Neuroma of the distal posterior interosseous nerve as a cause of persistent dorsal wrist pain. / El neuroma de la porción distal del nervio interóseo posterior como causa de dolor dorsal persistente de muñeca.

Dorsal wrist pain is a very common cause of complaint in the clinical practice of the hand surgeon. Such pain can frequently be related to traumatic, inflammatory or degenerative diseases, but sometimes its origin is far away from these common causes. A rare case is reported of chronic dorsal wrist pain of neuropathic origin, due to a pre-capsular neuroma of the posterior interosseous nerve. Possible causes, diagnostic hints, and treatment options are thoroughly discussed.

[Identification of items for creating a questionnaire for the assessment of instrumental activities of daily living (IADL) in elderly patients]. / Identificación de ítems para la creación de un cuestionario de valoración de actividades instrumentales de la vida diaria en personas mayores.

OBJECTIVE: To identify items to design a questionnaire to assess IADL in the elderly in the community. DESIGN: Delphi study. LOCATION: Community setting, primary health care. PARTICIPANTS: Fifty seven multidisciplinary experts (family doctors, geriatricians, physiotherapists, social workers, male nurses) who are members of the Spanish Society of Family and Community Medicine or the Spanish Geriatrics and Gerontology Society. METHODS: Three consecutive questions sent via e-mail or fax. First: what items you would take into account in a questionnaire to assess IADL in the elderly? Second: out of the groupings select 10 you consider to be of special relevance? Third: among the 14 more most selected items, select, by scoring from 1 to 10, the ones you consider more important? In the end we obtained the 10 items to include in the questionnaire according to their scores. RESULTS: Thirty experts answered the 3 mailings. The 53 initial proposals were grouped into 24 items. In the end we obtained the following selection (from higher to lower score): dealing with medication, use of the telephone, housework, handling money, walking outside the home, security measures and risk avoidance, shopping, dealing with doors and keys, transport use, and means of social contact. CONCLUSIONS: Only 2 items could have gender influence (in contrast to other questionnaires), as "shopping" does not refer only to the household ones and "housework" also includes activities carried out by males. The most important items are "dealing with medication" (due to the high prevalence of problems and clinical outcomes) and "the use of the telephone" (survival item).

Adherence to treatment in inflammatory bowel disease.

AIM: Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. PATIENTS AND METHODS: We explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests. RESULTS: A 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn s disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03). CONCLUSIONS: Intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.