Inappropriate prescribing in elderly people with diabetes admitted to hospital.

AIMS: To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS: In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS: Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS: Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.

Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients.

[Internet-based Continuing Medical Education. Presentation of the first experience of the Spanish Society of Internal Medicine]. / Formación médica continuada basada en Internet. Presentación de la primera experiencia de la Sociedad Española de Medicina Interna.

This paper presents the first experience of the Spanish Society of Internal Medicine in the development of an Internet-based Continuing Medical Education program for Society members, accredited by the Health Ministry and the Autonomous University of Barcelona, and funded by the Menarini Group SA. Academic performance and satisfaction of participants in this course have been very satisfactory, both with respect to scientific content and the virtual learning environment. This experience shows that Internet-based continuing medical education is a field with a great future that is well accepted by participating physicians, and that the scientific societies, with the collaboration of other institutions and companies, can lead Internet-based Continuing Medical Education programs especially designed and tailored to their members.

[Nutritional support in the home-based hospitalization setting]. / El soporte nutricional en el ámbito de la hospitalización a domicilio.

UNLABELLED: The Hospital at Home (HAD) is a choice of care that enables own care in a hospital at home patient. Moreover, the nutritional support (NS) -enteral or parenteral nutrition- is usually indicated in patients with serious underlying disease, and/or frequently remain severely disabled. AIMS: To analyze the characteristics of the patients, attended at home for specific questions of the NS that receive. MATERIAL AND METHODS: descriptive and retrospective study of the patients attended by the Nutritional Support Unit (NSU), in the area of the HAD, from September 1, 2006 until August 31, 2007. RESULTS: At home, the realized procedure was: refill of gastrostomia or jejunostomia feeding tube in 158 cases; modification of the guideline of enteral nutrition (EN) or parenteral nutrition (PN) in 53 cases; training of the skill of artificial nutrition in 14 cases. 39 visits were realized by complications -by infection or lead throught the estoma and by obstruction of the feeding tube-. Only in 3 patients (7.7%) the domiciliary assistance indicated the movement of the patient to the Emergency Unit. CONCLUSION: In our center, the infrastructure of the HAD has allowed to give answer to the needs of the patients who receive NS at home in our area of influence.

Peabody Picture Vocabulary Test-III: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Peabody Picture Vocabulary Test-III (PPVT-III) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Honduras, Guatemala, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the PPVT-III as part of a larger neuropsychological battery. PPVT-III scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age in all countries, such that scores increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Paraguay. Models showed that children whose parent(s) had a MLPE >12 years obtained higher scores compared to children whose parent(s) had a MLPE ≤12 years in all countries, except for Cuba, Peru, and Puerto Rico. Sex affected scores for Chile, Ecuador, Guatemala, Mexico, and Spain. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the PPVT-III when used in pediatric populations.

[A superior vena cava syndrome secondary to intracavitary pacemakers. The diagnostic and therapeutic aspects]. / Síndrome de vena cava superior secundario a marcapasos intracavitarios. Aspectos diagnósticos y terapéuticos.

Two cases of superior vena cava syndrome secondary to an endocardial pacemaker are reported. We discuss diagnosis methods and we point out the use of radioisotope cavography in patients with iodate contrast allergy. We suggest early administration of thrombolytic therapy besides of anticoagulants and we review the literature of previous observation of venous occlusion.

[Psychoactive drug use in nursing homes]. / Utilización de fármacos para el sistema nervioso central en residencias geriátricas.

BACKGROUND: Our purpose was to know the use of psychoactive drugs including neuroleptics (NL), benzodiazepines (BNZ) and antidepressants (AD) in nursing homes (NH) in the city of Barcelona. METHOD: Cross-sectional descriptive study of 384 clinical records of people living in 19 NH. The correct use of drugs was estimated by Garrad's and Beers et al criteria. RESULTS: Average age (SD) of residents was 83 years (2.0). The average consumption of drugs was 5 (2.7); 248 individuals (64.6%) were taking at least one psychoactive drug: 81 (21%) consumed NL, 179 (46.6%) BNZ and 73 (19%) AD. 48 (12.5%) NH residents consumed long-acting BNZ and 26 (6.7%) had surpassed the recommended time of consumption for short-acting BNZ. In 21 (26%) NH residents who consumed NL, its use would not be justified. CONCLUSIONS: It is necessary to reduce the use of long-acting BNZ, to encourage a correct use of NL and to achieve a correct identification of depressive disorders in NH.

[Cardiac and hematological involvement in idiopathic hypereosinophilic syndrome. Study of 12 cases]. / Afección cardíaca y hematológica en el síndrome hipereosinofílico idiopático. Estudio de 12 casos.

BACKGROUND: The idiopathic hypereosinophilic syndrome (IHS) is a rare entity of unknown etiology. Hematological and cardiac involvement is predominant. A series of 12 patients with this syndrome, initiated in 1982, is described. METHODS: Cardiological study by repeated echocardiograms and hematological study in peripheral blood and bone marrow upon initiation of the disease were performed. RESULTS: Median follow up was of 48 +/- 31 months. Males predominated (75%) with mean age being 55 +/- 15 years. The principal organs or systems involved were the heart (50%) and the nervous system (41%). Of the 6 cases with cardiac involvement only 2 had clinical manifestations. The remaining 4 patients were diagnosed from echocardiographic changes with the principal alterations observed being: atypical occupation of the ventricles, endocardial thickening and mitral and tricuspid subvalvular cumulus. Echocardiographic follow-up only showed changes in one case. Hematological involvement was characterized by moderate leukocytosis with hypereosinophilia formed by mature eosinophils, conservation of other hematopoietic series, absence of blasts in peripheral blood, finding suggestive of diseosinophilopoiesis and appearance of myelofibrosis and cytogenetic alterations. Survival at four years was 58%. CONCLUSIONS: In the series studied cardiac involvement is frequent, being principally diagnosed in a subclinical phase and with a very slow echocardiographic evolution. At a hematological level changes typical in myelodysplastic syndromes and myeloid leukemia were observed.

[A study of the stability of lipid emulsions in mixtures for peripheral parenteral nutrition]. / Estudio de la estabilidad de emulsiones lipídicas en mezclas para nutrición parenteral por vía periférica.

This study is an attempt to contribute practical information on the stability of the mixtures of parenteral nutrition administered peripherally, using two different brands of lipids and amino acids for peripheral administration, with the addition of polivitamins and calcium. The tests performed included the determination of osmolarity, pH and size of lipidic globule using two methods: Coulter Counter and microscopic interference contrast method. The time factor and conservation temperature were taken into account in the stability of the mixtures.

[Replacement therapy with protein C for meningococcal sepsis and fulminant purpura in pediatric patients]. / Tratamiento sustitutivo con proteína C en sepsis meningocócica y púrpura fulminante en pacientes pediátricos.

Disseminated intravascular coagulation as associated to sepsis contributes to the development of clinical multiple organ failure by extensive thrombosis in microcirculation vessels. This condition commonly manifests itself in severe meningococcal sepsis. On the skin, its clinical manifestation is extensive purpura with necrotic lesions that usually progress to serious distal ischemia and may call for amputation. A common denominator in these events regarding hemostasis is a depletion of so-called natural anticoagulant proteins, particularly protein C. According to clinical observations replacement therapy with human plasma-derived protein C concentrates has been associated with significantly improved clinical outcome in patients with meningococcal sepsis and fulminant purpura. This paper reports a case of acquired protein C deficiency in a girl with meningococcal sepsis, fulminant purpura, disseminated intravascular coagulation, and septic shock. Fresh plasma therapy was intended to increase consumption coagulopathy-depleted coagulation factors and to provide small amounts of protein C. The inability to restore protein C concentrations above 30%, and the presence of severe thrombopenia in the setting of disseminated intravascular coagulation led to the onset of replacement therapy using a human protein C concentrate (Ceprotin), which increased plasma protein C concentrations and contributed to revert the existing hypercoagulability status. Finally, evidence available in the literature regarding fulminant meningococcal sepsis management using human protein C concentrates and recombinant activated protein C is discussed.

[Aspects of pre-operational information of the patient in emergency surgery]. / Aspectos de la información preoperatoria al paciente en la cirugía de urgencia.

BASIS: Under the conditions in which hospital activity is carried out, information can present important shortcomings. The aim of our study is to analyse the perception held by the patients of the information provided before an emergency surgical operation. MATERIAL AND METHODS: The study was carried out by means of a survey to 115 patients (66 men and 49 women) before they received emergency surgery, in the Hospital de Navarra, in the months from March to December, 1999. The sample was selected when the researchers responsible for this work were on duty. The majority of the operations corresponded to general surgery (39.1%) and traumatology (42.6%). The average age was 45.7 years (SD = 21.57, range 15-85 years). RESULTS: The results express the relations and differences between the degree of information requested and the cultural level, age and sex of the patient. Eighty seven per cent of the patients had been informed about the operation they were about to undergo. Seventy eight per cent had not signed their consent for such an operation and the doctors signature appeared in only 6%. Some 8.7% did not feel they had received information from anybody. Seventy three per cent understood the information provided. The information was considered insufficient by 44.6% of the patients. Forty five per cent were able to express their doubts to the informant, and 96.4% of them were satisfied with the clarifications. CONCLUSIONS: The patients considered themselves to be informed about the surgical process, but very few of them about the most relevant sensations they were to experience in post-operation. Information should be supplied that includes both types of content.

Utility of geriatric assessment tools to identify 85-years old subjects with vitamin D deficiency.

OBJECTIVES: To calculate the prevalence of hypovitaminosis D in subjects aged 85 years old and to study the relationship between some common geriatric evaluation scales and vitamin D status. DESIGN: Prospective cohort study. SETTING: A community-based study. PARTICIPANTS: 312 subjects aged 85 years old. MEASUREMENTS: Geriatric assessment was based on comorbidity, functional status according to the Barthel Index (BI) and Lawton Index (LI), cognitive status measured by the Spanish version of the Mini-Mental State Examination (MEC), nutritional risk according to the Mini Nutritional Assessment (MNA), and gait using the Tinetti Gait Scale. Serum 25(OH)D concentrations were used to assess vitamin D status. Hypovitaminosis D was considered as < 25 ng/ml and deficiency < 11 ng/ml. RESULTS: Mean serum 25(OH)D level was 28 ± 30 ng/ml. The prevalence of hypovitaminosis D was 52.5% (38.1% insufficiency and 14.4% deficiency). Men had higher levels than women (32.2 ± 44 vs. 25.2 ± 25 ng/ml; p=0.04). The bivariate analyses identified an association between MNA scores and hypovitaminosis D, and showed that females ande participants with poor BI, Tinetti and MNA scores were associated with deficiency. Logistic regression analysis confirmed a significant association between poor MNA scores and both hypovitaminosis D (p < 0.04, OR 1.066, 95% CI 1.002-1.135) and vitamin D deficiency (p < 0.0001, OR 1.192, 95% CI 1.099-1.293). CONCLUSIONS: More than half the population aged 85 years has a vitamin D deficit and 14.4% show a deficiency. A lower score on the MNA scale is associated with a greater likelihood of having lower vitamin D serum values.