Determination of a cutoff value for medication regimen complexity index to predict polypharmacy in HIV+ older patient.

OBJECTIVE: HIV+ patients have increased their life expectancy with a parallel increase in age-associated co-morbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients. METHODS: A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated. RESULTS: A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressive-psychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity=91.8%). CONCLUSIONS: A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them.

Influence of pharmacist intervention, based on CMO model, to improve activation in HIV patients.

OBJECTIVE: The aim of study was to evaluate the influence of pharmacist intervention based on "CMO model", to improve activation in HIV-patients. METHODS: Longitudinal, prospective, single-center study. Eligible patients were HIV-infected, taking antiretroviral treatment. The collected data included demographic characteristics, clinical and HIV-related and pharmacotherapeutic variables. The primary outcome was the variation of patient activation measured by Spanish adapted patient activation measure questionnaire. This questionnaire assesses people's knowledge, skills and confidence in managing their own health care. The assessment was performed at the beginning and 6 months after the program start, which consisted of individualized interventions planned in the stratification model, a motivational interview and a specific pharmacotherapeutic follow-up. RESULTS: A total of 140 patients were included. The most common regimens prescribed were based on non-nucleoside plus nucleoside reverse transcriptase inhibitor (44.0%) and more than half of the patients had chronic concomitant medication. The patients who achieved the highest activation level increased from 28.1% to 68.3% (p<0.0005). The relationship between this increase in patient activation and the stratification level that occurs in largest increases in patients with a low need level, where it was observed an improvement in the percentage of patients with high activation from 28.3% to 74.3% (p<0.001) after intervention. The percentage of patients with adequate adherence to concomitant treatment increased by 18.4% (p = 0.035). Baseline PAM values showed high activation for 28.6% (40 patients), intermediate for 43.6% (61) and low for 27.9% (39). CONCLUSIONS: CMO model has an important role for patient activation, improving adherence and health outcomes for HIV+ patients.

What have we learned from reporting safety incidents in the Surgical Block?: Cross-sectional descriptive study of two-years of activity of a multidisciplinary analytical group. / ¿Qué hemos aprendido de la notificación de incidentes de seguridad en el Bloque Quirúrgico?: estudio descriptivo transversal de 2 años de actividad de un grupo analizador multidisciplinar.

BACKGROUND AND OBJECTIVES: Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). MATERIAL AND METHOD: Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. RESULTS: Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. CONCLUSIONS: The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels.

[Evolution of the Complexity Index of the antiretroviral therapy in HIV+ patients in a real life clinical practice]. / Evolución del índice de complejidad de la terapia antirretroviral en paciente VIH en una cohorte de práctica clínica real.

OBJECTIVE: HIV infection has been one of the biggest successes in the healthcare world, mainly due to the appearance of antiretroviral treatment (ART). The complexity of this type of treatment has been one of the decisive factors in the follow-up of these patients. METHODS: An analytical, unicentric, retrospective observational study. We included all patients older than 18 years of age who were diagnosed with HIV who received ART in follow-up for the consultation of pharmaceutical pathology care during the year 2015. The evolution of the complexity index of ART over time and its relation with adherence to ART and concomitant treatment. RESULTS: A total of 619 patients were included in the study with a mean age of 47.03 ± 10.18 years. There was a reduction in CI over the years, with a significant decrease in the year 2013 and in 2015. The results obtained after the analysis of the secondary variables showed a significant relation between the adhesion to the ART and the CI of this. Patients have a lower CI (3.5) than non-adherent patients (4.25). (P = 0.003). CONCLUSIONS: The complexity of ART is being reduced mainly by new treatment strategies and the increasing appearance of pharmaceutical coformulations. A reduction in the complexity of ART assumes a better adherence to it.

Influence of adding etravirine on complexity index and patients' perceived complexity.

WHAT IS KNOWN AND OBJECTIVE: Adherence to highly active antiretroviral treatment (HAART) is an important predictive factor of treatment outcome. Medication regimen complexity can be one of the main causes of non-adherence. Thus, treatment simplification is a key strategy in the development of antiretroviral therapy. The aim of this study was to determine the influence of adding etravirine on complexity index and patients' perceived complexity of their treatment regimen. METHODS: We conducted a prospective two-centre observational study. Patients on etravirine-based therapy, for at least 6 months, who came personally to pharmacy departments for a drug refill from February to July 2012 were included. Data were collected for the current etravirine-based HAART and for the previous HAART without etravirine. The main variables were complexity index and patients' perceived complexity. We also evaluated the adherence during the 6 months before and after the introduction of etravirine into HAART. The complexity index was based on a score which takes into account the number of pills per day, the dosing schedule, the dosage form and any specific instructions linked to use of the drug. To evaluate the patients' perceived complexity of their current and previous HAART, patients were asked to assign a mark on a visual analogue scale ranging from 0 (minimum) to 10 (maximum). We assessed the differences in the variables collected between the current and previous antiretroviral therapy. Finally, we carried out a correlation analysis between the complexity index and the patients' perceived complexity. RESULTS AND DISCUSSION: Eighty patients were included. The complexity index was significantly reduced after the addition of etravirine to HAART (P = 0·035). Perceived complexity was also reduced (P = 0·015). After the introduction of the drug, the proportion of adherent patients increased from 65% to 81·3% (P = 0·002). The correlation between the complexity index and the patients' perceived complexity was positive (r = 0·594). The correlation increased (r = 0·696) when the difference between the complexity index before and after the introduction of etravirine in HAART grew. WHAT IS NEW AND CONCLUSION: The addition of etravirine to HAART results in a significant reduction in complexity index and patients' perceived complexity of their therapy. These changes were associated with better adherence to treatment.

Perfil de uso de los diferentes tipos de nutrición artificial en un hospital de agudos y de crónicos / No disponible

Objetivo: Conocer el perfil de uso de nutrición parenteral, enteral y nutrición mixta en un hospital de agudos y otro de crónicos. Diseño Estudio observacional retrospectivo, no aleatorizado. Ámbito Área Sanitaria Sevilla Sur: Hospital de Agudos (H1) y Hospital de Crónicos (H2) de 447 y 84 camas respectivamente. Se analizan todos los episodios de nutriciones artificiales administradas en un periodo de 6 meses. Criterios de exclusión: edad < 18 años, suplementos orales o nutrición periférica. Resultados Se empleó nutrición artificial en 568 episodios; 406 de nutrición enteral, 162 de nutrición parenteral, un 4,95; 3,54 y 1,41% respectivamente del total de ingresos. La nutrición enteral fue más frecuente en el hospital H2 (n=219, 15,5/100 hospitalizaciones) y la nutrición parenteral fue más usada en H1 (n=155, 6,96/100 hospitalizaciones), siendo el servicio mayoritario UCI; 43,8%.Se recurrió al soporte nutricional mixto en 68 pacientes (0,59% del total de ingresos), siendo mayoritario su uso en Cirugía n=32 (p < 0,001). La fórmula dieta enteral más utilizada fue la especial para diabetes; H1 41,2%, H2 46,6%. La mortalidad en pacientes con nutrición enteral fue H1 37%, H2 63%, que se asoció con la edad (OR=1,025; IC 95%: 1,006-1,046; p<0,05), el género masculino (OR=1,612; IC 95%: 1,023-2,540; p<0,05) y estancia en UCI (OR=49,379; IC 95%: 11,971-203,675; p<0,01).Conclusiones La nutrición enteral fue empleada de forma mayoritaria tanto en el hospital de agudos como en el de crónicos. La nutrición parenteral y el soporte nutricional mixto se usaron casi exclusivamente en el hospital de agudos (AU)

Objective: To evaluate the use of parenteral, enteral, and mixed nutrition in one acute and one chronic hospital. Design: Retrospective, non-randomised, observational study. Study sites: South Seville Health Area: Acute Hospital (H1) and Chronic Hospital (H2) with447 and 84 beds, respectively. We analysed all episodes of artificial nutrition administered in a 6-month period. Exclusion criteria included: age <18 years, oral supplements, and peripheral nutrition. Results: Artificial nutrition was used in a total of 568 episodes: 406 were enteral nutrition, 162were parenteral nutrition, constituting 4.95%, 3.54% and 1,41% of all hospitalisations, respectively. Enteral nutrition was more common at H2 hospital (n = 219, 15.5/100 hospitalisations)and parenteral nutrition was more commonly used at H1 (n = 155, 6.96/100 hospitalisations),with the ICU providing the majority of treatments (43.8%).Mixed nutritional support was used in 68 patients (0.59% of all cases), and was most commonlyused in the surgery department (n = 32, P<.001). The most commonly used enteral formula was the special diabetes diet; 41.2% at H1 and 46.6% at H2. Patient mortality with enteral nutrition was 37% at H1, 63% at H2, and was correlated with age (OR = 1.025, 95% CI: 1.006-1.046, P<.05), male sex (OR = 1.612, 95% CI: 1.023-2.540, P<.05), and time in ICU (OR = 49.379,95% CI: 11.971-203.675, P<.01).Conclusions: Enteral nutrition was more frequently used in both the acute and chronic hospitals.Parenteral nutrition and mixed nutritional support were used almost exclusively at the acutehospital (AU)

[Usage profile of different parenteral support options in acute and chronic care facilities]. / Perfil de uso de los diferentes tipos de nutrición artificial en un hospital de agudos y de crónicos.

OBJECTIVE: To evaluate the use of parenteral, enteral, and mixed nutrition in one acute and one chronic hospital. DESIGN: Retrospective, non-randomised, observational study. STUDY SITES: South Seville Health Area: Acute Hospital (H1) and Chronic Hospital (H2) with 447 and 84 beds, respectively. We analysed all episodes of artificial nutrition administered in a 6-month period. Exclusion criteria included: age <18 years, oral supplements, and peripheral nutrition. RESULTS: Artificial nutrition was used in a total of 568 episodes: 406 were enteral nutrition, 162 were parenteral nutrition, constituting 4.95%, 3.54% and 1,41% of all hospitalisations, respectively. Enteral nutrition was more common at H2 hospital (n=219, 15.5/100 hospitalisations) and parenteral nutrition was more commonly used at H1 (n=155, 6.96/100 hospitalisations), with the ICU providing the majority of treatments (43.8%). Mixed nutritional support was used in 68 patients (0.59% of all cases), and was most commonly used in the surgery department (n=32, P<.001). The most commonly used enteral formula was the special diabetes diet; 41.2% at H1 and 46.6% at H2. Patient mortality with enteral nutrition was 37% at H1, 63% at H2, and was correlated with age (OR=1.025, 95% CI: 1.006-1.046, P<.05), male sex (OR=1.612, 95% CI: 1.023-2.540, P<.05), and time in ICU (OR=49.379, 95% CI: 11.971-203.675, P<.01). CONCLUSIONS: Enteral nutrition was more frequently used in both the acute and chronic hospitals. Parenteral nutrition and mixed nutritional support were used almost exclusively at the acute hospital.

Estudio comparativo entre la ecografía y la neuroestimulación en el aprendizaje del bloqueo ciático poplíteo posterior / No disponible

Introducción: La anestesia regional guiada mediante ecografía es un campo en rápido crecimiento y su docencia está siendo objeto de estudio. Este trabajo compara la realización del bloqueociático-poplíteo posterior mediante ecografía (ECO) o neuroestimulación (NE) por médicos especialistas en formación. Material y método: Se realizó un estudio prospectivo aleatorizado, con los pacientes distribuidos en dos grupos: el grupo ECO mediante técnica guiada con ecografía; el grupo NE empleó referencias de anatomía de superficie más neuroestimulación, considerando válida una respuesta muscular entre 0.2-0.5 mA. Las variables registradas fueron: tiempo de ejecución, número de intentos, número de punciones vasculares y de parestesias, así como éxito del bloqueo. Las técnicas fueron realizadas por un único especialista en formación, sin experiencia previa en anestesia regional ni ecografía, bajo la supervisión de un anestesiólogo experto. Resultados: Se obtuvieron 19 casos (ECO: 10; NE: 9). El grupo ECO requirió menos tiempo que el NE (108,5-338,6 sg, IC95%; p < 0,005) y menor número de intentos, 1,6 ± 0,7 para ECO, frente 9,5 ± 3,8 para NE (media ± ds; p < 0,05), obteniendo éxito en primera punción en un 80% para ECO frente a al11,1% para NE (p < 0,05). El grupo ECO asoció una menor incidencia de punciones vasculares y de parestesias. La tasa de éxito de la técnica fue del 100% en el grupo ECO, frente al 67,7% en NE. Conclusiones: Estos resultados sugieren que el empleo de ecografía en el aprendizaje del bloqueo poplíteo posterior por especialistas en formación, pudiera facilitar la ejecución de la técnica, asociar menor morbilidad y proporcionar mayor éxito del bloqueo nervioso periférico (AU)

Background: The ultrasound-guided regional anesthesia is a rapidly growing field and its teaching is being studied. This paper compares the performance of the posterior popliteal sciatic blockadeby ultrasound (ECO) with that of neurostimulation (NS) carried out by specialist doctors in training. Material and method: A prospective randomized trial was conducted with patients divided into two groups: group ECO treated with ultrasound-guided technique, and group NE in which surface anatomy and neurostimulation references were used, considering valid a muscle response between 0.2 and 0.5 mA. The variables recorded were run time, number of attempts, number of vascular punctures and paresthesias, and success of the blockade. The techniques were performed by a single training specialist without prior experience in regional anesthesia and ultrasound, under the supervision of an expert anaesthesiologist. Results: 19 cases were obteined (ECO: 10, NE 9), the ECO required less time than NE (108,5-338,6 sg, 95%, p < 0.005)and fewer attempts, 1.6 ± 0.7 for ECO, versus 9.5 ± 3.8 for NE(mean ± sd, p < 0.05), and success was achieved on first puncture on 80% of attempts in ECO group, versus 11.1% in NE group (p< 0.05). The ECO group associated a lower incidence of vascular puncture and paresthesia. The success rate of the technique was 100% in the ECO group, versus 67,7% in NE group. Conclusions: These results suggest that the use of ultrasound in the posterior popliteal block learning by training specialists could facilitate the implementation of the technique, and provideless morbidity associated with more successful peripheral nerveblock (AU)