Adherencia a estatinas y resultados en salud durante un año de seguimiento tras infarto agudo de miocardio con elevación del segmento ST / Statin adherence and health outcomes after st-elevation myocardial infarction: 1-year follow-up study

Antecedentes y objetivos Existe un control deficiente de la dislipemia tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) pese a una tasa de prescripción de estatinas elevada. El objetivo es estimar, tras un primer episodio de IAMCEST tipo 1, la tasa de adherencia a estatinas, los factores que la condicionan y su impacto en la morbimortalidad cardiovascular durante el primer año de evolución. Diseño Estudio observacional y retrospectivo en una cohorte de pacientes ingresados entre 2008 y 2013, con una prescripción de estatina activa durante el primer año de seguimiento. Material y método Determinación de la adherencia mediante la proporción de días cubiertos. Relación entre la adherencia con el resto de variables mediante el análisis de regresión logística binaria, y con la morbimortalidad cardiovascular a través del análisis de incidencia acumulativa. Resultados Se incluyeron 552 pacientes (64,7 ± 13,7 años, 73,9% hombres) de los 613 analizados. Existió una menor adherencia en caso de nacionalidad extranjera, tabaquismo o insuficiencia hepática; fue mayor a partir de 50 años, en los pensionistas, en la dislipemia, obesidad, insuficiencia renal y en caso de adherencia al resto de grupos indicados en prevención secundaria. La adherencia redujo la mortalidad cardiovascular, 1,9% frente a 9,1% (HR = 0,201; IC 95%, 0,075-0,539; p = 0,001), pero no la aparición de un nuevo evento cardiovascular, 5,5% frente a 6,5% (p = 0,834). Conclusiones La adherencia a estatinas durante el primer año tras un IAMCEST es un factor clave en la mortalidad, período en el que es necesaria su evaluación más allá de la prescripción (AU)

Background and objectives There is deficient control of dyslipidaemia after ST-elevation myocardial infarction (STEMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment adherence after a first type 1 STEMI episode, the factors that determine the adherence and its impact on cardiovascular outcomes during the first year of progression. Design We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. Material and methods We determined the adherence using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with adherence. Results The study included 552 patients (64.7 ± 13.7; 73.9% men) of the 613 analysed. There was less adherence among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = .001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = .834). Conclusions Statin adherence during the first year after a STEMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription (AU)

Statin adherence and health outcomes after st-elevation myocardial infarction: 1-year follow-up study.

BACKGROUND AND OBJECTIVES: There is deficient control of dyslipidaemia after ST-elevation myocardial infarction (STEMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment adherence after a first type 1 STEMI episode, the factors that determine the adherence and its impact on cardiovascular outcomes during the first year of progression. DESIGN: We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS: We determined the adherence using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with adherence. RESULTS: The study included 552 patients (64.7 ±â€¯13.7; 73.9% men) of the 613 analysed. There was less adherence among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = .001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = .834). CONCLUSIONS: Statin adherence during the first year after a STEMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.

Treatment compliance to statins and health results during a year of follow-up after acute myocardial infarction with ST-segment elevation. / Adherencia a estatinas y resultados en salud durante un año de seguimiento tras infarto agudo de miocardio con elevación del segmento ST.

BACKGROUND AND OBJECTIVES: There is deficient control of dyslipidaemia after an acute myocardial infarction with ST-segment elevation (STEAMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment compliance after a first episode of type 1 STEAMI, the factors that determine the compliance and its impact on cardiovascular morbidity and mortality during the first year of progression. DESIGN: We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS: We determined the compliance using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. The relationship with cardiovascular morbidity and mortality was determined with a cumulative incidence analysis. RESULTS: The study included 552 patients (64.7 ± 13.7; 73.9% men) of the 613 analysed. There was less compliance among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = 0.001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = 0.834). CONCLUSIONS: Statin treatment compliance during the first year after a STEAMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.

Trail Making Test: Normative data for the Latin American Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Trail Making Test (TMT) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 3,337 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TMT as part of a larger neuropsychological battery. The TMT-A and TMT-B 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 on both scores, such that as children needed less time to complete the test while they become older. TMT-A scores were affected by age2 for all countries except, Cuba, Guatemala, and Puerto. TMT-B scores were affected by age2 for all countries except, Guatemala and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years of education needed less time to complete the test compared to children whose parent(s) had a MLPE ≤12 years for Mexico and Paraguay in TMT-A scores; and Ecuador, Mexico, Paraguay, and Spain for TMT-B scores. Sex affected TMT-A scores for Chile, Cuba, Mexico, and Peru, in that boys needed less time to complete the test than girls. Sex did not affect TMT-B scores. 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 approach to interpret the TMT in pediatric populations.

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.

Shortened Version of the Token Test: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Shortened Version of the Token Test in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Shortened Version of the Token Test as part of a larger neuropsychological battery. Shortened Version of the Token Test total 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 score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Puerto Rico. Models showed that children whose parent(s) had a MLPE >12 years obtained higher score compared to children whose parents had a MLPE ≤12 years in Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Puerto Rico, and Spain. The child's sex did not have an effect in the Shortened Version of the Token Test total score for any of the countries. 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 Shortened Version of the Token Test when used in pediatric populations.

Stroop Color-Word Interference Test: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Stroop Word-Color Interference test in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Stroop Word-Color Interference test as part of a larger neuropsychological battery. The Stroop Word, Stroop Color, Stroop Word-Color, and Stroop Interference 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 on all scores, except on Stroop Interference for Guatemala, such that scores increased linearly as a function of age. Age2 affected Stroop Word scores for all countries, Stroop Color scores for Ecuador, Mexico, Peru, and Spain; Stroop Word-Color scores for Ecuador, Mexico, and Paraguay; and Stroop Interference scores for Cuba, Guatemala, and Spain. MLPE affected Stroop Word scores for Chile, Mexico, and Puerto Rico; Stroop Color scores for Mexico, Puerto Rico, and Spain; Stroop Word-Color scores for Ecuador, Guatemala, Mexico, Puerto Rico and Spain; and Stroop-Interference scores for Ecuador, Mexico, and Spain. Sex affected Stroop Word scores for Spain, Stroop Color scores for Mexico, and Stroop Interference for Honduras. 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 approach to interpret the Stroop Word-Color Interference test in pediatric populations.

Monitorización de la concentración libre de ácido valproico en un paciente posquirúrgico septicémico / Monitoring free valproic acid concentrations in a post-surgical patient with sepsis

No disponible

Elementos críticos para la ampliación horaria de un Servicio de Farmacia Hospitalario / Critical elements for the extension of working hours in an in-hospital Pharmacy Department

Introducción: La dispensación individualizada de medicamentos por paciente facilita el cumplimiento de la prescripción validada, aplicar criterios de uso racional, prevenir y resolver los problemas relacionados con los medicamentos. No obstante su complejidad conlleva un riesgo de errores en el diseño y aplicación de procedimientos que obliga a una evaluación y mejora continua de calidad. Objetivo: Analizar los elementos críticos que justifiquen una ampliación horaria de un Servicio de Farmacia hospitalario y demás mejoras del proceso farmacoterapéutico, a través de indicadores de actividad y de calidad asistencial del hospital. Métodos: Se trata de un estudio observacional y analítico en el que se han establecido siete indicadores de actividad y de calidad. Para estos últimos se ha realizado un análisis de causas cuali y cuantitativo. El periodo de estudio fue de abril a junio de 2001.Resultados: La media mensual de ingresos hospitalarios han sido de 641ñ50, de éstos, el 40 por ciento son de tarde-noche y se han realizado 559ñ197 intervenciones quirúrgicas programadas. Se han procesado 1.499ñ158 prescripciones mensuales que han supuesto 36.790ñ733 dosis. El 18 por ciento de las prescripciones diarias se han recibido entre 14-15h y el 21 por ciento han presentado un desfase de 24h con respecto a la fecha de prescripción. Durante la tarde-noche, el supervisor de guardia ha visitado farmacia 4 veces al día para dispensar 10 medicamentos correspondientes a 4 pacientes, produciéndose el 47,7 por ciento de los casos entre 15-21h y siendo los ingresos de pacientes y los errores de dispensación de farmacia los principales motivos de las visitas. Conclusiones: La ampliación del horario de un Servicio de Farmacia mejoraría la atención farmacoterapéutica del paciente, pero ha de ir acompañada de mejoras integrales en los procedimientos de trabajo del médico y enfermería de sala y farmacia (AU)

[Critical elements for the extension of working hours in an in-hospital Pharmacy Department] / Elementos críticos para la ampliación horaria de un Servicio de Farmacia Hospitalaria.

INTRODUCTION: Individualised drug dispensation facilitates compliance with validated prescriptions, the application of criteria for rational use, the prevention and solution of drug-related problems. However, its complexity entails a risk for errors in procedure design and implementation, which renders quality assessment and continual improvement mandatory. OBJECTIVE: To analyse critical elements justifying the extension of working hours in an in-hospital Pharmacy Department, and other improvements within the pharmaco-therapeutic process through activity and hospital care quality indicators. METHODS: This is an observational, analytic study wherein seven activity and quality indicators were established. Regarding the latter, a qualitative and quantitative cause analysis was performed. The study period was from April to June 2001. RESULTS: Monthly average of hospital admissions was 641+/-50; of these, 40% take place during the evening-night hours, and 559+/-197 scheduled surgical procedures were performed. A total of 1,499+/-158 monthly prescriptions were processed, representing 36,790+/-733 doses. Eighteen percent of daily prescriptions were received at 14-15 h, and 21% were offset 24 h with respect to prescription date. During the evening-night period the on-call supervisor visited the Pharmacy 4 times a day to dispense 10 drugs corresponding to 4 patients; 47.7% of cases took place at 15-21 h, patient admissions and pharmacy dispensation errors being the main reason for visits. CONCLUSIONS: Extending the hours of operation in a Pharmacy Department would improve pharmaco-therapeutic patient care, but this should be associated with an integral improvement of doctor and both ward and pharmacy nursing staff work procedures.