Microorganisms and Antibiotic Resistance of Bacterial Keratitis at a Rural County Hospital in Seville.

PURPOSE: To review the incidence, resistance patterns, and management of bacterial keratitis during the past 4 years. METHODS: We retrospectively reviewed the clinical records of microbiological isolates from patients with a clinical diagnosis of bacterial keratitis. RESULTS: A total of 159 patients were analyzed, and 102 microorganisms were isolated from 129 cultures. In these cultures, 23.7% of the microorganisms were gram positive, 60.8% were gram negative, and 15.5% were fungi. Pseudomonas aeruginosa was the most common bacteria (9.2%), followed by Serratia marcescens (4.4%) and Staphylococcus aureus (4%). Resistance to fluoroquinolones and aminoglycosides was found to be 23.1% and 53.1% in gram-positive and 2.8% and 13.9% in gram-negative bacteria, respectively. Resistance to ceftazidime against gram-negative bacteria was 13.9%. No resistance to vancomycin was observed. CONCLUSIONS: A high resistance rate to aminoglycosides and fluoroquinolones was observed in gram-positive bacteria. We concluded that fluoroquinolones or aminoglycosides may not be suitable for initial monotherapy in patients with severe bacterial keratitis.

Association between sleep-disordered breathing and prostate cancer.

BACKGROUND: Sleep-disordered breathing (SDB) has been associated with a greater aggressiveness of melanoma tumors, but the association with other cancers is unknown. This study investigates the relationship between the severity of SDB and the aggressiveness of prostate cancer (PC). METHODS: 165 patients under 66 years consecutively diagnosed with PC in three University Hospitals underwent a home respiratory polygraphy. SDB severity was assessed by means of the apnea-hypopnea index (AHI) as well as several oximetric parameters. The primary marker of the aggressiveness of PC was the Gleason score, while secondary markers included the tumor stage and metastatic spreading. RESULTS: The patients had a median (P 25-75) age of 60 (56-63) years, AHI of 13.3 (5.7-25.8), and 4% oxygen desaturation index of 8.7 (2.9-17.8). The prevalence of an AHI≥5 and AHI≥15 was 78.2% and 46.7%, respectively. The median AHI was similar in patients with Gleason 6 and > 6 [13.7 (5.6-28.7) vs 12.2 (5.7-23.2), p = 0.44], tumor stage I-II and III-IV [13.5 (5.3-26.5) vs 11.7 (7.8-21.1), p = 0.67], and presence or absence of metastasis [14.2 (9.6-31.8) vs 13.3 (5.2-24.6), p = 0.46]. The prevalence of an AHI≥5 and AHI≥15 was similar in patients with Gleason 6 and > 6 (79.2% vs 77.2%; p = 0.85, and 49.3% vs 44.33%; p = 0.53, respectively). These results did not change when different oximetric variables were analyzed instead of the AHI. CONCLUSIONS: Despite the high prevalence of SDB in patients with PC, our results do not support any association between the severity of SDB and PC aggressiveness.

Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos / Delay in the diagnosis and treatment of five types of cancer in two urban health centres

Objetivos: Evaluar los intervalos de diagnóstico (ID) y tratamiento (IT) de los cánceres más prevalentes en pacientes adscritos a 2 centros de salud, y analizar la influencia de factores sociodemográficos, clínicos y de organización del sistema sanitario (SS).DiseñoEstudio observacional de cohortes, retrospectivo y analítico.LocalizaciónAtención primaria. Dos centros de salud urbanos.ParticipantesTrescientos sesenta y cinco pacientes diagnosticados de cáncer colorrectal (CCR), mama, pulmón, próstata o vejiga entre el 1/1/2012 y el 31/12/2017.Medidas principalesSe comparan las medianas de ID e IT y el riesgo (OR) de ID e IT superiores a esas medianas según los factores mencionados. Se analiza la contribución de cada etapa del proceso al ID.ResultadosLa mediana del ID fue 92 días, máxima en cáncer de próstata (395 días) y mínima en pulmón (54 días). Factores relacionados con ID prolongado (OR>92 días) fueron sexo femenino, localización CCR o prostática, estadío localizado, consulta índice en atención primaria (AP) y ruta diagnóstica ambulatoria. Un IT prolongado (OR>56 días) se relacionó con la localización de CCR o prostática y ruta diagnóstica ambulatoria. Componentes del ID con mayor influencia en la demora fueron: intervalo de atención primaria (IAP), demora de atención secundaria (DAS) y demora de la prueba complementaria de atención secundaria (DPCAS). La contribución del IAP fue mayor en pacientes con CCR, pulmón y vejiga.ConclusionesLos ID e IT fueron 92 y 56 días, respectivamente. Los componentes del ID con mayor contribución a la demora fueron IAP, DAS y DPCAS. Aumentar la capacidad diagnóstica en AP y organizar itinerarios específicos de diagnóstico y tratamiento, acortaría dichos intervalos y permitiría una detección más temprana.

Objectives: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors.DesignObservational, retrospective, analytical cohort study.SitePrimary care. Two urban health centres.ParticipantsThree hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017.Main measuresThe medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed.ResultsMedian ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder.ConclusionsID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.

[Delay in the diagnosis and treatment of five types of cancer in two urban health centres]. / Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos.

OBJECTIVES: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors. DESIGN: Observational, retrospective, analytical cohort study. SITE: Primary care. Two urban health centres. PARTICIPANTS: Three hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017. MAIN MEASURES: The medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed. RESULTS: Median ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder. CONCLUSIONS: ID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study / Prevalencia y factores asociados a la polifarmacia en pacientes VIH+ en España. Estudio POINT

PurposeSurvival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population.Material and methodsWe recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs.ResultsOverall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40–54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8–34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2–6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold.ConclusionsPolypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

ObjetivoLa supervivencia de las personas con infección por el VIH ha aumentado notablemente en los últimos años incrementado la edad de estos sujetos. Ello se asocia con una mayor presencia de multimorbilidad y polifarmacia. El objetivo de este estudio es evaluar la prevalencia de la polifarmacia en pacientes VIH+ con tratamiento antirretroviral activo seguidos en las consultas externas de los servicios de farmacia hospitalaria en toda España. Adicionalmente, analizar los factores asociados a polifarmacia y a la complejidad farmacoterapéutica en esta población.Material y métodosEstudio multicéntrico, transversal. Se recogieron variables demográficas, variables relacionadas con el control de la enfermedad como la carga viral y los linfocitos CD4, las comorbilidades, el tratamiento farmacológico completo del paciente y la presencia de interacciones. La polifarmacia se definió como el uso de al menos 6 fármacos incluyendo el TAR. Se definió polifarmacia mayor como la toma de más de 11 fármacos diferentes. Se midió la complejidad farmacoterapéutica por la escala de valoración Medication Regimen Complexity Index (MRCI).ResultadosSe incluyeron 1.225 pacientes. La mediana (RIQ) de edad fue de 49 años (40-54). En total 819 (67,0%) pacientes presentaban al menos una comorbilidad en el momento del estudio, teniendo 2 o más comorbilidades, el 47,0% de los mismos. Un total de 397 (32,4%; IC 95%: 29,8-34,9) pacientes cumplieron los criterios de polifarmacia y 67 (5,5%; IC 95%: 4,2-6,7) los de polifarmacia mayor. Los factores asociados con la polifarmacia fueron: el tratamiento antirretroviral, la presencia de interacciones potenciales, el uso de diferentes tipos de fármacos y el número de comorbilidades. La complejidad farmacoterapéutica se asoció de forma importante con la presencia de polifarmacia, incrementándose su probabilidad de aparición entre 2 y 3 veces por cada incremento en un punto en su escala de valoración.Conclusión

Long-term recurrences and mortality in patients with noncardiac syncope.

INTRODUCTION AND OBJECTIVES: There are no in-depth studies of the long-term outcome of patients with syncope after exclusion of cardiac etiology. We therefore analyzed the long-term outcome of this population. METHODS: For 147 months, we included all patients with syncope referred to our syncope unit after exclusion of a cardiac cause. RESULTS: We included 589 consecutive patients. There were 313 (53.1%) women, and the median age was 52 [34-66] years. Of these, 405 (68.8%) were diagnosed with vasovagal syncope (VVS), 65 (11%) with orthostatic hypotension syncope (OHS), and 119 (20.2%) with syncope of unknown etiology (SUE). During a median follow-up of 52 [28-89] months, 220 (37.4%) had recurrences (21.7% ≥ 2 recurrences), and 39 died (6.6%). Syncope recurred in 41% of patients with VVS, 35.4% with OHS, and 25.2% with SUE (P=.006). In the Cox multivariate analysis, recurrence was correlated with age (P=.002), female sex (P <.0001), and the number of previous episodes (< 5 vs ≥ 5; P <.0001). Death occurred in 15 (3.5%) patients with VVS, 11 (16.9%) with OHS, and 13 (10.9%) with SUE (P=.001). In the multivariate analysis, death was associated with age (P=.0001), diabetes (P=.007), and diagnosis of OHS (P=.026) and SUE (P=.020). CONCLUSIONS: In patients with noncardiac syncope, the recurrence rate after 52 months of follow-up was 37.4% and mortality was 6.6% per year. Recurrence was higher in patients with a neuromedial profile and mortality was higher in patients with a nonneuromedial profile.

Days Needed for the Disappearance of a Cough Due to the Use of an Angiotensin-Converting Enzyme Inhibitor and Identification of Predisposing Factors Associated With Its Appearance in a Clinical Cohort of Hypertensive Patients.

Our main objective was to investigate the numbers of days necessary for the disappearance of the cough caused by an angiotensin-converting enzyme inhibitor (ACEI) subsequent to the discontinuation of treatment, and to identify the associated factors that contribute to the appearance of said cough and angioneurotic edema. We studied 1101 patients with hypertension treated with an ACEI for 15 years. A multivariate analysis of binary logistic regression was performed to identify predisposing cough factors. In the 1101 patients treated with ACEI, 270 were diagnosed as having a cough caused by an ACEI (24.5%). The average numbers of days until the cough disappeared was 6.06 ± 1.58 days. The significant predisposing factors of the cough were female sex (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.31-2.39), previous diagnosis of obstructive sleep apnea (OR, 1.85; 95% CI, 1.31-2.61), and concomitant use of thiazides (OR, 1.50; 95% CI, 1.11-2.04). Statins were shown as a protective factor (OR, 0.69; 95% CI, 0.51-0.93). In the case of angioneurotic edema, 25 patients (2.3%) were diagnosed, without significant determinants. Our analysis showed that the cough disappeared in a period of ≤10 days for 96.7% of patients diagnosed with a cough, subsequent to the discontinuation of ACEI treatment. The risk factors identified for the appearance of a cough include female sex, previous obstructive sleep apnea, and concomitant use of thiazides. The use of statins was found to be a protective factor. The incidence of angioneurotic edema in our cohort is greater than that described in the literature.

Prevalence of polypharmacy and associated factors among patients living with HIV infection in Spain: The POINT study.

PURPOSE: Survival in people living with HIV (PLWH) has increased and thus people are aging with HIV, increasing the frequency of multimorbidity and polypharmacy. This cross-sectional study was conducted to evaluate the prevalence of polypharmacy among PLWH who were on antiretroviral treatment and were followed in an outpatient setting by the pharmacy department of several hospitals across Spain. In addition, we aimed to evaluate factors associated with polypharmacy and treatment complexity among this population. MATERIAL AND METHODS: We recorded information on demographic data, data on disease control including viral load and CD4 count at the time of inclusion, comorbidities, pharmacologic treatment and drugs interactions. Polypharmacy was defined as the use of 6 or more different drugs, including antiretroviral medication; major polypharmacy was defined as the use of ≥11 different drugs. RESULTS: Overall, 1225 PLWH were eligible in the study. The median (IQR) age was 49 (40-54). Comorbidities were present in 819 (67%) PLWH and 571 (47%) had two or more comorbidities. Overall, 397 (32.4%, 95% CI 29.8-34.9) PLWH met the criteria for polypharmacy, and 67 (5.5%, 95% CI, 4.2-6.7) had major polypharmacy. Several factors were associated with polypharmacy such as type of antiretroviral treatment, presence of potential interactions, the use of several types of medications and the number of comorbidities. Treatment complexity was also a factor strongly associated with polypharmacy; for each point increase in the medication regimen complexity index (MRCI), the likelihood of polypharmacy increased 2.3-fold. CONCLUSIONS: Polypharmacy is frequent among PLWH in Spain and contributes to a relevant extent to treatment complexity.

Increased Incidence of Stroke, but Not Coronary Heart Disease, in Elderly Patients With Sleep Apnea.

Background and Purpose- The influence of age on the relationship between obstructive sleep apnea (OSA) and the incidence of hard cardiovascular events remains controversial. We sought to analyze the relationship between OSA and the incidence of stroke and coronary heart disease in a large cohort of elderly patients, as well as to investigate the role of continuous positive airway pressure (CPAP) treatment in these associations. Methods- Post hoc analysis of a prospective observational study of consecutive patients ≥65 years studied for OSA suspicion at 2 Spanish University Hospitals. Patients with an apnea-hypopnea index (AHI) <15 were the reference group. OSA was defined by an AHI ≥15 and classified as untreated (CPAP not prescribed or compliance <4 hours/day), mild-moderate (AHI 15-29), untreated severe (AHI ≥30), and CPAP-treated (AHI ≥15 and CPAP compliance ≥4 hours/day). Results- 859 and 794 elderly patients were included in the stroke and coronary heart disease analyses, respectively. The median (interquartile range) follow-up was 72 (50-88.5) and 71 (51.5-89) months, respectively. Compared with the reference group, the fully adjusted hazard ratios for the incidence of stroke were 3.42 (95% CI, 1.37-8.52), 1.02 (95% CI, 0.41-2.56), and 1.76 (95% CI, 0.62-4.97) for the untreated severe OSA group, CPAP-treated group, and untreated mild-moderate OSA group, respectively. No associations were shown between any of the different OSA groups and coronary heart disease incidence. Conclusions- The incidence of stroke, but not coronary heart disease, is increased in elderly patients with untreated severe OSA. Adequate CPAP treatment may reduce this risk.

Association between sleep-disordered breathing and breast cancer aggressiveness.

BACKGROUND: Sleep-disordered breathing (SDB) has been associated with cancer aggressiveness, but studies focused on specific tumors are lacking. In this pilot study we investigated whether SDB is associated with breast cancer (BC) aggressiveness. METHODS: 83 consecutive women <65 years diagnosed with primary BC underwent a home respiratory polygraphy. Markers of SDB severity included the apnea-hypopnea index (AHI) and the 4% oxygen desaturation index (ODI4). The Ki67 proliferation index, lack of hormone receptors (HR-), Nottingham Histological Grade (NHG), and tumor stage were used as markers of BC aggressiveness. The association between SDB and molecular subtypes of BC was also assessed. RESULTS: The mean (SD) age was 48.8 (8.8) years and body mass index was 27.4 (5.4) Kg/m2. 42 women (50.6%) were post-menopausal. The median (IQR) AHI was 5.1 (2-9.4), and ODI4 was 1.5 (0.5-5.8). The median (IQR) AHI did not differ between the groups with Ki67>28% and Ki67<29% [5.1 (2.6-8.3) vs 5.0 (1.5-10), p = 0.89)], HR- and HR+ [5.7 (1.6-12.4) vs 4.9 (2-9.4), p = 0.68], NHG (Grade3, Grade2, and Grade1; p = 0.86), tumor stage (stage III-IV, stage II, and stage I; p = 0.62), or molecular subtypes (Luminal A, Luminal B, HER2, and triple negative; p = 0.90). The prevalence of an AHI≥5 did not differ between the groups with Ki67>28% and Ki67<29% (51.2% vs 52.3%, p = 0.90), HR- and HR+ (58.3% vs 49.1%, p = 0.47), NHG categories (p = 0.89), different tumor stages (p = 0.71), or molecular subtypes (p = 0.73). These results did not change when the ODI4 was used instead of the AHI. CONCLUSION: Our results do not support an association between the presence or severity of SDB and BC aggressiveness.

Predictors of primary non-adherence to concomitant chronic treatment in HIV-infected patients with antiretroviral therapy.

OBJECTIVES: To identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases. METHODS: We conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication. RESULTS: Out of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001). CONCLUSION: One-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.

Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment.

OBJECTIVES: To develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment. METHODS: We conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index. RESULTS: 442 patients were included in the study. The variables 'CD4 count <200 (cells/µL)', 'drug/alcohol use', 'detectable viral load (>50 copies/mL)', 'number of previous admissions', and 'number of drugs different from antiretroviral treatment' were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively. CONCLUSIONS: The model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B.

BACKGROUND: There are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate. OBJECTIVE: To determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence. METHODS: We conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1-48, weeks 48-96, and weeks 96-144); and a Kaplan-Meier analysis to evaluate the evolution of persistence. RESULTS: A total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (p<0.005). Entecavir had the best profile of persistence, followed by tenofovir. CONCLUSIONS: This study showed that high genetic barrier drugs had a better profile of persistence in the initial treatment of patients with CHB. Data seem to suggest entecavir may offer better persistence rates than tenofovir, and the persistence rates for all five medications dropped in weeks 48-96.

Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria / Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma “excelente” a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria (AU)

Object: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. Methods: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. Results: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered “excelent” in all items of questionnaire in both phases. The Cronbach’s alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. Conclusions: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy (AU)

[Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation]. / Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria.

OBJECT: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. METHODS: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. RESULTS: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered "excelent" in all items of questionnaire in both phases. The Cronbach's alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. CONCLUSIONS: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy.

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma "excelente" a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria.

Concurrent use of comedications reduces adherence to antiretroviral therapy among HIV-infected patients.

BACKGROUND: The use of highly active antiretroviral therapy has significantly reduced morbidity and mortality, thus increasing life expectancy of human immunodeficiency virus (HIV)-infected individuals, transforming HIV into a chronic disease. Accordingly, there has been an increase in the number of comorbidities concomitantly present in these individuals and also an increased use of comedications, which may negatively impact antiretroviral therapy adherence. These factors can affect adherence to antiretroviral therapy. The role of the HIV clinical pharmacist is essential to achieve therapeutic objectives and enhance adherence. OBJECTIVE: To determine the influence of the comorbidities and comedications on antiretroviral therapy adherence among HIV-infected patients receiving services from a clinical pharmacist. METHODS: We conducted a prospective observational study that included HIV-infected outpatients who attended the pharmaceutical care office of a hospital pharmacy service, which initiated antiretroviral treatment between January 2002, and December 2011. The variables analyzed in the study were demographics (sex and age), HIV transmission mode, and the following variables at the time of comedication collection: hepatitis C virus or hepatitis B virus coinfection, HIV plasma viral load (copies/mL) and CD4+ T-cell count (cells/µL), Centers for Disease Control and Prevention HIV classification, number of hospital admissions and emergency room visits, and antiretroviral therapy-related features (type at baseline, treatment-naïve status, and number of changes since starting antiretroviral therapy). For follow-up at 12 months, antiretroviral therapy adherence was measured through pharmacy dispensing records and the Morisky Medication Adherence Scale (MMAS). Patients were considered adherent if antiretroviral therapy adherence through dispensing records was greater than 90%, and the MMAS score was 4. Other variables were number of comorbidities and number of comedications for other chronic diseases (non-HIV drugs). According to the number of comorbidities, patients were categorized as having multiple chronic conditions (polypathology) if they had 2 or more chronic diseases. Polypharmacy was defined specifically as the use of 5 or more prescription medications in a medication regimen. In addition, a complexity therapeutic index of antiretroviral therapy was calculated for each patient. We determined the risk of drug-related problems using the tool Predictor Index. To identify independent predictors of adherence to antiretroviral therapy, we performed a univariate logistic regression. Afterward, those variables that showed statistical significance in the univariate analysis and those with P less than 0.25 were included in a multivariate model. The sample size was estimated by the Freeman equation. RESULTS: We included 594 patients in the study (80.1% men, median age 47 years). In the univariate analysis, the variables that showed statistically significant relationships with antiretroviral therapy adherence were HIV transmission mode, detectable viral load, CD4+ T-cell count, AIDS-defining condition, hospital admission, antiretroviral therapy-naïve treatment, type of antiretroviral therapy, high risk of drug-related problems, polypathology, and polypharmacy. Multivariate analysis showed that independent predictors of nonadherence to antiretroviral therapy were HIV transmission by intravenous drug use (OR = 0.56, 95% CI = 0.35-0.90), previous treatment with antiretroviral therapy (OR = 0.09, CI = 0.04-0.24), nontreatment changes (OR = 0.12, CI = 0.05-0.31), high risk of drug-related problems (OR = 0.38, CI = 0.23-0.63), and polypharmacy (OR = 0.36, CI = 0.21-0.61). The value of the Hosmer and Lemeshow test confirmed the validity of this model (P = 0.378). CONCLUSIONS: Recently, the number of HIV-infected patients with polypharmacy has been higher, increasing the risk of nonadherence. Furthermore, previous treatment with antiretroviral therapy, HIV transmission by intravenous drug use, and high risk of drug-related problems are also associated with lower adherence.

Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women.

RATIONALE: It is unknown whether obstructive sleep apnea (OSA) may be a risk factor for incident cardiovascular events in women. OBJECTIVES: We sought to investigate whether OSA increases the incidence of a composite of stroke or coronary heart disease (CHD) in women, and the role of continuous positive airway pressure (CPAP) treatment on this association. METHODS: This was a prospective, observational study conducted in two Spanish teaching hospitals between 1998 and 2007. Consecutive women referred for suspected OSA and free of previous stroke and CHD were analyzed. Women with an apnea-hypopnea index (AHI) less than 10 comprised the control group, and those with an AHI greater than or equal to 10 were diagnosed with OSA and classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). The follow-up ended in December 2010. MEASUREMENTS AND MAIN RESULTS: A total of 967 women were studied (median follow-up, 6.8 yr; interquartile range, 5.2-8.2). The untreated OSA group showed a greater incidence rate of the composite outcome than the control group (2.19 vs. 0.54 per 100 person-years; P < 0.0005). Compared with the control group, the fully adjusted hazard ratios for the composite outcome incidence were 2.76 (95% confidence interval [CI], 1.35-5.62) for the untreated OSA group, and 0.91 (95% CI, 0.43-1.95) for the CPAP-treated group. When the type of cardiovascular event was separately assessed, untreated OSA showed a stronger association with incident stroke (adjusted hazard ratio, 6.44; 95% CI, 1.46-28.3) than with CHD (adjusted hazard ratio, 1.77; 95% CI, 0.76-4.09). CONCLUSIONS: In women, untreated OSA is associated with increased incidence of serious cardiovascular outcomes, particularly incident stroke. Adequate CPAP treatment seems to reduce this risk.

Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA), but compliance and variables involved in long-term CPAP adherence in females with OSA are unknown. We performed an observational study including all consecutive females diagnosed with CPAP who started CPAP treatment in two Spanish teaching hospitals between 1999 and 2007 and were followed-up until December 2010. The Kaplan-Meier method was used to calculate the probability of continuing with CPAP treatment and a multivariate Cox regression analysis was used to identify baseline predictors of CPAP dropout. We analysed 708 females, median (interquartile range) age 60 (52-67) years and apnoea-hypopnoea index 43.0 (27.2-66.8). Females were followed for a median of 6.2 (4.2-7.7) years. The probability of still being on CPAP at 5 and 10 years was 82.8% and 79.9%, respectively. The median CPAP use was 6 (interquartile range 4-7) h · day(-1). In the multivariate analysis, independent baseline predictors of CPAP dropout were psychoactive medication (hazard ratio 1.47, 95% CI 1.03-2.08), age (hazard ratio 1.01, 95% CI 1.00-1.03) and CPAP pressure (hazard ratio 0.89, 95% CI 0.81-0.96). Long-term CPAP adherence in females with OSA is good. Psychoactive medication and increasing age were independent predictors of CPAP dropout, whereas higher CPAP was associated with continued treatment.