Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal / Results of a home physical exercise program in patients with kidney disease

INTRODUCCIÓN: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. OBJETIVO: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. MATERIAL Y MÉTODO: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. RESULTADOS: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4±14,9 años. La velocidad de la marcha en 4 metros aumentó en 0,18 m/s (IC95%: 0,08-0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95%: 0,6-2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). CONCLUSIÓN: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5

INTRODUCTION: Scientific evidence is greater on the benefits of physical exercise programs to improve functional capacity and health-related quality of life of patients with chronic kidney disease. However, implementing these programs is not an easy task. OBJECTIVE: To evaluate the effectiveness of a home physical exercise program on hand grip strength, functional capacity and quality of life in patients with advanced chronic kidney disease in stages 4-5. MATERIAL AND METHOD: Prospective experimental study. The patients performed a complete home exercise program of 3 weekly sessions for 12 weeks. The main data analyzed were manual dynamometry, the Short Physical Performance Battery (SPPB) test, and the EuroQoL 5D questionnaire to assess quality of life. RESULTS: Sixty-two patients were included, 34 men and with a mean age of 67.4±14.9 years. The 4-meter gait speed increased by 0.18 m/s (95%CI: 0.08-0.28). The SPPB results increased by 1.4 points (95%CI: 0.6-2.2 points). No significant changes were observed either in manual dynamometry (from 26.1 to 26.4Kg) or in health-related quality of life (from 67.8 to 71.3 points). CONCLUSION: A 12-week home physical exercise program was safe and improved the functional capacity of patients with advanced chronic kidney disease in stages 4-5

Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia / A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine

Objetivo: Localizar de forma efectiva los medicamentos más implicados en interacciones graves,como base para diseñar actividades de mejora en la seguridad de los pacientes en AtenciónPrimaria.Diseño: Estudio transversal de las prescripciones realizadas en OMI-AP, la historia clínica electrónicade Atención Primaria.Emplazamiento: Áreas I, VI, VII y IX de Murcia (723.664 habitantes).Participantes: 362.271 pacientes que disponen de OMI-AP, son mayores de 14 años y estánadscritos a un médico que usa OMI-AP habitualmente.Mediciones principales: Analizamos los fármacos que cada paciente pudiera estar tomando enbusca de interacciones graves. Construimos una escala de peligro para interacción grave (e-PIG)calculando: 1) la probabilidad de que un paciente no seleccionado este tomando un fármacodeterminado, y 2) la probabilidad de que un medicamento produzca una interacción grave. Conello estimamos el riesgo de producir interacción grave para cada medicamento, que se traducea una escala logarítmica de 5 puntos.Resultados: Hallamos 83.138 pacientes (22,9%) en riesgo (toman 2 o más fármacos). Identificamos466.940 prescripciones provenientes de 939 fármacos y 5.597 interacciones graves(prevalencia 5,8%). En ellas hay implicados 167 fármacos, de los que e-PIG identifica 5 (3%)con valor extremo: omeprazol, diazepam, acenocumarol, ibuprofeno y calcio.Conclusiones: e-PIG es una expresión logarítmica del riesgo de que prescribir un determinadomedicamento produzca una interacción grave en un escenario de lugar y tiempo determinados.Su monitorización puede convertirse en un elemento de priorización que facilite el diseño deestrategias de mejora de la seguridad del uso de medicamentos(AU)

Objective: To effectively locate the drugs most implicated in severe interactions as a basis ofdesigning actions to improve patient safety in Primary Care.Design: Cross-sectional study of prescriptions using the Primary Care computerised medicalrecords database (OMI-PC).Setting: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants).Participants: There are 362,271 patients over 14 years-old available in the OMI-PC and areassigned to a doctor who uses the OMI-PC regularly.Main measurements: We analysed the drugs that each patient could be taking, looking forsevere interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1]the probability that a non-selected patient may be taking a particular drug and [2] the probabilitythat a drug may produce a severe interaction. With this, we estimated the risk ofproducing a severe interaction for each drug, which was converted into a 5 point logarithmicscale.Results: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%).In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value:omeprazole, diazepam, acenocoumarol, ibuprofen and calcium.Conclusions: e-PIG is a logarithmic expression of the risk that prescribing a particular drug mayproduce a severe interaction in a determined setting and time. Its monitoring could become aprioritisation element that may assist the design of strategies for improving the safety of theuse of drugs(AU)

A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care.

The authors tested the effectiveness and estimated the cost of several interventions aimed at reducing drug interactions in primary care by designing a 15-month cluster-controlled trial. The trial involved 265 family physicians and their patients who were randomized into 4 groups: control, report (received feedback reports), session (group sessions), and face-to-face (personal interviews). The outcome was the mean of relevant interactions detected on electronic medical records. Cost-effectiveness was defined as the incremental cost to reduce drug interactions by 1%. The authors detected a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up. No improvement was seen in the report group when compared with the control group, whereas progressive improvement in the other groups was noted (P < .001). Incremental cost was higher in the face-to-face group (69.4€ vs 50.7€); cost-effectiveness results were slightly better in the session group (4.2€ vs 4.5€).

[A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine]. / Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia.

OBJECTIVE: To effectively locate the drugs most implicated in severe interactions as a basis of designing actions to improve patient safety in Primary Care. DESIGN: Cross-sectional study of prescriptions using the Primary Care computerised medical records database (OMI-PC). SETTING: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants). PARTICIPANTS: There are 362,271 patients over 14 years-old available in the OMI-PC and are assigned to a doctor who uses the OMI-PC regularly. MAIN MEASUREMENTS: We analysed the drugs that each patient could be taking, looking for severe interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1] the probability that a non-selected patient may be taking a particular drug and [2] the probability that a drug may produce a severe interaction. With this, we estimated the risk of producing a severe interaction for each drug, which was converted into a 5 point logarithmic scale. RESULTS: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified 466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%). In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value: omeprazole, diazepam, acenocoumarol, ibuprofen and calcium. CONCLUSIONS: e-PIG is a logarithmic expression of the risk that prescribing a particular drug may produce a severe interaction in a determined setting and time. Its monitoring could become a prioritisation element that may assist the design of strategies for improving the safety of the use of drugs.

Prevalence and typology of potential drug interactions occurring in primary care patients.

PURPOSE: To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. METHODS: Cross-sectional descriptive study. SETTING: Two areas in Spain comprising 715,661 inhabitants. PATIENTS: 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. RESULTS: On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. CONCLUSIONS: 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.