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1.
Cir. Esp. (Ed. impr.) ; 97(9): 480-488, nov. 2019. graf, ilus
Artículo en Español | IBECS | ID: ibc-187624

RESUMEN

La cirugía de los sarcomas retroperitoneales debe ser compartimental «en bloque», lo que implica la resección de órganos adyacentes al tumor. Su empleo «de entrada» permite un elevado porcentaje de resecciones con márgenes negativos, lo que supone un mejor control local y mayor supervivencia en muchos pacientes. La preservación de órganos debe hacerse de forma personalizada, especialmente en la pelvis, y adaptarla a la agresividad histológica del tumor. La biopsia preoperatoria permite establecer el subtipo de sarcoma y una adecuada estrategia perioperatoria. Estos pacientes deben ser manejados por cirujanos expertos en centros de referencia, con unidades multidisciplinarias y comités oncológicos. El uso de quimioterapia y radioterapia aún no está bien definido, por lo que solo se recomienda en centros de referencia con ensayos clínicos. En la actualidad esta es la única opción para ofrecer las mejores tasas de morbimortalidad, y las posibles mejoras en la supervivencia de estos pacientes


Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients


Asunto(s)
Humanos , Neoplasias Pélvicas/terapia , Neoplasias Retroperitoneales/terapia , Sarcoma/cirugía , Biopsia , Quimioterapia/métodos , Quimioterapia/normas , Márgenes de Escisión , Recurrencia Local de Neoplasia/cirugía , Neoplasias Pélvicas/epidemiología , Neoplasias Pélvicas/patología , Periodo Preoperatorio , Pronóstico , Radioterapia/métodos , Radioterapia/normas , Neoplasias Retroperitoneales/epidemiología , Neoplasias Retroperitoneales/patología , Sarcoma/mortalidad , Cirujanos , Tasa de Supervivencia
2.
Drugs Aging ; 36(10): 969-978, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31435913

RESUMEN

BACKGROUND: To improve drug treatment in older people, who often present with multimorbidity and related polypharmacy, the FORTA (Fit fOR The Aged) List was developed via a Delphi consensus procedure. As a patient-in-focus listing approach (PILA), it has been clinically validated (VALFORTA trial). Unlike drug-oriented listing approaches (DOLAs), its application requires knowledge of patients' characteristics, including diagnoses and other details. As a drug list with discrete labels, application of FORTA seems particularly amenable to electronic support. METHODS: An information technology (IT) algorithm was developed to analyze bulk data on International Classification of Diseases (ICD)-coded diseases and Anatomical Therapeutic Chemical (ATC)-coded drugs. FORTA-labeled diagnoses and drugs were used to compute the FORTA score, an automatically generated score that describes medication quality by adding up points assigned for errors related to over- and under-treatment. The algorithm detects mismatches between diagnoses and drugs, suboptimal drugs, omitted drugs, and deficient medication escalation schemes. The read-out produces explanations for each error point. RESULTS: A total of 5603 and 7954 patients ≥ 65 years were included from two claims datasets (> 30,000 patients each, public health insurance). The FORTA scores were comparable (mean ± standard deviation 4.29 ± 3.37 vs. 4.17 ± 3.16), and similar to that determined in VALFORTA (pre-intervention 3.5 ± 2.7). Under-treatment was two times more prevalent than over-treatment. The main areas of under-treatment were pain, type 2 diabetes mellitus, and depression, and the main areas of over-treatment were gastrointestinal (proton pump inhibitors), pain (non-steroidal anti-inflammatory drugs), and arterial hypertension (ß-blockers). The FORTA score is positively correlated with higher age, a higher Charlson Comorbidity Index, and more frequent hospitalizations. Patients in disease management programs run by public health insurers had higher scores than comparators. CONCLUSIONS: The algorithm produces plausible analyses of medication errors in older people, pointing to established areas of therapeutic deficiencies. Though individual recommendations exist, the algorithm cannot employ the full potential of FORTA as important details (e.g., blood pressure values, pain intensity) are not (yet) included. However, it seems capable of detecting medication problems in large cohorts-FORTA-EPI (Epidemiological) is designed to support epidemiological analyses, e.g., on comparisons of large cohorts, interventional impact, or longitudinal trends.


Asunto(s)
Algoritmos , Quimioterapia/normas , Errores de Medicación/estadística & datos numéricos , Polifarmacia , Factores de Edad , Anciano , Anciano de 80 o más Años , Consenso , Técnica Delfos , Métodos Epidemiológicos , Femenino , Humanos , Prescripción Inadecuada/prevención & control , Masculino , Errores de Medicación/prevención & control
3.
Med Hypotheses ; 129: 109258, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31371075

RESUMEN

AIM: The Gregorian calendar divides a common year into 12 months of irregular length. As a result, whenever time is measured in months, an unavoidable degree of inaccuracy exists. We hypothesize that the use of this unprecise measure of time has profound implications for the field of pharmacotherapy from practical and drug safety issues, to variations in drug budgets, and pharmacoepidemiological, industrial and drug regulatory considerations, such as price-fixing policies. In this paper, we have tried to gather evidence in favor of our hypothesis, focusing on the particular case of antipsychotics. METHODS: First, we examined all monthly prescriptions of long acting injectable aripiprazole or paliperidone in the Basque Country from January 1st to December 31st, 2017. Second, we investigated how the WHO Collaborating Centre for Drug Statistics defines the defined daily dose (DDD) for these drugs. Third, we analyzed the pack size of oral solid formulations of antipsychotics on the market in Spain. Finally, we explored how evidence from clinical trials is transferred to clinical practice and how it may affect drug fixing-policies. RESULTS: We found that "monthly" and "every 4 week" injections were prescribed for approximately half of patients. We estimated that an extra cost of almost half a million euros (€495,420) would have been incurred if all prescriptions had been every 4 weeks. We also found that 21 additional adverse site reactions per year could be expected for aripiprazole. Besides, the WHO Collaborating Centre for Drug Statistics calculates the defined daily dose using a 30-day interval for these drugs. In addition, we found that pack sizes for currently available solid oral antipsychotic formulations are inconsistent, with 53% being sold as 28-day multiples and 46% as 30-day multiples. Finally, we found out that although the vast majority of clinical trials are performed in weeks, drug regulatory agencies frequently use the term "month" or "monthly" in the summary of product characteristics of marketed antipsychotics. CONCLUSION: This study shows that the inconsistent definition of month has deep implications on various aspects of pharmacotherapy. Considering all the data given above, we urge drug regulatory agencies to specifically avoid the term "month" in the summary of product characteristics and adopt 4-week intervals instead. We also suggest that the WHO Collaborating Centre for Drug Statistics establishes a new 28-day based DDD for "monthly" antipsychotics. Finally, healthcare providers worldwide should abstain from using "monthly" frequencies in drug prescription software tools.


Asunto(s)
Antipsicóticos/administración & dosificación , Aripiprazol/administración & dosificación , Esquema de Medicación , Quimioterapia/normas , Palmitato de Paliperidona/administración & dosificación , Humanos , Cumplimiento de la Medicación , Modelos Teóricos , Esquizofrenia/tratamiento farmacológico , Programas Informáticos , España , Tiempo
4.
J Pharm Pract ; 32(5): 546-557, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31327285

RESUMEN

PURPOSE: To summarize the top 10 most influential peer-reviewed infectious diseases (ID) pharmacotherapy articles published in the year 2018. SUMMARY: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were thought to have most notably contributed to ID pharmacotherapy in 2018, including those related to human immunodeficiency virus (HIV). A total of 26 articles were nominated: 22 articles pertaining to general ID pharmacotherapy and 4 articles involving HIV/AIDS. To select the most significant articles of 2018, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP) asking members to vote on their top 10 general ID publications and 1 HIV publication. Of the 462 members surveyed, 213 (46%) and 108 (23%) voted for general ID pharmacotherapy- and HIV-related articles, respectively. The top article(s) for both categories are summarized. CONCLUSION: With the increased emphasis on antimicrobial stewardship initiatives and the growing problem of multidrug-resistant (MDR) organisms, the amount of ID literature centered on stewardship, appropriate treatment durations, and newly approved antimicrobial agents continues to expand, making it challenging for clinicians to stay informed on the most relevant publications. This review summarizes significant ID-related publications in 2018 with the goal of aiding clinicians in staying up to date on the most noteworthy publications in ID pharmacotherapy.


Asunto(s)
Antiinfecciosos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Revisión por Pares/normas , Publicaciones Periódicas como Asunto/normas , Enfermedades Transmisibles/epidemiología , Quimioterapia/métodos , Quimioterapia/normas , Humanos , Revisión por Pares/métodos
6.
Eur J Oncol Nurs ; 41: 24-32, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31358254

RESUMEN

PURPOSE: The administration of chemotherapy is a complex task which has many safety issues. Safe administration of chemotherapy by nurses should be evidence-based. The aim of this integrative review was to synthesise the evidence about education and practice requirements for safe administration of chemotherapy by nurses. METHOD: A systematic search of four databases identified 17 studies for inclusion in this review. Key words: Nurse, chemotherapy, cytotoxic drug, administration, safety, education. Data extracted from the studies included author, year, aims, design, sample, outcome measures and findings. After screening the articles, extracting study data and completing a summary table, critical appraisal of the studies was completed using the Mixed Methods Appraisal Tool (MMAT). RESULTS: All the studies focused on strategies to promote patient and nurse safety during nursing administration of chemotherapy. Content analysis identified five themes: governance, process safeguards, communication, interdisciplinary collaboration and education. Key strategies or interventions that increased patient and/or nurse safety identified were standardised computer-generated chemotherapy orders, barcodes, medication safety procedures, education and simulated learning. CONCLUSIONS: This review found low-level evidence exists about the education and safety requirements for nursing administration of chemotherapy. High-level research is needed to assist healthcare services to select evidence-based educational and safety strategies and provide appropriately resourced work environments to support the safe nursing administration of chemotherapy and deliver the best possible patient outcomes.


Asunto(s)
Prestación de Atención de Salud/normas , Quimioterapia/normas , Personal de Enfermería en Hospital/educación , Enfermería Oncológica/educación , Enfermería Oncológica/normas , Seguridad del Paciente/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
BMC Palliat Care ; 18(1): 45, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31159782

RESUMEN

BACKGROUND: This study aimed to analyze the determinants of patients' choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). METHODS: An oncologist explained the palliative chemotherapy and BSC options to 129 patients with incurable cancer during their first consultation. Data on the ECOG PS, treatment decision, OS, and the length of hospitalization were retrospectively collected over 4 years. RESULTS: Patients with an ECOG PS of 0-2 chose palliative chemotherapy more often than those with an ECOG PS of 3-4 (P < 0.01). Patients with ≤70 years chose palliative chemotherapy more often than those with > 70 (P < 0.05). And patients with gastric cancer and colon cancer chose palliative chemotherapy more often than those with CUP (carcinoma of unknown primary) (P < 0.05, P < 0.05 respectively). Factors associated with a significantly poorer OS in an adjusted analysis included the ECOG PS and treatment decision (hazard ratios: 0.18 and 0.43; P < 0.001, P < 0.01 respectively). In patients with an ECOG PS of 0-2, palliative chemotherapy was not associated with a longer OS compared with BSC (median OS: 14.5 vs. 6.8 months, respectively; P = 0.144). In patients with an ECOG PS of 3-4, palliative chemotherapy resulted in a significant survival gain compared to with BSC (median OS: 3.8 vs. 1.4 months, respectively; P < 0.05). Strong positive correlations between OS and the length of hospitalization were observed in patients with an ECOG PS of 3-4 who underwent palliative chemotherapy (r2 = 0.683) and the length of hospitalization was approximately one-third of their OS. CONCLUSIONS: The determinants for treatment choice were age, ECOG PS and type of cancer, not sex difference. Oncologists should explain to patients that OS and the length of hospitalization vary according to the ECOG PS when selecting between palliative chemotherapy and BSC.


Asunto(s)
Tratamiento Conservador/normas , Quimioterapia/normas , Neoplasias Gastrointestinales/mortalidad , Tiempo de Internación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Quimioterapia/métodos , Quimioterapia/estadística & datos numéricos , Femenino , Neoplasias Gastrointestinales/tratamiento farmacológico , Neoplasias Gastrointestinales/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Japón/epidemiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Resultado del Tratamiento
8.
Rev Gaucha Enferm ; 40(spe): e20180347, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31038608

RESUMEN

OBJECTIVE: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. METHOD: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. RESULTS AND DISCUSSION: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. CONCLUSION: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.


Asunto(s)
Prescripciones de Medicamentos , Quimioterapia , Servicios Médicos de Urgencia/organización & administración , Errores de Medicación/prevención & control , Sistemas de Medicación/organización & administración , Seguridad del Paciente , Preparaciones Farmacéuticas/administración & dosificación , Administración de la Seguridad/organización & administración , Adulto , Brasil , Quimioterapia/enfermería , Quimioterapia/normas , Prescripción Electrónica , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/psicología , Asistentes de Enfermería/psicología , Grupo de Enfermería , Investigación Cualitativa , Gestión de Riesgos , Administración de la Seguridad/legislación & jurisprudencia
9.
BMC Palliat Care ; 18(1): 42, 2019 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-31109330

RESUMEN

BACKGROUND: The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. METHODS: We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3-4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. RESULTS: Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1-507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P <  0.001) were significantly associated with 30-day mortality. CONCLUSIONS: Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.


Asunto(s)
Quimioterapia/normas , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Adulto , Anciano , Brasil/epidemiología , Estudios de Cohortes , Quimioterapia/métodos , Quimioterapia/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
10.
Rev Gaucha Enferm ; 40(spe): e20180302, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-30970108

RESUMEN

OBJECTIVE: To demonstrate the role of nurses as project managers in the planning and development phases of an educational game about safe medication management for nursing technicians. METHOD: Case report of the experience in the use of the Agile Scrum Methodology with the objective of creating an educational game in the fortnightly sessions of the participating group, between December 2015 and December 2018, in a university hospital in Curitiba. RESULTS: The nurse's abilities to lead the group using the Scrum Methodology were demonstrated in an effective way, which led to the achievement of the objectives. CONCLUSIONS: By sharing their clinical and educational experience, combining management skills developed throughout their professional practice, the nurse is able to contribute not only with scientific knowledge about patient quality and safety, but also in management of projects and achievement of goals set by the team.


Asunto(s)
Quimioterapia/normas , Educación Continua en Enfermería/métodos , Juegos Experimentales , Rol de la Enfermera , Seguridad del Paciente , Humanos
11.
Int Rev Psychiatry ; 31(4): 332-346, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30870048

RESUMEN

Shared decision-making (SDM) means that clinicians and the patient make decisions about the treatment together. Regarding drug treatment in eating disorders (EDs), such decisions may include psychopharmacological treatment for the ED itself, medications for potential co-morbid psychiatric disorders, pharmacological strategies to alleviate the health consequences of an ED, or 'pro re nata' (PRN) medication which is given in acute care when required. Decisions regarding drug treatment in EDs should be specific in terms of the active pharmacological substance, its dose, its route of administration, and the duration of treatment. Decisions should be made with regard to the specific health risks of patients with EDs and the entire treatment approach, and should take alternative measures, additional therapies, and specific combinations of therapies into account. The differences in the expectations of patients, carers, and clinicians towards drug treatment, the lack of specific suggestions in clinical practice guidelines, and the lack of approved psychopharmacological treatment options make SDM necessary, but also a challenge. However, SDM may be limited due to the patient's impaired insight or limited capacity due to the ED. Thus, the legal framework must be taken into consideration.


Asunto(s)
Anorexia Nerviosa/tratamiento farmacológico , Antipsicóticos/uso terapéutico , Trastorno por Atracón/tratamiento farmacológico , Bulimia Nerviosa/tratamiento farmacológico , Agonistas de Receptores de Cannabinoides/uso terapéutico , Inhibidores de Captación de Dopamina/uso terapéutico , Quimioterapia/normas , Agonistas de Aminoácidos Excitadores/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Inhibidores de la Captación de Serotonina/uso terapéutico , Humanos
12.
Int J Health Care Qual Assur ; 32(1): 59-70, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30859880

RESUMEN

PURPOSE: The purpose of this paper is to develop a chemotherapy scheduling template that accounts for nurse resource availability and patient treatment needs to alleviate the mid-day patient load and provide quality services for patients. DESIGN/METHODOLOGY/APPROACH: Owing to treatment complexity in chemotherapy administration, nurses are required at the beginning, end and during treatment. When nurses are not available to continue treatment, the service is compromised, and the resource constraint is violated, which leads to inevitable delay that risks service quality. Consequently, an optimization method is used to create a scheduling template that minimizes the violation between resource assignment and treatment requirements, while leveling patient load throughout a day. A case study from a typical clinic day is presented to understand current scheduling issues, describe nursing resource constraints, and develop a constraint-based optimization model and leveling algorithm for the final template. FINDINGS: The approach is expected to reduce the variation in the system by 24 percent and result in five fewer chemo chairs used during peak hours. Adjusting staffing levels could further reduce resource constraint violations and more savings on chair occupancy. The actual implementation results indicate a 33 percent reduction on resource constraint violations and positive feedback from nursing staff for workload. RESEARCH LIMITATIONS/IMPLICATIONS: Other delays, including laboratory test, physician visit and treatment assignment, are potential research areas. ORIGINALITY/VALUE: The study demonstrates significant improvement in mid-day patient load and meeting treatment needs using optimization with a unique objective.


Asunto(s)
Quimioterapia/normas , Enfermería Oncológica/organización & administración , Admisión y Programación de Personal/organización & administración , Gestión de la Calidad Total/organización & administración , Carga de Trabajo , Centros Médicos Académicos , Atención Ambulatoria/organización & administración , Quimioterapia/tendencias , Femenino , Humanos , Masculino , Minnesota , Relaciones Enfermero-Paciente , Personal de Enfermería en Hospital/organización & administración , Seguridad del Paciente , Investigación Cualitativa
13.
Rev Bras Enferm ; 72(1): 125-133, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30916277

RESUMEN

OBJECTIVE: To analyze the social representations of chemotherapy and the experiences built by people with cancer. METHOD: Descriptive study with a qualitative approach. Data collection occurred between August and December 2016, through interviews with 29 cancer patients undergoing chemotherapy at an institution in the northern part of Paraná State, and the Thematic-Categorical Content Analysis. RESULTS: Four categories have emerged denoting attitudes, feelings and experiences associated with chemotherapy and the need for reconstruction of daily life, permeated by the distancing of social life and work. At the same time, we note the close ties with friends and family, as well as adaptive strategies, new meanings of experiences lived and life priority setting. FINAL CONSIDERATIONS: Cancer represents an interruption of plans and dreams, modifying everyday tasks and generating new experiences. This process facilitates giving a new meaning to the past and the reconstruction of subjectivity.


Asunto(s)
Quimioterapia/normas , Neoplasias/complicaciones , Adaptación Psicológica , Adulto , Brasil , Quimioterapia/métodos , Quimioterapia/psicología , Femenino , Humanos , Relaciones Interpersonales , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Investigación Cualitativa , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Resultado del Tratamiento
14.
JMIR Mhealth Uhealth ; 7(2): e11094, 2019 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-30714943

RESUMEN

BACKGROUND: Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. OBJECTIVE: This study aimed to determine the feasibility and efficacy of smartphone app-based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. METHODS: A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app-based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. RESULTS: A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks (P<.001), and 448.1 m (SD 50.0) at 12 weeks (P<.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response (P=.07). Role (P=.02), emotional (P<.001), and social functioning (P=.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue (P<.001), anorexia (P=.047), and diarrhea (P=.01) also showed significant improvement. There was significant improvement in depression (P=.048) and anxiety (P=.01), whereas there was no significant change in QoL (P=.06) and severity of pain (P=.24). CONCLUSIONS: Smartphone app-based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy.


Asunto(s)
Neoplasias Pulmonares/rehabilitación , Aplicaciones Móviles/normas , Rehabilitación/métodos , Anciano , Quimioterapia/métodos , Quimioterapia/normas , Femenino , Humanos , Neoplasias Pulmonares/psicología , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/tendencias , Dimensión del Dolor/métodos , Proyectos Piloto , Psicometría/instrumentación , Psicometría/métodos , Calidad de Vida/psicología , Rehabilitación/psicología , República de Corea , Encuestas y Cuestionarios
15.
Rev Gaucha Enferm ; 40(spe): e20180175, 2019 Jan 10.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-30652802

RESUMEN

OBJECTIVE: To describe the construction of the scenarios and the development of the realistic simulation technique in health on safe administration of drugs for nursing professionals. METHOD: Report of experience developed from October 2017 to May 2018 involving the steps of training of the facilitators, construction of the scenarios, development of the realistic simulation with nursing staff of a teaching hospital in the southern region of Brazil. The best simulation practice guidelines used from the International Nursing Association for Clinical Simulation and Learning. RESULTS: Four practice-based scenarios were constructed based on adverse events. The nurses educators trained the facilitators participating in all stages. There was concern about the fidelity of the scenarios, as well as the execution of the briefing and debriefing stages. CONCLUSIONS: The simulation allowed the reflection of the "way of doing" of the teams adjusting the process of preparation and administration of medicines to the institutional recommendations and, thus, promoting the safety of the process.


Asunto(s)
Quimioterapia/normas , Educación en Enfermería/métodos , Seguridad del Paciente , Entrenamiento Simulado/métodos , Entrenamiento Simulado/organización & administración , Humanos
16.
J Pharm Pract ; 32(5): 534-545, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30099951

RESUMEN

PURPOSE: The most significant peer-reviewed articles pertaining to infectious diseases (ID) pharmacotherapy, as selected by panels of ID pharmacists, are summarized. SUMMARY: Members of the Houston Infectious Diseases Network (HIDN) were asked to nominate peer-reviewed articles that they believed most contributed to the practice of ID pharmacotherapy in 2017, including the areas of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). A list of 33 articles related to general ID pharmacotherapy and 4 articles related to HIV/AIDS was compiled. A survey was distributed to members of the Society of Infectious Diseases Pharmacists (SIDP) for the purpose of selecting 10 articles believed to have made the most significant impact on general ID pharmacotherapy and the single significant publication related to HIV/AIDS. Of 524 SIDP members who responded, 221 (42%) and 95 (18%) members voted for general pharmacotherapy- and HIV/AIDS-related articles, respectively. The highest ranked articles are summarized below. CONCLUSION: Remaining informed on the most significant ID-related publications is a challenge when considering the large number of ID-related articles published annually. This review of significant publications in 2017 may aid in that effort.


Asunto(s)
Antiinfecciosos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Revisión por Pares/normas , Publicaciones Periódicas como Asunto/normas , Enfermedades Transmisibles/epidemiología , Quimioterapia/métodos , Quimioterapia/normas , Humanos , Revisión por Pares/métodos
17.
Ann Pharm Fr ; 77(2): 136-145, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30392589

RESUMEN

Our multidisciplinary geriatric mobile unit works in behalf of the frail elderly people, aged at least 75, who are in loss of self-reliance. One of its main aims is so optimize medical prescriptions. The purpose of this study was to show the benefit of geriatrician and pharmacist interventions over the quality of medical prescriptions for the elderly. Medication reconciliation of treatment and reassessment of the appropriateness of the prescriptions was systematically carried out. The problems related to drug therapy have been listed and classified according to the criteria of pharmaceutical interventions defined by the French Society of Clinical Pharmacy (SFPC). Out of 181 patients, 86,2% had potentially an inappropriate or sub-optimal prescription. Finally, 462 optimizations were proposed (2.9±1.9 by patients): 204 withdrawals, 166 additions, 58 dosage adaptations, 21 therapeutic follow-ups and 13 modalities of administration. This reassessment of the prescriptions allowed to develop between our geriatric mobile unit and the liberal professionals a communication focused on the therapeutic optimization and to spread recommendations on the proper use of drugs in the elderly population.


Asunto(s)
Anciano/estadística & datos numéricos , Prescripciones de Medicamentos/normas , Geriatría/organización & administración , Unidades Móviles de Salud/organización & administración , Anciano de 80 o más Años , Quimioterapia/normas , Femenino , Anciano Frágil , Francia , Humanos , Prescripción Inadecuada , Masculino , Conciliación de Medicamentos , Farmacéuticos , Servicio de Farmacia en Hospital
18.
Eur J Clin Pharmacol ; 75(2): 157-170, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30341498

RESUMEN

PURPOSE: To summarize literature specific to therapeutic interchange (TI) focusing on methodological approaches in order to develop a list of steps that healthcare facilities can consult when developing pharmacotherapeutic interchange guidelines (PTIGs) in hospitals and primary care centers. METHODS: A search was conducted in PreMEDLINE, Medline, EMBASE, PsycINFO, and the Cochrane Library up to and including December 2015. PRISMA guidelines were used. The inclusion criteria were articles published on TI: methodology, implementation, guidelines, and position statements of scientific societies. Two authors independently reviewed all articles for eligibility and extracted the data. RESULTS: A total of 102 articles were selected for full-text review; we included three guidelines on how to effect TI, nine position papers of various scientific societies with regard to TI, two articles dealt exclusively about methodology, three articles consisted of recommendations and perspectives on TI, three articles dealt with legal aspects, four articles examined general implementation procedures, two articles were a post-discharge follow-up of patients who had TI, six were surveys referring to TI, and three were articles on the use of TI in ambulatory care The remaining 67 articles focused on therapeutic groups. Study quality was generally low. CONCLUSIONS: This review identified articles on TI as published guidelines, recommendations, and studies on TI carried out in hospital settings. As a result, eight fundamental steps were established for obtaining adequate results in the development of TI programs.


Asunto(s)
Atención Ambulatoria/métodos , Atención Ambulatoria/normas , Quimioterapia/métodos , Quimioterapia/normas , Hospitales/normas , Humanos
19.
Drugs Aging ; 36(3): 269-277, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30578459

RESUMEN

BACKGROUND: The Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labelling of drugs, has been clinically (VALFORTA-trial) validated to improve medication quality and clinical endpoints. OBJECTIVE: The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests. PATIENTS AND METHODS: Data from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53 years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic conditions, and body mass index as well as comparisons between high and low FORTA-score (cut-off 3) patients were performed. RESULTS: The FORTA score was significantly correlated with Instrumental Activities of Daily Living (p < 0.0001), the Tinetti test (p < 0.002), Essen Questionnaire on Age and Sleepiness (p < 0.0001), Mini-Mental State Examination (p < 0.0001), and handgrip strength (p < 0.04) in the univariate analysis, and with Instrumental Activities of Daily Living (p < 0.003), the Tinetti test (p < 0.003), and the Essen Questionnaire on Age and Sleepiness (p < 0.0001) in the multivariate analysis. Effect size was weak for Instrumental Activities of Daily Living (R-squared = 0.12) and the Tinetti test (R-squared = 0.03) and medium for the Essen Questionnaire on Age and Sleepiness (R-squared = 0.22). Significant differences between patients with high and low FORTA scores were found for Instrumental Activities of Daily Living, the Tinetti test, mini-nutritional assessments, Mini-Mental State Examination, Essen Questionnaire on Age and Sleepiness, and the Geriatric Depression Scale. All significant tests revealed that higher FORTA scores (lower medication quality) were associated with less favorable test outcomes. CONCLUSIONS: The FORTA score is associated with relevant aspects of comprehensive geriatric assessment, underlining the importance of medication quality for the functional and cognitive well-being of older patients. TRIAL REGISTRATION NUMBER: DRKS00000531.


Asunto(s)
Cognición/efectos de los fármacos , Evaluación Geriátrica/métodos , Errores de Medicación , Rendimiento Físico Funcional , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Quimioterapia/métodos , Quimioterapia/normas , Femenino , Fuerza de la Mano , Humanos , Masculino , Estudios Prospectivos , Psicometría , Encuestas y Cuestionarios
20.
Eur J Emerg Med ; 26(4): 301-307, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30044240

RESUMEN

OBJECTIVE: During medical emergencies, underweight and obese children are at a higher risk of weight-estimation errors than 'average' children, which may lead to poorer outcomes. In obese children, optimum drug dosing requires a measure of both total body weight (TBW) and ideal body weight (IBW) for appropriate scaling. We evaluated the ability of the Broselow tape, the Mercy method and the PAWPER XL tape to estimate TBW and IBW in obese and underweight children. PARTICIPANTS AND METHODS: Data for children aged 0-18 years were extracted and pooled from three previous weight-estimation studies. The accuracy of estimation of TBW and IBW by each method was evaluated using percentage of estimations within 10% of target weight (PW10) as the primary outcome measure. RESULTS: The Broselow tape estimated TBW poorly in obese and underweight children (PW10: 3.9 and 41.4%), but estimated IBW extremely accurately (PW10: 90.6%). The Mercy method estimated TBW accurately in both obese and underweight children (PW10: 74.3 and 76.3%) but did not predict IBW accurately (PW10: 14.3%). The PAWPER XL tape predicted TBW well (PW10: 73.0% in obese children and 74.9% in underweight children) and predicted IBW extremely accurately (PW10: 100%). CONCLUSION: The Broselow tape predicted IBW, but not TBW, accurately. The Mercy method estimated TBW very accurately, but not IBW. The PAWPER XL tape estimated both TBW and IBW accurately. The PAWPER XL tape should be considered when choosing a weight-estimation strategy for obese and underweight children.


Asunto(s)
Índice de Masa Corporal , Peso Corporal/efectos de los fármacos , Quimioterapia/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Obesidad Pediátrica/diagnóstico , Delgadez/diagnóstico , Adolescente , Factores de Edad , Niño , Preescolar , Estudios Transversales , Quimioterapia/tendencias , Urgencias Médicas , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Peso Corporal Ideal/efectos de los fármacos , Lactante , Recién Nacido , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo
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