Hip and knee arthroplasty: What prosthesis did you say I would get? (part two)

1 Feb

Olga Martínez, Xavier Mora

We continue the interview with Olga Martínez from the Catalan Arthroplasty Register (RACat) and Xaxier Mora, specialist in traumatology and orthopaedic surgery with a Master in biomaterials.

The aim of today’s post is to know a little more about prostheses and the biomaterials used in arthroplasties.

With this post and the previous one, we have wanted to present the opinions of these two professionals.

Are all prostheses the same?

Xavier: No, because each patient is different. Therefore, the orthopaedic surgeon will recommend one type of prosthesis or another, depending on the extent to which the bone is affected, the patients’ age, associated diseases and the daily activity of a the patient.

Olga: At present, there are different types of prosthesis on the market in terms of design, materials used in their manufacture and the way they are anchored to the bone. There are prostheses that range from replacing only a part of the joint to more complex joint replacements in situations where bone damage is extensive.

As a user of the health system, to which hospital should I go to receive the best prosthesis?

Xavier: One cannot talk about better or worse prostheses because all prostheses used for implants have to follow a standardised procedure according to specific international standards, such as those of the American FDA and the European CE seal of approval, for materials that will be implanted in humans. In the same way, hospitals in Catalonia are certified to be able to carry out this type of surgery.

Olga: The prostheses which are commercialised in Catalonia meet the international standards of quality and public hospitals base their choices of prostheses on the scientific evidence available. This is allows them to select those with the best results according to arthroplasty registries, using recommendations from different institutions such as the NICE (National Institute of Healthcare and Clinical Excellence) and the ODEP (Orthopaedic Data Evaluation Panel).

Olga: In addition, the new European legislation passed in 2016, regarding implants used in health, aims to increase the supervision of the industry by implementing stricter norms and regulations including the obligation of clinical assessment, while at the same time fostering innovation in this field.

Who does the research into the best materials available and what factors are taken into account?

Olga: These days, the research of new materials and manufacturing techniques as well as the design and improvement of new prosthetic implants is a multidisciplinary process. The contributions of orthopaedic surgeons are especially important together with studies in joint biomechanics and surgical technique. In Catalonia there are research centres in biomaterials such as Leitat and the Technical University of Catalonia (UPC).

Olga: From the AQuAS we have written up and published short reports on biomaterials (polyethylene, cements and ceramics and metals) aimed at professionals that work in services of orthopaedic surgery and traumatology, with the aim of updating their knowledge.

Reports available in Catalan:

Xavier: Nowadays, when manufacturing new materials, the interaction between the surface of a biomaterial and the bone is taken into account more and more often, so that bone cells can consider an implant as part of its own structure and thereby avoid the prosthesis from moving about because this is one of the biggest problems in getting an implant to function well.

How have materials evolved since the first prostheses to the present day?

Olga: The discovery of new materials and/or the progress made both in terms of manufacturing techniques and the knowledge gained in the biomechanics of the human body have influenced the design of prostheses over time.

Xavier: The first experiences in joint implants date back to the 20s of last century. One of the first attempts at replacing the surface of the head of the hip was done by manufacturing a metal socket or dome (Smith-Petersen).

Xavier: In the last 20 years, many important advances have been made regarding the use of new biomaterials, much safer and of greater resistance to wear, thus extending the life of an implant in a biological environment such as the human body. Together with metallic biomaterials, these days ceramic biomaterials are used with good results in relation to their integration in bone tissue.

Xavier: On the other hand, research in 3D technology has paved the way for a more precise surgery, and in the future it will be possible to manufacture more personalised implants.

Xavier and Olga: We both agree that we are getting closer and closer to having a prosthesis that is for life.

Hip and knee arthroplasty: What prosthesis did you say I would get? (part one)

25 Jan

Olga Martínez, Xavier Mora

Today, we interview Olga Martínez from the Catalan Arthroplasty Register (RACat) and Xavier Mora, specialist in traumatology and orthopaedic surgery with a Master in biomaterials. They are two professionals involved in arthroplasties, a subject of great impact among a large sector of the population. We focus on aspects of recommendation and prognosis related to the pathology and on the value of registries for quality care.

In what cases is an arthroplasty intervention recommended?

Xavier: The most important surgical indication to carry out a knee or hip arthroplasty is arthrosis. Advanced arthrosis has a considerable social impact with a loss of life quality for the person affected due to pain, a loss of personal autonomy and an increase in dependency. In addition, the loss or reduction in mobility can worsen existing diseases such as diabetes or heart diseases. It is in these situations when an arthroplasty is recommended which will reduce pain and improve joint mobility.

Olga: In our field, according to the data from the Conjunt Mínim de Dades dels Hospitals d’Aguts (Minimum Set of Data from Acute Care Hospitals) and the Catalan Arthroplasty Register (RACat), the main reason for an intervention in knee and also hip arthroplasties is arthrosis. In the case of the hip, femoral neck fractures are the second cause for arthroplasty recommendation.

It seems that there are more and more people who undergo arthroplastic surgery each day to implant a prosthesis. Is this a fact?

Xavier: Yes, around 9,6% of the Spanish population suffer from this disease to some degree, a percentage that increases up to 33,7% among people aged between 70 and 80. With the ageing of the population, it is evident that there will be an increase in the number of people who could be candidates for arthroplastic surgery in the future. In the context of Catalonia, if we do a simulation with 2026 as the time horizon, based on data from the Idescat, the population aged between 15 and 39 will decrease while the population of 40 to 64 will increase (227,000 people and 330,000 people respectively).

Olga: At present, knee arthrosis has a prevalence of 10,2% and that of the hip is around 5%, more frequent among women, even though the data vary between one study and another.

The AQuAS, the Agency for Quality and Health Assessment of Catalonia, has been managing the Catalan knee and hip arthroplasty registry (prosthesis) for many years. What purpose does a registry like this have?

Xavier: The aim of all orthopaedic surgery is the survival and good functioning of a prosthesis and in consequence, the improvement in the quality of life of patients. Although a prosthetic implant undergoes strict manufacturing procedures before being used and follows a rigorous surgical technique during surgery, the functional results in a patient need to be assessed via follow up sessions from the time they receive an implant. To this effect, arthroplasty registries can help detect models of prosthesis with a malfunction, both in the short and long term, and identify the patients who have received these implants.

Olga: This is what happened a few years ago with the ASR model, a hip prosthesis that some publications and registries, such as the National Joint Registry, pointed out due to an unusual increase in the rate of revisions. This motivated an international health alert and a protocol was adopted to monitor patients.

Olga: One of the first prosthetic failures that prompted the creation of registries was that of the 3M Capital Hip, a hip prosthesis introduced in 1991 in the United Kingdom as an inexpensive prosthesis. After six years and more than 4,600 prosthesis implants, the risk of undergoing a revision was considered to be 4 times higher than that expected with the added difficulty of the traceability of the implants as no registry existed at a national level.

Olga: The Registry for Arthroplasties of Catalonia created in 2005, an epidemiological tool of surveillance in the Catalan Health System, stemmed from the collaboration between the AQuAS, CatSalut and the Catalan Society of Orthopaedic Surgery and Traumatology.

Are there other similar experiences of registries of this type in other countries?

Olga: Sweden (1975) and Finland (1980) were the first countries to push for a national registry of arthroplasties of a demographic nature.

Olga: At present, many countries have implemented this tool, be it in Europe, America, Oceania, etc… with different territorial coverage, but with a common aim: to be a valid instrument in assessing arthroplasty procedures and implants used.

As a patient or as a family member of a person that suffers from joint arthrosis, what is the message that you would like to get across based on your experience?

Xavier: The first consultation that a patient has is always because of the pain they are experiencing in the hip or knee joint when walking, going up or down stairs, getting up from a sitting position in a chair, having difficulty to put on shoes, etc. The aim of treatment should be to eliminate pain by using medication, doing physical exercise and physiotherapy that help improve 95% of patients. An arthroplasty intervention should only be considered as a last therapeutic resort. In this context, shared decisions between professionals and patients are very important too when talking about arthroplasties. We should all ask ourselves whether the best option to reduce this pain is to implant a prosthesis.

Does a patient go back to normal routine life after an arthroplasty intervention?

Xavier: After a surgical intervention and once the period of functional recovery has come to an end, a normal lifestyle can begin, due to the disappearance of pain and an improvement in joint mobility. In certain cases, constraints will be limited to intense activity that could overburden the joint.

(To be continued …)

Sleep apnea: towards precision medicine

18 Jan

Ferran Barbé

Obstructive sleep apnea is a chronic disorder characterised by recurrent episodes of a blockage of the upper airways during sleep which affects between 5% and 14% of adults from 30 to 70 years of age, mainly men. In addition, sleep apnea leads to a reduction of the intake of oxygen (hypoxia) during sleep. In order to counteract this lack of oxygen, the brain reacts by forcing a short awakening known as arousal which reactivates the muscles in the upper airway and allows air to pass through (reoxygenation).

These cycles of hypoxia-reoxygenation produce stress to the circulatory system and leads to an increase in the risk of cardiovascular, hypertensive, metabolic, cerebrovascular, or neoplastic diseases, and lastly, a risk of death. At the same time, the arousals prevent a person from having a good night’s rest, produce the feeling of tiredness and an excessive desire to sleep during the day, which is associated with an increase in road accident rates and a decrease in life quality.

A standardised approach in the treatment of sleep apnoea exists: the use of continuous positive airway pressure (CPAP) during the night in order to keep the upper airways open which helps the person rest.

However, treatment with CPAP shows contradictory results. On the one hand, it has been demonstrated that the use of a CPAP for at least 4h per night increases quality of life and reduces blood pressure among population groups with high blood pressure. In contrast, it has not been demonstrated that the use of CPAP reduces the risk of major cardiovascular events or deaths. Therefore, sleep apnea is a heterogeneous disorder and the use of CPAP is not equally effective with all patients. Which patients can benefit most from the treatment? Should all patients be treated in the same way?

We believe it is important to look for patients with sleep apnea profiles that can benefit from a treatment with CPAP. The creation of the PADRIS programme (Public Data Analysis for Health Research and Innovation Programme in Catalonia), whose aim it is to make related health data available to the scientific community to drive research, innovation and assessment in health, has given us the opportunity to be able to analyse all subjects with sleep apnea treated with CPAP in Catalonia. We are talking about 71,217 people, approximately 1% of the general population who were attended by the public health system in Catalonia (primary care, hospital care, social health and/or pharmacy) in the period 2012-2013.

To establish these profiles (that is, groups of patients having similarities with each other but at the same time very different from the remainder) the most frequent comorbidities of patients with sleep apnea have been taken into consideration as well as the clinically relevant comorbidities. Six different profiles of patients were identified among patients with sleep apnea and treated with CPAP in Catalonia.


Despite defining these six different patient profiles, we can safely say that the population of Catalonia receiving CPAP is divided into two large basic groups: on the one hand, old age patients, with a high mortality rate and a frequent use of resources, and on the other, patients with fewer comorbidities, a low mortality rate and an infrequent use of resources. You can read it in an article in Plos ONE.

Do both groups need to be treated in the same way? It seems not. In the group with fewer comorbidities, a low mortality rate and an infrequent use of resources, it seems that sleep apnea is the most important determinant in the prognosis of these patients and there is evidence that this would be the group that could most benefit from treatment with CPAP. In contrast, it seems that in the other group sleep apnoea is at a secondary level, given that the predominant diseases are more serious.

The study has allowed us to assess the association between treatment with CPAP and mortality; that is, whether more people die who are being treated with CPAP or whether more people die having the same comorbidities but without sleep apnea.

To be able to achieve this objective, for each patient treated with CPAP we looked for three people with similar characteristics but without sleep apnea. What we observed was surprising, namely that despite presenting a greater number of comorbidities, treatment with CPAP is associated with a decrease in mortality rate at a population level (Am J Crit Care Med 2018 press).

We now need to continue working to find out what occurs in each of the patient profiles. Having access to this volume of data helps us to make an estimate of the groups of patients with sleep apnoea that will benefit more with CPAP treatment and this means that we are getting closer and closer to precision medicine.

Diseases do not exist, ill people do

Post written by Ferran Barbé, Hospital Institut de Recerca Biomèdica de Lleida.

Blog AQuAS Awards 2017

11 Jan

Today we are inaugurating the AQuAS Blog Awards 2017 to reward the most read post of the year.

In this first edition, the award was a contest between five finalists: Assumpció Mestre, Lluís Bohígas, Emili Vela, Paula Traver and Cristina Colls, as we explained a few days ago here.

The winner of the first edition is Emili Vela with the following post:

Congratulations Emili!

Let’s begin the year…

4 Jan

We begin the year by giving thanks to all the people that have collaborated in the blog AQuAS during 2017: Laura Muñoz, Laia Domingo, Mercè Piqueras, Emili Vela, Xavier Serra-Picamal, Xavier Trabado, Angelina González-Viana, Andreu Segura, Daniel Chaverri, Miquel Pons, Luis Lobo, Glòria Ruiz, Neus Méndez, Toñi Parra, Jordi Fàbrega, Núria Radó, Paula Adam, Cristina Colls, Lluís Bohígas, Dolores Ruiz-Muñoz, Guillem López Casasnovas, Anna García-Altés, Òscar Solans, Paula Traver, Víctor M. Montori, Jean Patrick Mathieu, Rossana Alessandrello, Marc Fortes, Dolors Benítez, Ioan Arrizabalaga, Esther Vizcaino, Emmanuel Giménez, Johanna Caro, Assumpció González Mestre, Elisa Puigdomènech, Rosa Maria Vivanco, Ramon Gomis, Sònia Abilleira, Joan MV Pons and Toni Dedéu.

Many thanks to everybody!

From Tokyo to Tarragona: connected health

28 Dec

Over the last few years, the number of medical applications for mobile phones or health apps has increased exponentially. Thus, in 2017, it is estimated that there are nearly 200.000 health apps on the market.

They are related to technological solutions that monitor data such as blood pressure, the steps we take, the minutes we run, our pulse, the calories we ingest and even whether we sleep well or badly. There are also mobile devices that can be synchronised with other devices such as a calculator of the levels of blood glucose.

Four years ago, the FDA published its guide on medical applications for mobile phones aimed at manufacturers. The regulatory agencies take into consideration aspects which could present a risk to users of a particular product; in the context of health apps, on the one hand, this refers to applications that function with a regulated medical instrument (for example, medical imaging) and on the other, to applications that function as a medical device (for example, ECG electrocardiograms for cardiovascular patients).

But what happens with the remainder of medical apps? The Agency for Health Quality and Assessment of Catalonia (AQuAS) has worked on a proposed theoretical framework to assess medical apps. It is important to identify what scales can be useful when assessing a health app in terms of scientific evidence, safety and aspects of privacy.

HTA agencies can play an active role in assessment as well as in the development of technological solutions. The role of the AQuAS is worthy of mention in its pilot experiences in different projects of connected health: PEGASO, centred on the promotion of healthy lifestyles among adolescents, DECIPHER, as a comprehensive solution to facilitate the geographic mobility of patients with chronic diseases and m-Resist, centred on schizophrenia and patients who have resistance to treatment.

In addition to these experiences, the AQuAS has recently signed an agreement of collaboration for the design and development of the mobile application Human-Castle, aimed at professionals and citizens. A delegation of Japanese health professionals from the company Kikkoman has been on an extended visit to the AQuAS with this objective in mind.

“It has been 25 years since Barcelona shared the human castle phenomenon with the rest of the world at the opening ceremony of the 1992 Barcelona Olympic Games. It is a historical coincidence that coincides with the birth of technological assessment in Catalonia two years later, in 1994. We have a considerable challenge ahead that could mean a change of paradigm, both sustainable and scalable.”

“If we bring all knowledge together and join forces, the probabilities of raising a human castle successfully will increase.”

These are two of the highlights of a brief article published in The Economist on this emerging Catalan-Japanese initiative which will probably become a reality in the setting of the upcoming Summer Olympics in 2020, officially known as The Games of the XXXII Olympiad, a sporting event which will take place between 24 July and 9 August, 2020, in the city of Tokyo.

It concerns a multidisciplinary and inclusive project that highlights the strength of the human castle phenomenon, Catalan architecture applied to the computing architecture of technological solutions and the methodology of assessment.

Wishing you a pleasant festive season from the AQuAS blog

21 Dec

From the blog at AQuAS, the Agency for Health Quality and Assessment of Catalonia, we would like to thank you for having accompanied us for yet another year.

With the aim of sharing knowledge and creating an area for reflection, we have published 40 posts in 2017.

The blog’s Editorial line looks at subjects such as health assessment and health systems, the participation of patients and citizens, low value practices, eHealth and connected health, data analysis, research, gender issues, inequalities in health, innovation and current affairs; with content generated by authors at the AQuAS as well as by guest contributors.

The five most read posts in 2017 have been the following (in alphabetical order):

•   Caregiving first hand, by Assumpció González Mestre
•   Double health insurance cover, by Lluís Bohígas
•   Adjusted morbidity groups: a new population morbidity classifier, by Emili Vela
•   Mendeley, from reference manager to discovery tool and scientific visibility, by Paula Traver
•   An indicator for a more fairly funded primary care, by Cristina Colls

Thank you very much for reading us and this is wishing you all a very pleasant festive season!

Post by Marta Millaret (@MartaMillaret), editor of the AQuAS blog.

To drip or not to drip (and thus, ship); that is the question!!

14 Dec

Sònia Abilleira

The proof given in 2015 of the efficacy of a mechanical thrombectomy in patients suffering from a severe ischemic stroke caused by a large vessel occlusion in the brain represents a change of paradigm because it forces us to reconsider the organised systems of care for people suffering from a severe stroke.

These models of organisation, or systems of stroke code as they are known in our environment, started being developed at the end of the 90s and beginning of the year 2000 in response to the evident difficulties observed in accessing intravenous thrombolytic therapy, a highly time dependent treatment, eminently due to the delay of the arrival of patients at emergency services.

Rightly, these difficulties were overcome by developing organised systems of care where a protocol was established for the rapid transfer of these patients to specially designated and previously alerted hospitals equipped to manage these cases expertly.

Recently, we have scientific evidence that establishes that a mechanical thrombectomy is the new therapeutic standard in the case of strokes caused by large vessel occlusion in the brain, clinically more severe, where the effect of intravenous thrombolysis is very limited (30% maximum rates of revascularisation). A mechanical thrombectomy, however, is a highly specialised and complex treatment that needs to be undertaken as quickly as possible in centres with advanced technology to guarantee adequate results.

This recentralising tendency in carrying out endovascular treatment contrasts with the decentralisation which was done in its day to ensure an adequate access to thrombolytic therapy which by nature needs to be administered in the first 4,5 hours after the onset of symptoms. This is why nowadays we talk about a change of paradigm to refer to the obsolescence of the models in stroke care developed in the era of thrombolysis, now that we are fully in the thrombectomy era.

The situation today is even more complex if we bear in mind what the mechanical thrombectomy trials established: that endovascular therapy was better than medical treatment, including intravenous thrombolysis. As a result, the current standard of care establishes that, with patients having no contraindications for thrombolytic treatment, this care must be given as soon as possible before a thrombectomy.

In urban metropolitan areas, mostly served by hospitals with the capacity of carrying out both treatments, the translation of the results of trials to clinical practice does not pose a problem.

However, the question is: what needs to be done when there is a stroke in one of the areas primarily covered by centres without endovascular capacity? Should we hold the patient back in the nearest stroke hospital, and in this way prioritise intravenous thrombolysis, even if by taking this decision we are in fact delaying the arrival of the patient at the tertiary stroke centre, the only one with the capacity of carrying out a thrombectomy? Or should we transfer these patients directly to the tertiary stroke centre with the understanding that a thrombectomy is the only valid therapeutic option in these cases, even if this means delaying or disregarding intravenous thrombolysis?

This is, in fact, the controversy between the “drip-and-ship” model which prioritises thrombolysis, and the “mother-ship” model which adopts the opposite approach and defends the direct transfer to a tertiary hospital where the entire process of care can be performed: from an ultra-rapid diagnosis to whatever type of reperfusion treatment.

If that weren’t enough, one must bear in mind that these models are based on the prehospitalisation selection of patients strongly suspected of having a stroke but without confirmation or diagnosis, nor of the subtypes of stroke, ischemic or haemorrhagic.

At present, we do not have the necessary evidence to prioritise the transfer of patients with acute stroke following either the “drip-and-ship” or the “mother-ship” protocol and this is why the RACECAT (NCT02795962) is being carried out in Catalonia since the beginning of 2017 which aims to provide answers to this controversy.

This study has been made possible thanks to the effort of a large number of health professionals: from those in charge of prehospital care (SEM/112), specially trained in the use of the RACE scale (a scale to assess the gravity of stroke and, therefore, those cases with a higher probability of having a large vessel occlusion and susceptible to being treated with mechanical thrombectomy), to the people in charge of care in each of the 26 hospitals in the stroke code network in Catalonia. Would you like to know more? Then you must watch this video.

The RACECAT trial is being carried out at present and in a couple of years, the evidence obtained from this study will allow us to modify the circuits of care in the case of a serious stroke code and so be able offer the greatest clinical benefit to these patients.

Post written by Sònia Abilleira.

Open access depredatory journals

7 Dec

Joan MV Pons

As soon as it has been published and identified with an email address, it will not come as a surprise to receive a lot, but I mean a lot, of emails that often invite one to publish in what are apparently scientific journals (by name), to participate in congresses or conferences on subjects that seem of interest or to join as a member of some board of editors. These emails come in constantly and which I always mark as junk mail so as not to waste more time on them.

And it is true that this type of business, which is purely that, has proliferated in recent times largely due to the inherent zeal of the human species for lining one’s pockets, but also perhaps because of the great proliferation of researchers and research institutes. There is a lot of money at stake and it is well-known, that with minimal effort, one ends up publishing anything that one desires. If editors of journals in the past strived for readers and subscribers, now in addition to these open access journals, what they are looking for are columnists, people who publish in their pages …. in exchange for a small (and not so small) fee. There is no need to talk about the advantages of these open access journals and how some of them have attained a pretty high impact factor within a short period of time. Here the impact factor is a correct measure because it gives an approximation of the citations the articles receive which are published in these journals; it is a mistake, we know, to use the impact factor of the journal as an approximate measure or substitute (proxy or surrogate) for the value of an article.

Jeffrey Beal, a librarian, is the person who introduced this term and who elaborates and updates a list of journals periodically that can fit in to this  typology. According Wikipedia’s definition, those considered as predatory journals are those open access publications that stem from a business model based on the exploitation of open access publications by means of charging a publishing fee to the authors without providing the editing and publishing services of journals considered as legitimate (be they open access or not). Beall’s List up to December 2016 – a good sample of how Wikipedia updates itself in some subjects – had some 1,155 journals included.

The same universal cybernetic encyclopaedia provides a series of associated characteristics with this type of predatory journal (also hunters, that hunt to survive).

Post written by Joan MV Pons

Reusing health data: oral anticoagulants and cerebral haemorrhages

23 Nov

Rosa Maria Vivanco

Last September, the 35th scientific meeting of the Spanish Epidemiological Society (SEE in Spanish) took place in Barcelona.

The AQuAS presented the impromtu roundtable “The reuse of health data for research: how, when and what is expected from the PADRIS programme in Catalonia.”

At this roundtable, moderated by Mireia Espallargues and Ramon Roman, the attendees were informed of what the PADRIS programme consists of (Public Data Analysis for Health Research and Innovation Programme in Catalonia) and some results were presented, such as those that derive from the study we are carrying out at the IMIM (Medical Research Institute of the Hospital del Mar), with the support  of the Catalan Stroke Program, on the link between the use of oral anticoagulants and cerebral haemorrhages.

Cerebral haemorrhages are the second most frequent type of stroke in the world, with an incidence of 48 cases per 100,000 inhabitants per year (Global Burden Disease 2010). The most frequent cause is high blood pressure.

As with other causes, it points to the use of anticoagulant drugs and old age. High blood pressure is a risk factor which is being detected the earliest and which is being controlled more efficiently in recent years in high income countries, and thus it is estimated that associated cases of cerebral haemorrhages will decrease.

By contrast, it is foreseeable that due to the ageing of the population and the increase in the prescription of anticoagulants to prevent stroke at a primary and secondary stage, cerebral haemorrhages associated to these other risk factors will increase.

On the other hand, new oral anticoagulants have appeared on the market (known as direct action) which, according to clinical trials, offer similar efficacy and improved safety features over the anticoagulants that there have been till now, known as vitamin K dependent.

These results, however, need to be verified in habitual clinical practice.

This is the context in which it is so necessary to have a programme available with the characteristics of the PADRIS programme.

What can we get out of it?

To know, by using population data, among other elements, the incidence of cerebral haemorrhages over the last 10 years, their association with the use of these drugs, both dependent vitamin K coagulants and the new oral anticoagulants, whether the tendency of the prescription has changed, whether the new oral anticoagulants are associated to a lower risk of cerebral haemorrhages as studies seem to indicate, what segment of the population is most affected and even to be able to make estimates for the years ahead.

In the case of our study, the preliminary results that we presented show a tendency for a greater prescription of new oral anticoagulants and a stabilisation of the number of cerebral haemorrhages in recent years. To be able to give more definitive results, more analyses need to be done and we continue working because this is what the complexity of managing data requires.

Making the most of our experience, we feel we are in a position to offer a series of advice to any research group that is considering putting in a request to the PADRIS programme for health data.

One must bear in mind the characteristics of the registries and the data bases from which health information is obtained: namely, that the data obtained is administrative data, with the limitations that this entails, and that technical personnel do not speak the same language as research personnel.

This is why we consider it necessary to have the figure of an interlocutor or mediator that enables the research group and technical and administrative personnel “to understand each other” and that via the feedback from both sides, the group can benefit from the numerous opportunities that the PADRIS programme offers.

In our case, thanks to the Catalan Stroke Program, we were able to push ahead with the project and we hope to be able to publish our results soon and provide society with the corresponding benefits.

Post written by Rosa Maria Vivanco, researcher at the Neurovascular Diseases Research Group of  at IMIM.