Comparison of 1-year outcome in patients with severe aorta stenosis treated conservatively or by aortic valve replacement or by percutaneous transcatheter aortic valve implantation (data from a multicenter Spanish registry)

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.

Using a brief questionnaire to assess the overall perception of basketball spectators

Purpose – The purpose of this paper is twofold. The first aim is to obtain a valid and reliable instrument for the holistic analysis of sporting events, and the second is to test a causal model in which future intentions depend on spectators’ perceptions of quality, satisfaction, and value of these events. Design/methodology/approach – A total of 493 spectators of a professional basketball team in the Spanish ACB league responded to a survey to measure the overall performance of the sporting event service. Exploratory factor analysis and further confirmatory factor analysis using structural equation models provides the methodology for testing the reliability and validity of the instrument. Findings – The scales have adequate reliability and validity indices. The path model explains 35.8 percent of the variance in future intentions, 54.0 percent in perceived value, and 49.5 percent in spectators’ satisfaction. Quality proves a better predictor of perceived value than satisfaction. Both perceived value and satisfaction have a similar weight in predicting spectators’ future intentions. The data indicate that quality has an effect on spectators’ future intentions, by altering their perceptions of value and satisfaction. Research limitations/implications – The research findings are somewhat limited, due to the sample consisting entirely of spectators of a single team in the Spanish ACB league. Practical implications – Managers can use these findings to develop loyalty strategies by creating service value and increasing spectators’ satisfaction through quality improvements. Originality/value – This study contributes to the literature on service quality by providing an overall measure to assess service in professional sporting events in a Latin-American context.

Toward a comprehensive care of HIV patients: Finding a strategy to detect depression in a Spanish HIV cohort

Depression is a common but frequently undiagnosed feature in individuals with HIV infection. To find a strategy to detect depression in a non-specialized clinical setting, the overall performance of the Hospital Anxiety and Depression Scale (HADS) and the depression identification questions proposed by the European AIDS Clinical Society (EACS) guidelines were assessed in a descriptive cross-sectional study of 113 patients with HIV infection. The clinician asked the two screening questions that were proposed under the EACS guidelines and requested patients to complete the HADS. A psychiatrist or psychologist administered semi-structured clinical interviews to yield psychiatric diagnoses of depression (gold standard). A receiver operating characteristic (ROC) analysis for the HADS-Depression (HADS-D) subscale indicated that the best sensitivity and specificity were obtained between the cut-off points of 5 and 8, and the ROC curve for the HADS-Total (HADS-T) indicated that the best cut-off points were between 12 and 14. There were no statistically significant differences in the correlations of the EACS (considering positive responses to one [A] or both questions [B]), the HADS-D ≥ 8 or the HADS-T ≥ 12 with the gold standard. The study concludes that both approaches (the two EACS questions and the HADS-D subscale) are appropriate depression-screening methods in HIV population. We believe that using the EACS-B and the HADS-D subscale in a two-step approach allows for rapid, assumable and accurate clinical diagnosis in non-psychiatric hospital settings.