Adecuación del tratamiento inhalado en pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica / Suitability of inhaled therapy in patients diagnosed with chronic obstructive pulmonary disease (COPD)

Objetivo: Valorar la adecuación a las guías clínicas (GOLD) del tratamiento por vía inhalada de los pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica (EPOC). Diseño del estudio: Estudio observacional transversal de indicación-prescripción. Emplazamiento: Atención Primaria en la provincia de Orense. Participantes: Todos los casos de EPOC incluidos en el registro de pacientes crónicos de 28 cupos de 9 Centros de Salud de la provincia de Orense. Mediciones principales: Se determinó: edad, sexo, datos espirométricos, adecuación diagnóstica según resultados espirométricos y tratamiento farmacológico por vía inhalada (anticolinérgicos de larga duración, corticoides inhalados, beta-2 de larga duración y beta-2 de corta duración). Resultados: Eran varones 297 (77,7%) casos, con una media de edad de 77,0 (DE 11,0) años. El índice VEF1/CVF estaba registrado en 174 (45,5%) pacientes, siendo menor de 0,7 en 138 casos (36,1%), y figurando el VEF1 en 125 casos (90,6%). Fueron clasificados como Graves o Muy graves 71 pacientes (56,8%). El tratamiento era conforme a las recomendaciones en el 26,4% de los casos. En el 19,2% era incorrecto por defecto y en el 54,4% por exceso de medicación, relacionado fundamentalmente con el uso de corticoides inhalados, que estaban correctamente indicados en el 9% de los casos. No existían diferencias en el uso de fármacos en asociación en función de la gravedad de la EPOC. Conclusiones: En la terapia de la EPOC con fármacos inhalados existe una baja adecuación a los criterios recomendados en las principales guías de práctica clínica, sobre todo en el uso de corticoides (AU)

Objective: To assess the compliance of inhaled therapy in patients diagnosed with chronic obstructive lung disease to clinical guidelines (GOLD) Design: Indication/prescription cross-sectional observational study Location: Primary care in the province of Orense Participants: All cases of COPD included in the register for 28 chronic patients in 9 health centres in the province of Orense. Main Surveyed Data. The following were determined: age, sex, spirometric data, adjustment of diagnosis based on spirometric results, and inhaled drug therapy (long-acting anticholinergics, inhaled corticosteroids, long-acting beta-2 and short-acting beta-2) Results: 297 cases (77.7%) were male, with an average age of 77.0 years. The FEV1/ FVC ratio was registered in 174 (45.5%) patients. It was lower than 0.7 in 138 cases (36.1%) and FEV1 appeared in 125 cases (90.6%). 71 patients (56.8%) were classified as severe or very severe. The treatment was in accordance with recommendations in 26,4% of the cases. In 19.2% it was incorrect by default and in 54.4%, through over-medication, related primarily to the use of inhaled corticosteroids, which were correctly indicated in 9% of cases. There were no differences in the use of associated drugs based on the severity of the COPD. Conclusions: In COPD therapy with inhaled drugs, there is a low level of compliance with criteria recommended in the main clinical practice guidelines, especially regarding the use of corticosteroids (AU)

Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico / Prevalence of neuropsychiatric symptoms and associated factors in institutionalised dementia patients: a multicentre cross-sectional study

Objetivo. El objetivo fue estimar la prevalencia y la gravedad de los síntomas neuropsiquiátricos en los pacientes con demencia ingresados en centros residenciales, evaluando su asociación con ciertos factores que podrían influir en su aparición. Material y métodos. Se realizó un estudio transversal. Se incluyeron todos los ancianos diagnosticados de demencia degenerativa, vascular o mixta, en estadios 4 a 7 de la Global Deterioration Scale de Reisberg (GDS), y residentes en 6 centros residenciales de la provincia de Ourense (España). Se calculó un tamaño de muestra de 120 individuos. La evaluación de los síntomas se realizó utilizando el Neuropsychiatric Inventory-Nursing Home (NPI-NH). La influencia de los factores considerados se analizó mediante el análisis de regresión lineal y logística. Resultados. Fueron incluidos 212 casos con una media de edad de 85,7 (6,7) años. La prevalencia de síntomas neuropsiquiátricos fue 84,4%. El síntoma más común fue la apatía, seguido por la agitación y el delirio; los menos frecuentes fueron la euforia y las alucinaciones. El síntoma que producía más interrupción ocupacional fue la agitación. El análisis multivariante mostró que una mayor puntuación en el NPI-NH estaba asociada con mayor puntuación en la escala GDS y el uso de neurolépticos, inhibidores de la colinesterasa y memantina. Conclusiones. En los pacientes con demencia institucionalizados los síntomas neuropsiquiátricos que presentan prevalencia elevada se asociaban con la gravedad de la demencia GDS, el uso de neurolépticos, inhibidores de la colinesterasa y memantina(AU)

Objective. The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. Material and methods. A cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. Results. A total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. Conclusions. In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine(AU)

[Prevalence of neuropsychiatric symptoms and associated factors in institutionalised dementia patients: A multicentre cross-sectional study]. / Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico.

OBJECTIVE: The aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. MATERIAL AND METHODS: A cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. RESULTS: A total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. CONCLUSIONS: In nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine.

Forma de acceso a los Servicios de Urgencia hospitalarios y pertinencia de la consulta / Means of access to hospital emergency departments and relevance of the consultation

Objetivo. Conocer las diferentes formas de acceso a los Servicios de Urgencia Hospitalarios (SUH), valorar la adecuación de las consultas allí atendidas y analizar la posible asociación entre forma de acceso y adecuación, así como con otros factores relacionados. Diseño. Estudio observacional transversal. Emplazamiento. Servicio de urgencias hospitalario. Participantes. Pacientes que acuden al SUH, espontáneamente o derivados por Servicios de Urgencia Extrahospitalarios (SUE) o médico de atención primaria (MAP). No hubo negativas a contestar. Mediciones principales. Cuestionario elaborado ad hoc con 14 variables: sociodemográficas y otras relacionadas con la forma de remisión y el tipo de consulta en el SUH. La encuesta fue llevada a cabo en el SUH por los investigadores que prestaban la asistencia a la totalidad de los pacientes atendidos por ellos en cada jornada de servicio. Resultados. Fueron analizadas 264 encuestas. El 77,6% (205) de los casos se corresponde con cuadros agudos de inicio y patología de tipo traumatológico. En 74 casos (28,0%) el paciente había consultado previamente a su MAP por este mismo motivo. En los pacientes remitidos por su MAP, en el 68,4% de los casos procedía la consulta en el SUH. En los pacientes que acudían espontáneamente este porcentaje era del 25,7%. No se constataron diferencias en el porcentaje de pacientes en los que no procedía consulta urgente. Los pacientes que acudían espontáneamente al SUH eran más jóvenes (diferencia de medias 9,2 años; IC 95%: 3,4-14,9; p = 0,001) y procedían mayoritariamente del medio urbano (x2 = 9,8; p = 0,002). Conclusiones. La mayoría de los pacientes que demandan atención urgente lo hacen mediante el bypass de los SUE, fenómeno influido por la procedencia urbana, una menor edad y la existencia de ingresos previos. La remisión por SUE o MAP mejora la pertinencia de la consulta en los SUH (AU)

Objective. To determine the different means of access to hospital emergency departments (ED), assess the appropriateness of consultations given there and analyze the possible association between access and appropriateness as well as other related factors. Design. Observational cross-sectional study. Setting. Hospital Emergency Departments. Participants. Patients who go to the ED on their own accord or are referred by Prehospital Emergency Care (PEC) services or a General Practitioner (GP). No-one refused to answer the questionnaire. Measurements. Ad hoc questionnaire with 14 variables: socio-demographic and others related with the means of access and type of consultation in the ED. The survey was conducted in the ED by the researchers who provided care to all patients seen by them on each shift. Results. A total of 264 surveys were analyzed. 77.6% (205) of cases were due to acute episodes of disease onset and trauma related events. At total of 74 (28.0%) patients had previously consulted their GP for the same reason. For 68.4% of the patients referred by their GP and 25% of the patients who came on their own accord the consultation in the ED was appropriate. There were no differences in the percentage of patients whose emergency consultation was not appropriate. Patients who came to ED on their own accord were younger (mean difference 9.2 years, 95% CI: 3.4-14.9, p = 0.001) and mostly came from urban areas (x2 = 9.8, p = 0.002). Conclusions. Most patients requiring emergency care access the ED through the PEC service, this is influenced by the urban origin, younger age and the existence of previous admissions. Referrals by PEC or GP improves the appropriateness of the consultations in the ED (AU)

Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular / Prostate cancer, antiandrogen treatment and cardiovascular risk

Objetivo: Comprobar si las tablas de riesgo cardiovascular (RCV) habitualmente empleadas soncapaces de identificar el incremento de riesgo producido por la terapia de bloqueo androgénico(BA) en los pacientes con cáncer de próstata (CP).Diseño: Estudio de cohortes retrospectivo.Emplazamiento: Centros de salud urbanos y rurales de la provincia de Ourense.Participantes: Pacientes diagnosticados de CP que tenían prescrito tratamiento de BA entre losaños 2007 y 2008.Mediciones principales: Se registró edad, residencia (rural/urbana), estadificación (Gleason),procedimiento diagnóstico y, al comienzo y fin del seguimiento, perfil lipídico, presión arterial,diagnóstico de diabetes mellitus, tabaquismo, uso de fármacos hipotensores e hipolipemiantes,e índices Framingham calibrado y ATP III. Se registraron los eventos cardiovasculares (ECV) alo largo del seguimiento. Cada paciente fue su propio control. Para calcular los índices al finaldel período no se consideró el incremento de edad. Los índices se compararon utilizando la tde Student para muestras apareadas (SPSS 15.0).Resultados: Se incluyeron 209 casos. La media (DE) de edad fue de 73,8 (8,0) años, con un 64,6%de casos urbanos. Los índices al inicio y a los 12 meses de seguimiento fueron: Framingham 9,0(4,6) y 9,2 (4,8) (p = 0,5); ATP III 14,2 (1,7) y 14,2 (1,7) (p = 0,9).Conclusión: Las tablas de RCV no permiten valorar adecuadamente el incremento del riesgoasociado a la terapia de bloqueo androgénico en cáncer de próstata(AU)

Aim: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk causedby androgen deprivation therapy (ADT) in patients with prostate cancer (PCa).Design: Retrospective cohort study.Location: Urban and rural health centres in the province of Ourense.Participants: Patients diagnosed with PCa who had been prescribed treatment for ADT between2007 and 2008.Main measures: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, atthe beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus,smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATPIII indexes, were determined. Cardiovascular events were recorded during the follow-up. Eachpatient was his own control. Increasing age was not used in the calculation of the scores atthe end of the follow up period. The scores were compared using the t-test for paired samples(SPSS 15.0).Results: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6%of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0(4.6) and 9.2 (4.8) (P = 0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P = 0.9).Conclusion: CVR charts do not assess the increased risk associated with androgen deprivationtherapy in prostate cancer(AU)

[Prostate cancer, antiandrogen treatment and cardiovascular risk]. / Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular.

AIM: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk caused by androgen deprivation therapy (ADT) in patients with prostate cancer (PCa). DESIGN: Retrospective cohort study. LOCATION: Urban and rural health centres in the province of Ourense. PARTICIPANTS: Patients diagnosed with PCa who had been prescribed treatment for ADT between 2007 and 2008. MAIN MEASURES: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, at the beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus, smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATP III indexes, were determined. Cardiovascular events were recorded during the follow-up. Each patient was his own control. Increasing age was not used in the calculation of the scores at the end of the follow up period. The scores were compared using the t-test for paired samples (SPSS 15.0). RESULTS: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6% of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0 (4.6) and 9.2 (4.8) (P=0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P=0.9). CONCLUSION: CVR charts do not assess the increased risk associated with androgen deprivation therapy in prostate cancer.