Valoración del dolor en personas con demencia y problemas de comunicación en España. Revisión sistemática / Pain assessment in individuals with dementia and communication problems in Spain. A systematic review

Antecedentes y objetivo: La valoración del dolor en personas con demencia avanzada y problemas de comunicación continúa siendo infradiagnosticada e infratratada debido a la dificultad que conlleva realizar esta valoración. Esta revisión pretende explorar y sintetizar cómo se está valorando el dolor en personas con demencia avanzada y problemas de comunicación en el contexto sanitario español. Materiales y métodos: Revisión sistemática de la literatura siguiendo los criterios PRISMA. Se revisaron las bases de datos Pubmed, Web of Science, Cinahl, Scopus, Dialnet y Cuitatge hasta diciembre de 2017. Cuatro revisores independientes identificaron los estudios que incluían instrumentos para evaluar el dolor en personas con demencia y problemas de comunicación, en el contexto sanitario español. Se realizó una síntesis narrativa de los artículos incluidos. Resultados: Después de aplicar los criterios de inclusión se seleccionaron 10 estudios. De estos 4 fueron estudios metodológicos de validaciones de escalas al español (Abbey, Algoplus, Doloplus y PAINAD-Sp) y uno del desarrollo de la escala original EDAD. Además, se identificaron 3 estudios realizados en España, que utilizaban una traducción de la PAINAD, un estudio que utilizó una traducción al español de la Doloplus2 y una publicación que incluyó el uso en España de una escala no validada para este perfil de pacientes (Pain-VAS). Conclusiones: Actualmente, existen varios instrumentos validados en español para valorar el dolor en personas con demencia avanzada y problemas de comunicación (Abbey, Algoplus, Doloplus y PAINAD-Sp). Aunque aún estos instrumentos no han sido muy utilizados en investigación y las propiedades psicométricas de los mismos pueden mejorar

Background and objective: Pain assessment in individuals with advanced dementia and communication problems continue to be underdiagnosed and undertreated due to the difficulty in performing this assessment. This review explores and synthesises how pain in individuals with advanced dementia and communication problems are being assessed in the context of Spanish healthcare. Materials and methods: A systematic review of the literature was conducted following the PRISMA criteria. We reviewed the databases of PubMed, Web of Science, Cinahl, Scopus, Dialnet and Cuitatge up to December 2017. Four independent reviewers identified studies that included instruments to assess pain in individuals with dementia and communication problems in the Spanish healthcare context. We performed a narrative synthesis of the included articles. Results: After applying the inclusion criteria, 10 studies were included. Of these, 4 were methodological studies validating Spanish versions of scales (Abbey, Algoplus, Doloplus and PAINAD-Sp), and 1 was on the development of the original EDAD scale. We also identified 3 studies conducted in Spain that used a translation of the PAINAD, 1 study that used a Spanish translation of Doloplus2 and 1 publication that included the use in Spain of a scale not validated for this patient profile (Pain-VAS). Conclusions: There are currently several instruments validated in Spanish to assess pain in individuals with advanced dementia and communication problems (Abbey, Algoplus, Doloplus y PAINAD-Sp). However, these instruments have still not been widely used in research, and their psychometric properties could be improved

A hermeneutic phenomenological explorations of living in old age.

Although there have been some studies that explore the meaning of aging and give voice to older people, the impact that the aging experience can have on them justifies continued research in this area. In this study, with a hermeneutic phenomenological design and an interpretation method inspired by the philosophy of Ricoeur, we conducted in-depth interviews with 14 elderly people at a social day center in Rome (Italy). The analysis revealed three central themes associated with the experience of being old: changes and limitations related with being aged, the experience that comes from having lived a long life, and an awareness of death. The findings could help health professionals, families and caregivers to achieve a deeper understanding of what old age entails, and may also serve as a platform for interventions that seek to enable older people to experience aging as a meaningful and positive process.

Gender analysis of moxifloxacin clinical trials.

PURPOSE: To determine the inclusion of women and the sex-stratification of results in moxifloxacin Clinical Trials (CTs), and to establish whether these CTs considered issues that specifically affect women, such as pregnancy and use of hormonal therapies. Previous publications about women's inclusion in CTs have not specifically studied therapeutic drugs. Although this type of drug is taken by men and women at a similar rate, adverse effects occur more frequently in the latter. METHODS: We reviewed 158 published moxifloxacin trials on humans, retrieved from MedLine and the Cochrane Library (1998-2010), to determine whether they complied with the gender recommendations published by U.S. Food and Drug Administration Guideline. RESULTS: Of a total of 80,417 subjects included in the moxifloxacin CTs, only 33.7% were women in phase I, in contrast to phase II, where women accounted for 45%, phase III, where they represented 38.3% and phase IV, where 51.3% were women. About 40.9% (n=52) of trials were stratified by sex and 15.3% (n=13) and 9% (n=7) provided data by sex on efficacy and adverse effects, respectively. We found little information about the influence of issues that specifically affect women. Only 3 of the 59 journals that published the moxifloxacin CTs stated that authors should stratify their results by sex. CONCLUSIONS: Women are under-represented in the published moxifloxacin trials, and this trend is more marked in phase I, as they comprise a higher proportion in the other phases. Data by sex on efficacy and adverse effects are scarce in moxifloxacin trials. These facts, together with the lack of data on women-specific issues, suggest that the therapeutic drug moxifloxacin is only a partially evidence-based medicine.

[The most frequent digestive disorders in the elderly]. / Los trastornos digestivos más frecuentes en las personas ancianas.

Aging is a stage with various changes and physiological modifications. It's a progressive, dynamic and irreversible process. Elderly people are beings fragile, multipathological, and polimedicated. 40 Of the world's population has indigestion. They are the most common digestive disorders: constipation, dysphagia, and dyspepsia, reaching levels of prevalence around the 25, 30 and 25 respectively. The main activity of the nursing professional lies in making a proper assessment of the patient and offer a health education regarding habits hygiene and dietetics, in order to reduce the intake of drugs and increase the quality of life of our elders. We should not forget that the family plays a fundamental role for the treatment of these disorders.

Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia / Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting

Objetivo: Evaluar la efectividad de un protocolo consensuado para la prevención de NVIQ en nuestro centro y la adherencia de las prescripciones al mismo. Método: Estudio observacional prospectivo. Se incluyeron pacientes tratados con quimioterapia (QT) en los que fue posible un seguimiento de 120 horas tras el ciclo. Se evaluó la respuesta al tratamiento, medida como: respuesta completa (RC) (ausencia de náuseas y vómitos, sin necesidad de tratamiento adicional en las 120 posteriores al ciclo), respuesta aguda (RA) (en las primeras 24 horas) y tardía (RT) (entre las 24 y las 120 horas), según si se ajustaban o no al protocolo del hospital. Se realizó un análisis estadístico descriptivo, analizando los diferentes factores riesgo y la adherencia al protocolo del hospital. Resultados: Se incluyeron un total de 167 pacientes en los que se observó una RC en el 71,9% de los casos (88,9% RA y 73,7% RT), con ausencia de vómitos en el 89,8%. El 7,2% de los casos no se ajustaron al protocolo. No se encontraron diferencias en la respuesta al tratamiento entre los pacientes que se ajustaron o no al protocolo (RC, RA o RT) pero si en la aparición de vómitos (8,3% vs 36,4%, p = 0,014). Conclusión: La efectividad de nuestro protocolo es buena especialmente en el control de los vómitos aunque las náuseas en la fase retardada siguen siendo un problema sin resolver. El control de vómitos es peor en los pacientes que no se ajustan al protocolo (AU)

Objective: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. Method: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. Results: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). Conclusion: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol (AU)

[Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting]. / Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia.

OBJECTIVE: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. METHOD: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. RESULTS: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). CONCLUSION: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol.

Caracterización de la educación en el trabajo para el perfil de laboratorio en la carrera de Tecnología de la Salud / Characterization of education at work for the profile of laboratory specialty in Health Technology career

El perfil de Laboratorio Clínico de la carrera de Licenciatura en Tecnología de la Salud se desarrolla en el quinto año en un sistema de rotación por los diferentes servicios de la especialidad, donde la educación en el trabajo es la forma fundamental de aprendizaje. En este estudio se expuso la importancia de la educación en el trabajo, se definieron sus formas y se describieron las variantes del vínculo docente asistencial.

The profile of clinical laboratory specialty in Health Technology is developed in the 5 th year of the career, as part of a system in which students rotate in the different services and education at work is the fundamental way of learning. This study set the importance of education at work, defined its modalities and described the variants of the teaching-medical assistance linking.

Pólipo endometrial metastásico de adenocarcinoma de colon tratado con análogos de la LHRH / Endometrial polyp with metastases from an adenocarcinoma of the colon, treated with LHRH analogs

Se presenta el caso de una paciente diagnosticada de metástasis peritoneales múltiples por adenocarcinoma de colon intervenido 2 años antes, y un pólipo endometrial metastatizado por el mismo tumor. Después de realizarle laparotomía exploradora y legrado diagnóstico, y debido a que el pólipo le provocaba metrorragias anemizantes, se inició tratamiento paliativo con análogos de la LHRH y quimioterapia, con lo que cedió la hemorragia. Casi 3 años después, la paciente continúa con buena calidad de vida. Se destaca la buena respuesta al tratamiento con análogos de la LHRH y a propósito del caso se revisa la bibliografía existente (AU)

Midazolam intranasal y bucal en el tratamiento de las convulsiones agudas / Intranasal and buccal midazolam in the treatment of acute seizures

Objetivo. El diacepam rectal plantea problemas personales y sociales que lo hacen inadecuado para su uso en lugares públicos y por personal no sanitario, en niños y especialmente en adolescentes y adultos. El midazolam intranasal (MIN) y bucal podría ser una opción al diacepam rectal. Se revisa la eficacia y seguridad de estas formas de administración del midazolam que se utilizan ya en algunos países como sedante y como anticonvulsionante, a pesar de que todavía no se han autorizado. Desarrollo. El MIN comenzó a utilizarse como sedante, especialmente en niños, para extracciones dentales, ecocardiografía, endoscopias o cirugía. Tras verificar electroencefalográficamente su eficacia en pacientes con convulsiones, empezó a utilizarse para interrumpir las convulsiones agudas. En tres ensayos aleatorizados, la eficacia del midazolam intranasal y bucal en pacientes hospitalizados fue similar e incluso superior a la del diacepam intravenoso o rectal, con similares rapidez de acción y seguridad; pero no hay estudios en el medio extrahospitalario, y su riesgo de depresión respiratoria puede ser similar al de otras benzodiacepinas. Un problema de utilizar la solución parenteral para la administración intranasal es la irritación que producen su pH ácido y el volumen relativamente alto que se ha de administrar. Estos problemas podrían reducirse con la utilización de aerosoles de una solución de midazolam en ciclodextrina, que consigue una concentración mayor con un pH menos ácido. En los pacientes con secreciones nasales o con movimientos intensos de cabeza puede preferirse la administración bucal. Conclusiones. El midazolam intranasal o bucal puede mejorar el tratamiento de las convulsiones agudas en el medio hospitalario y, especialmente, en el medio extrahospitalario, cuando los pacientes son atendidos por personal no sanitario; pero se requieren ensayos que demuestren su eficacia y seguridad en este medio (AU)

Aims. There are several personal and social problems involved in the administration of rectal diazepam that make it unsuitable for use in public places and by non-medical workers, in children and especially in teenagers and adults. Intranasal and buccal midazolam could be an alternative to rectal diazepam. We review the efficacy and safety of these ways of administering midazolam, which is already used in some countries as a sedative and as an anticonvulsive drug, despite the fact that it has not yet received authorisation. Development. Intranasal midazolam was first used as a sedative in dental extractions, echocardiography, endoscopies or surgery, especially in children. After proving its efficacy electroencephalographically in patients with seizures, it started to be used to interrupt acute seizures. In three randomised trials, the efficacy of intranasal and buccal midazolam in hospitalised patients was similar to, and even higher than, that of intravenous or rectal diazepam, with a similar speed of action and safety; no studies have been conducted, however, in the extra-hospital milieu and its risk of respiratory depression may be like that of other benzodiazepines. One of the problems of using the parenteral solution for intranasal administration is the irritation that is produced by its acidic pH and the relatively large volume that has to be administered. These problems could be reduced by using aerosols containing a solution of midazolam in cyclodextrin, which accomplishes a greater concentration with a pH that is less acidic. Buccal administration can be prefered in patients with nasal secretions or intense movements of the head. Conclusions. Intranasal or buccal midazolam can improve the treatment of acute seizures in the hospital milieu and, more especially, in the extra-hospital milieu when patients are attended by non-medical staff. There is a need, however, for trials that prove its efficacy and safety in this situation (AU)