Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals.

AIM: To comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge. METHODS: Our series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit. RESULTS: After adjusting for several potential confounders, hyperpolypharmacy (OR = 2.20; 95%CI = 1.11-4.37) and Beers violations (OR = 1.99; 95%CI = 1.17-3.49) were significantly associated with functional decline, while STOPP (OR = 1.10; 95%CI = 0.64-1.88) and combined Beers + STOPP violations (OR = 1.72; 95%CI = 0.97-3.05) were not. In logistic regression models simultaneously including both hyperpolypharmacy and PIMs, hyperpolypharmacy was always associated with functional decline (OR = 1.98; 95%CI = 1.0-3.97 in the model including Beers violations; OR = 2.19; 95%CI = 1.11-4.35 in the model including STOPP violations; OR = 2.04; 95%CI = 1.02-4.06 in the model including combined Beers and STOPP violations). Beers violations (OR = 1.89; 95%CI = 1.09-3.28) also remained significantly associated with the outcome in this latter analysis, but not STOPP or combined Beers and STOPP violations. CONCLUSIONS: Hyperpolypharmacy, and to a lesser extent Beers violations predict functional decline in older patients discharged from acute care hospitals, whilst STOPP criteria are no longer associated with the outcome after adjusting for potential confounders. Hyperpolypharmacy is associated with functional decline independent of PIMs.

Hemorroidectomia radical reconstrutiva (HRR): proposta de uma nova tecnica / Radical reconstructive haemorrhoidectomy: with a regard to a nent technique

Os autores, com base na propria experiencia no tratamento cirurgico das lesoes hemorroidarias de grau III, apresentam uma nova tecnica pessoal de hemorroidectomia, derivada em parte da hemorroidectomia reconstrutiva submucosade Parks, e analisam os resultados obtidos. Este estudo foi efetuado no Centro de Cirurgia INCA de Ancona (Italia), e foram tratados com este novo metodo 61 pacientes (76// homens e 33// mulheres), portadores de patologia hemorroidaria Grau III (96//) e Grau II (2//). Cerca de 29// dos pacientes eram portadores de fissura anal cronica, tratados com esfincterotomia lateral interna. Nao foram observadas complicaçoes de tipo maior, apenas um minimo de sangramento pos-operatorio (17//), edema em cerca de 20// e deiscencia parcial da plastica mucocutanea em 7// dos casos. O seguimento de 50 pacientes durante 24 meses demonstrou uma recidiv( 2//) e incontinencia em 22// dos pacientes