First month prednisone dose predicts prednisone burden during the following 11†months: an observational study from the RELES cohort.

AIM: To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). METHODS: 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the four-level prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI). RESULTS: Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2-12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2-12 doses of >7.5 mg/day, while patients receiving low-dose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change. CONCLUSION: The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months.

Competencia de la enfermera hospitalaria en drogodependencias / Competencies of the hospital nurse on drug dependencies

La drogadicción tiene importantes repercusiones en todos los niveles de la sociedad y, en particular, sobre el sistema sanitario, como consecuencia de las enfermedades y accidentes que producen, siendo elevado el número de personas drogadictas que precisan ingreso hospitalario para su tratamiento. Objetivos: conocer la competencia que tienen los profesionales de Enfermería del hospital para la atención de los pacientes con problemas de drogodependencia. Método: se realizó un estudio descriptivo y prospectivo en el Hospital General Universitario Reina Sofía de Murcia, desde noviembre de 2009 a enero 2010, mediante un cuestionario de elaboración propia que fue administrado al total de enfermeras del hospital. Resultados: se obtuvo una muestra de 120 cuestionarios cumplimentados. Un 59,2% de las enfermeras trata frecuentemente con pacientes drogodependientes. El 65,8% piensa que los prejuicios, la delincuencia, el miedo y las enfermedades asociadas influyen negativamente en la relación terapéutica. Un 38% incluyeron en la valoración enfermera el consumo de sustancias ilegales, registrándolo menos del 25%. Las enfermeras conocen los signos y síntomas de los síndromes de abstinencia yal menos el 50% de los de la abstinencia a benzodiazepinas. El 54% de los enfermeros estudiados tienen formación en drogodependencias, el40% adquirida en cursos de postgrado. Las enfermeras conocen los recursos de los que disponen, aunque solo el 45% sabe sus funciones. Conclusiones: las enfermeras refieren la necesidad de formación específica sobre drogodependencia, ya que ésta no se aborda plenamente en los planes de estudio, lo que podría mejorar su competencia (AU)

Drug addiction has important repercussions at all levels of society and particularly on the healthcare system, as a result of diseases and accidents that it causes, with a high number of drug addicts requiring hospitalization for treatment. Objectives: to determine the competencies of hospital nurses to care for patients with substance abuse problems. Method: a descriptive and prospective study was carried out at the Reina Sofía General teaching Hospital in Murcia, from November 2009 to January2010, using a specifically designed questionnaire that was administered to all the hospital nurses. Results: a sample consisting of 120 completed questionnaires was obtained.59,2% of nurses often care for drug-dependent patients. 65,8%think that prejudice, crime, fear and associated diseases negatively influence the therapeutic relationship. 38% included in the nursing assessment the consumption of illegal substances, registering this fact less than 25% of respondents. Nurses are familiar with the signs and symptoms of withdrawal syndromes and at least 50% of them are familiar with benzodiazepine withdrawal symptoms. 54% of surveyed nurses are trained in drug addiction, 40% of which acquired such knowledge in postgraduate courses. Nurses are familiar with the resources at their disposal, but only 45% is aware of what these resources consist of. Conclusions: nurses report the need for specific training on drug dependencies, as this subject is not fully addressed in the curriculum and its inclusion as part of their core study program could improve nursing competency and knowledge in this area (AU)