n=47), fueron los principales motivos manifestados por los pacientes absentistas. Una menor demora en la cita y la edad avanzada se asociaban significativamente con menos ausencias, al igual que haber frecuentado más las consultas en el último año. El coste económico fue superior a 3 millones de euros para una tasa de inasistencia del 13,8%. conclusiones. Los pacientes jóvenes que no frecuentan habitualmente las consultas constituyen el grupo de mayor riesgo de ausencia a las citas programadas en nuestra área sanitaria. Los principales motivos del absentismo son evitables y podrían beneficiarse de intervenciones como la mejora de los procedimientos de comunicación o sistemas de recordatorio de citas. Palabras clave. Citas y horarios. Consulta. Pacientes ambulatorios. Atención ambulatoria. Cooperación del paciente.
Background: Recruitment into randomized trials of hydroxychloroquine (HCQ) for prevention of COVID-19 is being threatened by a widespread conviction that HCQ is not effective for prevention. In the absence of an updated systematic review, we conducted a meta-analysis of randomized trials that study the effectiveness of HCQ to prevent COVID-19.
Methods and Findings: A search of PubMed, Embase, and medRxiv with expert consultation found four completed randomized trials: two pre-exposure prophylaxis trials and two post-exposure prophylaxis trials. We obtained or calculated the risk ratio of COVID-19 diagnosis for assignment to HCQ versus no HCQ (either placebo or usual care) for each trial, and then pooled the risk ratio estimates. The risk ratio estimated for each of the individual trials were 0.74 (95% CI 0.50-1.10), 0.95 (0.25, 3.64), 0.83 (95% CI: 0.58-1.18), and 0.69 (95% CI: 0.35-1.37). The pooled risk ratio estimate was 0.78 (95% CI: 0.61-0.99). All four trials found a similar rate of adverse effects in the HCQ and no HCQ groups.
Discussion: A pooled analysis of these randomized trials cannot rule out a moderate reduction of COVID-19 risk after assignment to HCQ. Yet the findings from the randomized trials were widely interpreted as definite evidence of lack of effectiveness of HCQ, simply because they were not statistically significant. Completion of the ongoing trials is needed to generate more precise estimates of the effectiveness of HCQ to prevent COVID-19.
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