Examinando por Autor "Losa, JE"

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Advice from a medical expert through the Internet on queries about AIDS and hepatitis: analysis of a pilot experiment
(Public Library Science, 2006-07-04) Marco, Javier; Barba, Raquel; Losa, JE; de la Serna, CM; Sainz, M; de la Serna, JL
Background: Advice from a medical expert on concerns and queries expressed anonymously through the Internet by patients and later posted on the Web, offers a new type of patient-doctor relationship. The aim of the current study was to perform a descriptive analysis of questions about AIDS and hepatitis made to an infectious disease expert and sent through the Internet to a consumer-oriented Web site in the Spanish language. Methods and findings: Questions were e-mailed and the questions and answers were posted anonymously in the "expert-advice" section of a Web site focused on AIDS and hepatitis. We performed a descriptive study and a temporal analysis of the questions received in the first 12 months after the launch of the site. A total of 899 questions were received from December 2003 to November 2004, with a marked linear growth pattern. Questions originated in Spain in 68% of cases and 32% came from Latin America (the Caribbean, Central America, and South America). Eighty percent of the senders were male. Most of the questions concerned HIV infection (79%) with many fewer on hepatitis (17%). The highest numbers of questions were submitted just after the weekend (37% of questions were made on Mondays and Tuesdays). Risk factors for contracting HIV infection were the most frequent concern (69%), followed by the window period for detection (12.6%), laboratory results (5.9%), symptoms (4.7%), diagnosis (2.7%), and treatment (2.2%). Conclusions: Our results confirm a great demand for this type of "ask-the-expert" Internet service, at least for AIDS and hepatitis. Factors such as anonymity, free access, and immediate answers have been key factors in its success.
The influence of nursing homes in the functioning of internal medicine services
(Elsevier, 2008-06) Barba, R; Losa, JE; Canora, J; Ruiz, J; Castilla, JV; Zapatero, A
Background: Some hospitals attend to great number of patients who come from nursing homes whose median age, seriousness of illness and comorbidity differ of these patients from those of non-institutionalized patients. This can partly modify and thereby affect some of the parameters used to measure "assistance quality". Materials and methods: The data related to the demographic, clinical factors, severity criteria and mortality, were studied in patients hospitalized in two Internal Medicine Services during 2005-6 on the basis of whether they arrived from a nursing home or not. The data were obtained from the electronic databases of the two centers. Results: During the study period, 13,712 patients were hospitalized (7110 in Fundación Hospital Alcorcón (FHA) and 6602 in Hospital Universitario Fuenlabrada (HUF)). A total of 789 (15.3%) patients of FHA arrived from a nursing home in comparison to 132 (2.6%) of those in HUF. Patients arriving from nursing homes were older (84.1 vs 69.8; p<0.05), had a more serious illness (Group Related Diagnostic weight 2.1 vs 1.9; p<0.05), more comorbidity (Charlson Index >0; 75.5% vs 67.3%; p<0.05) and increased mortality (16.8% vs 6.8%; p<0.05) than the non-institutionalized patients, while length of hospital stay were shorter in the institutionalized patients (7.8 vs 8.3; p<0.05). Intrahospital mortality was significantly associated with living in a nursing home (Odds Ratio 1.4 Confidence Interval 95% 1.1-1.8), regardless of age, gender, condition, comorbidity (Charlson Index), and the involved hospital. Discussion: The number of nursing homes attended by a hospital determined the activity of an Internal Medicine Service. This study indicates that the patients from nursing homes were older, with increased severity and comorbidity of their illness, greater mortality and rehospitalization although, with similar length of stay.