Estado nutricional y factores relacionados con la desnutrición en una residencia de ancianos / Nutritional state and desnutrition related factors in a nursing home

OBJETIVO: Las personas de la tercera edad frágiles son un colectivo en riesgo de sufrir desnutrición. El objetivo de este estudio fue describir el estado nutricional de una residencia asistida de 136 plazas y analizar su relación con otras variables. MÉTODOS: Estudio observacional descriptivo transversal sobre una muestra de 113 personas. Se recogieron las variables composición corporal del residente, estado de deterioro cognitivo, nutricional, tipo de desnutrición y alimentación (tipo de dieta, tratamiento nutricional, disfagia, anorexia y dependencia en la alimentación). Se realizaron comparaciones de medias mediante la prueba de la t de Student y comparación de proporciones mediante c2 de Pearson. RESULTADOS: El riesgo de desnutrición encontrada fue del 31% (n = 35); de ellos, el 22% (n = 25) presentaba desnutrición según Gasull. El 92% (104) de los participantes del estudio presentaban algún síntoma o patología y solamente 18 (15,9%) personas no padecían deterioro cognitivo. El 65,5% (74) seguía una dieta basal/diabética y el 35,4% (48) necesitaba ayuda para comer. El deterioro cognitivo moderado-elevado y las dietas terapéuticas obtuvieron mayor proporción de casos de desnutrición según Gasull. CONCLUSIÓN: El estado nutricional de la residencia se puede relacionar con la mayor complejidad que presentan los residentes (alto porcentaje de ellos con deterioro cognitivo moderado y grave y/u otras patologías) y con la calidad en la asistencia. La falta de asociación de desnutrición con el resto de las variables analizadas nos lleva a apoyar la hipótesis de que son múltiples factores los que interfieren en el estado nutricional de los adultos mayores

OBJECTIVE: elderly fragile people are a group at risk for malnutrition. Because of this, the study aimed to describe the nutritional status of an assisted residence of 136 beds and analyze the relationship between malnutrition and other variables. METHODS: descriptive, observational, cross-sectional study on a sample of 113 people. Variables collected were body composition of resident, nutritional and cognitive impairment, type of malnutrition and feeding (type of diet, nutritional therapy, dysphagia, anorexia, and eating dependence). Comparison of means using the Student T test and compared proportions using Chi-square of Pearson were made. RESULTS: The risk of malnutrition found was 31% (n = 35), of them, 22% (n = 25) of total residents were classified as Gasull malnutrition. 92% (104) of the participants of the study showed some symptoms or disease and only 18 (15.9%) were not suffering from cognitive impairment. The 65.5% (74) was at basal/diabetic diet and the 35.4% (48) needed help to eat. Moderate-high cognitive impairment and therapeutic diets showed a positive correlation with malnutrition according to Gasull cases. CONCLUSION: Nutritional state of the residence may be related with greater resident complexity (high percentage of them with moderate and severe cognitive impairment and/or other illnesses) and with the quality of assistance. The lack of association of malnutrition with the rest of the variables analyzed, leads us to support the hypothesis that multiple factors interfere in the nutritional status of elder adults

Puntos clave en la puesta en marcha y desarrollo de un Ensayo Clínico. De la pregunta a la realidad de un Ensayo Clínico investigador iniciado (I) / Key points in the start and conduct of a clinical trial. From question to reality in an investigator-initiated clinical trial (I)

La práctica clínica basada en la evidencia requiere la integración de la experiencia profesional individual con los mejores datos objetivos para tomar la mejor decisión terapéutica. Los datos científicos de mejor grado de evidencia derivan de ensayos clínicos controlados y aleatorizados e investigaciones de vigilancia farmacológica poscomercialización y metaanálisis. En muchas ocasiones durante nuestras actividades clínicas buscamos sin éxito el ensayo clínico que conteste a nuestras preguntas científicas. Es en estos momentos cuando en ocasiones nos planteamos la puesta en marcha de un ensayo clínico. Si usted como investigador clínico tiene una pregunta científica (relevante), que potencialmente requeriría la realización de un Ensayo Clínico para alcanzar una respuesta y carece del respaldo de una Compañía Farmacéutica para llevarlo a cabo, quizá encuentre de utilidad la lectura de este artículo, en el que intentamos presentar de forma breve y clarificadora la normativa regulatoria para planificar un Ensayo Clínico, con la humilde intención de que se convierta en una herramienta útil para cualquier investigador independiente (AU)

Evidence-based clinical practice requires integration of individual professional experience with the best objective data to make the best therapeutic decision. The best degree of scientific evidence derives from controlled, randomized clinical trials and post-marketing drug surveillance studies and meta-analyses. During our clinical activities, we often search unsuccessfully for a clinical trial which answers our scientific questions. It is at those times that we may sometimes consider the conduct of a clinical trial. If you, as a clinical investigator, have a (relevant) scientific question that could potentially require the conduct of a clinical trial to achieve a response and have no support from a pharmaceutical company to perform it, you may find it useful to read this article, in which an attempt has been made to briefly and clearly explain the applicable regulations for planning a clinical trial. Our humble intention is that this publication becomes a useful tool for any independent researche (AU)

TRAMOMTANA (Tratamiento Multidisciplinar de la Obesidad Mórbida: Medicamentos, Terapia de comportamiento, Apoyo Nutricional y Actividad física). De la pregunta a la realidad de un ensayo clínico investigador iniciado (II) / TRAMOMTANA (Multidisciplinary treatment of morbid obesity: Medication, behavioral therapy, nutritional support, and physical activity). From question to reality in an investigator-initiated clinical trial (II)

Comunicamos la puesta en marcha de un programa intensivo y multidisciplinar de pérdida de peso en pacientes con obesidad mórbida (OM). Este ensayo clínico se basa en la educación para la salud, el apoyo en el proceso de cambio, los medicamentos y las sesiones de terapia de grupo. Nuestra intención es demostrar que los resultados obtenidos con este programa de pérdida de peso a 2 años son, cuando menos, comparables a los resultados que se obtienen con la cirugía bariátrica en estos pacientes con OM. Es nuestra intención igualmente (..) (AU)

Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system (AU)

[TRAMOMTANA (Multidisciplinary treatment of morbid obesity: medication, behavioral therapy, nutritional support, and physical activity). From question to reality in an investigator-initiated clinical trial (II)]. / TRAMOMTANA (Tratamiento Multidisciplinar de la Obesidad Mórbida: Medicamentos, Terapia de comportamiento, Apoyo Nutricional y Actividad física). De la pregunta a la realidad de un ensayo clínico investigador iniciado (II).

Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system.

[Key points in the start and conduct of a clinical trial. From question to reality in an investigator-initiated clinical trial (I)]. / Puntos clave en la puesta en marcha y desarrollo de un Ensayo Clínico. De la pregunta a la realidad de un Ensayo Clínico investigador iniciado (I).

Evidence-based clinical practice requires integration of individual professional experience with the best objective data to make the best therapeutic decision. The best degree of scientific evidence derives from controlled, randomized clinical trials and post-marketing drug surveillance studies and meta-analyses. During our clinical activities, we often search unsuccessfully for a clinical trial which answers our scientific questions. It is at those times that we may sometimes consider the conduct of a clinical trial. If you, as a clinical investigator, have a (relevant) scientific question that could potentially require the conduct of a clinical trial to achieve a response and have no support from a pharmaceutical company to perform it, you may find it useful to read this article, in which an attempt has been made to briefly and clearly explain the applicable regulations for planning a clinical trial. Our humble intention is that this publication becomes a useful tool for any independent researcher.

Erlotinib as an alternative treatment for NSCLC. Case Report. / Erlotinib no tratamento de CPNPC em terceira linha linha. Caso clínico.

INTRODUCTION: Erlotinib is an approved treatment for NSCLC locally advanced or with metastases, after failure of initial chemotherapy. The authors present a NSCLC clinical case of great clinical and imaging improvement, with no drug-induced toxicity observed, after treatment with erlotinib. CASE PRESENTATION: A 76-year-old woman, never-smoker, had been diagnosed for lung adenocarcinoma, through thoracoscopy, after presenting a large-volume pleural effusion. At the time of diagnosis it was inoperable (stage IIIB - T4 N1 M0). She was submitted to two consecutive chemotherapy treatments with carboplatin+gemcitabin and pemetrexed, respectively. Due to its failure, with lack of response, erlotinib was set as the alternative choice, with great clinical and imaging improvement after 6 months of treatment. CONCLUSION: The authors recommend, even in the absence of EGFR result, the use of erlotinib when progression of the disease is seen, after initial chemotherapy, especially in lung adenocarcinoma and in never-smokers. Rev Port Pneumol 2008; XIV (Supl 3): S61-S63.