Functional Status of Patients over 65 Years Old Intervened on for a Hip Fracture One Year after the Operation.

OBJECTIVES: Evaluation of the functional status one year after a hip fracture surgery and the influence of sarcopenia and other clinical factors at the time of admission. METHOD: Prospective observational study with 135 patients over 65 years of age. Functional status of basic (modified Katz) and instrumental activities (Lawton and Brody) and walking ability (Functional Ambulation Classification, FAC) was measured on admission, at discharge, and telephonically one year later. The risk or positive screening of sarcopenia (SARC-F) and cognitive status (Pfeiffer), as well as clinical variables, were evaluated. RESULTS: 72% of patients are women; 36% have a risk of sarcopenia (Sarc-F ≥ 4), and 43% have moderate-severe cognitive impairment (Pfeiffer ≥ 5). Walking capacity at one year was closer to the values at admission more often in women than in men (0.2 ± 1.3 points vs. 0.9 ± 1.6; p = 0.001), as well as in patients without risk of sarcopenia versus sarcopenic patients (0.3 ± 1.2 points vs. 0.7 ± 1.7; p = 0.001), although their evolution did not show significant differences (p = 0.183). Instrumental activities after one year have not been recovered (1.7 ± 2.5 points; p = 0.032), and patients at risk of sarcopenia showed worse values (1.7 ± 1.9 points vs. 3.7 ± 2.7; p < 0.001) and worse evolution (p = 0.012). The evolution of basic activities varied according to the risk of sarcopenia (0.6 ± 1.4 points vs. 1.4 ± 2.1; p = 0.008). CONCLUSIONS: Functional status at one year is related to the functional status at admission, the positive screening of sarcopenia, sex, and cognitive impairment of the patient. Knowing at the time of admission an estimate of the functional status at one year will help to reinforce the individual treatment of patients with a worse prognosis.

Conocimiento, implementación y opinión acerca del consentimiento informado por escrito de las enfermeras de atención primaria: proyecto piloto CONOSER / Knowledge, use and opinion about written informed consent in primary healthcare nurses: CONOSER pilot project

Objetivos: Estudiar el conocimiento, implementación y opinión sobre el consentimiento informado de las enfermeras generalistas, especialistas y residentes de atención primaria. Diseño: Estudio descriptivo transversal a través de un cuestionario ad hoc autoadministrado online. Emplazamiento: Enfermeras de atención primaria de Madrid, de noviembre de 2020 a marzo de 2021. Participantes: Muestra de 114 enfermeras: 91 generalistas, 20 especialistas y 3 residentes. Mediciones principales: Sociodemográficas, conocimientos, implementación y opinión. Resultados: La tasa de respuesta fue del 27,7%. El 48,2% señalaron que el consentimiento informado se recogía de forma verbal por regla general, tal y como establece la ley, con diferencias entre las categorías; este porcentaje fue mayor en las especialistas y residentes (p=0,004) y, dentro de las especialistas, en aquellas que han obtenido la especialidad por vía enfermera interna residente (EIR) (p<0,0001). Además, especialistas y residentes fueron quienes más identificaron la norma jurídica que regula el consentimiento informado (p<0,0001). En cuanto a la implementación y la opinión, todos los grupos obtuvieron resultados similares. Discusión: No existen estudios previos que hayan analizado estos aspectos del consentimiento informado comparando las diferentes categorías. Estudios de otros ámbitos de atención sanitaria y geográficos evidencian que las enfermeras poseen mayor conocimiento, aunque la demanda de formación específica en bioética y bioderecho es mayor en las enfermeras participantes en este estudio. Conclusiones: Las enfermeras poseen un adecuado conocimiento sobre el consentimiento informado, lo emplean en la práctica clínica y tienen una apropiada concepción sobre él; en algunos ítems resulta más elevado en las enfermeras especialistas por vía EIR y en las residentes.(AU)

Objective: To know the knowledge, implementation and opinion on informed consent of generalist nurses, specialists and primary care residents. Design: Descriptive cross-sectional study using an online self-administered ‘ad hoc’ questionnaire. Setting: Primary care nurses in Madrid, from November 2020 to March 2021. Participants: Sample of 114 nurses: 91 generalist, 20 specialists and 3 residents. Main measurements: Sociodemographics, knowledge, implementation and opinion. Results: The response rate was 27.7%. As a general rule, 48.2% indicated that informed consent was collected verbally, as established by law, with differences being found between categories, this percentage being higher in specialists and residents (P=0.004), and within specialists in those who had obtained their speciality by internal resident nurse (IRN) (P<0.0001). In addition, specialists and residents were those who most identified the legal norm regulating informed consent (P<0.0001). In terms of implementation and opinion, all groups obtained similar results. Discussion: There are no previous studies that have analysed these aspects of informed consent comparing the different categories. Studies from other healthcare and geographical areas show that nurses have greater knowledge, although the demand for specific training in bioethics and biolaw is greater in the nurses participating in this study. Conclusions: Nurses have adequate knowledge about informed consent, use it in clinical practice and have an appropriate conception of it, being higher in some items in specialist nurses IRN and in residents.(AU)

[Knowledge, use and opinion about written informed consent in primary healthcare nurses: CONOSER pilot project]. / Conocimiento, implementación y opinión acerca del consentimiento informado por escrito de las enfermeras de atención primaria: proyecto piloto CONOSER.

OBJECTIVE: To know the knowledge, implementation and opinion on informed consent of generalist nurses, specialists and primary care residents. DESIGN: Descriptive cross-sectional study using an online self-administered 'ad hoc' questionnaire. SETTING: Primary care nurses in Madrid, from November 2020 to March 2021. PARTICIPANTS: Sample of 114 nurses: 91 generalist, 20 specialists and 3 residents. MAIN MEASUREMENTS: Sociodemographics, knowledge, implementation and opinion. RESULTS: The response rate was 27.7%. As a general rule, 48.2% indicated that informed consent was collected verbally, as established by law, with differences being found between categories, this percentage being higher in specialists and residents (P=0.004), and within specialists in those who had obtained their speciality by internal resident nurse (IRN) (P<0.0001). In addition, specialists and residents were those who most identified the legal norm regulating informed consent (P<0.0001). In terms of implementation and opinion, all groups obtained similar results. DISCUSSION: There are no previous studies that have analysed these aspects of informed consent comparing the different categories. Studies from other healthcare and geographical areas show that nurses have greater knowledge, although the demand for specific training in bioethics and biolaw is greater in the nurses participating in this study. CONCLUSIONS: Nurses have adequate knowledge about informed consent, use it in clinical practice and have an appropriate conception of it, being higher in some items in specialist nurses IRN and in residents.

Medicines in exceptional circumstances for solid tumours: focusing on evidence, effectiveness, and toxicity profiles.

OBJECTIVE: To analyse the applications for drugs in special situations (compassionate use, off-label use and foreign drugs) for solid  tumours, and to assess the level of evidence supporting these applications, as  well as the effectiveness and safety of most frequent drugs. METHOD: We performed a cross-sectional study of all applications for drugs in  special situations during 2018 and 2019 in a representative third-level centre.  We collected data about generic names of drugs, clinical indications, and level  of evidence provided on the application form. Furthermore, tumour response  was assessed according to the Response Evaluation Criteria in Solid Tumours  version 1.1., Progression Free Survival and Overall Survival. Safety was  evaluated with the National Cancer Institute Common Terminology Criteria for  Adverse Events, version 5.0. RESULTS: 2,273 drugs in special situations were approved between January  2018 and December 2019. In 431 cases (19%), they were used to treat solid  tumours. Out of 431, 291 (67.5%) applications were offlabel drugs, 76 (18%)  foreign drugs, and 64 (15%) were compassionate use of drugs. Most of them  were supported by phase 3 (47%) or phase 2 (33%)  clinical trials. The  majority of adverse effects were grade 1 and only in 6/67 cases the treatment  was discontinued due to toxicity. CONCLUSIONS: A significant number of drugs in special situations are prescribed  to Oncology patients. The majority of applications of these drugs was supported by clinical trials. The real-life experience showed an effectiveness and tolerance profile similar to those described in randomised  clinical trials.

OBJETIVO: Analizar las solicitudes de medicamentos en situaciones especiales (uso compasivo, uso fuera de indicación y medicamentos  extranjeros) para tumores sólidos, y evaluar el nivel de evidencia que avala  dichas solicitudes, así como la efectividad y seguridad de los medicamentos  más frecuentes.Método: Estudio transversal que incluyó las solicitudes de medicamentos en  situaciones especiales durante el período 2018-2019 en un centro representativo español de tercer nivel. Se recogieron datos sobre  principios activos, indicaciones clínicas y nivel de evidencia aportado en la  solicitud. Asimismo, la respuesta tumoral fue evaluada mediante criterios  Response Evaluation Criteria in Solid Tumours versión 1.1, supervivencia libre  de progresión y supervivencia global. La seguridad fue evaluada con la versión 5.0 de los criterios de toxicidad Common Terminology Criteria for  Adverse Events del National Cancer Institute de Estados Unidos. RESULTADOS: Un total de 2.273 medicamentos en situaciones especiales fueron aprobados entre enero de 2018 y diciembre de 2019. El 19% (431) se  aprobaron para el tratamiento de tumores sólidos. De estos 431, 291 (67,5%)  solicitudes fueron de medicamentos fuera de indicación, 76 (18%) extranjeros  y 64 (15%) en uso compasivo. La mayoría son avaladas por estudios clínicos  aleatorizados en fase III (47%) o fase II (33%). La mayor parte de los efectos  adversos fueron de grado 1 y solo en 6/67 casos el tratamiento fue  interrumpido por toxicidad. CONCLUSIONES: Un porcentaje importante de medicamentos en usos especiales se prescriben a pacientes oncológicos. La mayoría de las solicitudes fueron  avaladas por algún estudio clínico aleatorizado. La experiencia en vida real  mostró un perfil de efectividad y tolerancia similar al descrito en los estudios  clínicos aleatorizados.

Medicamentos en situaciones especiales paratumores sólidos: profundizando en la evidencia y los perfiles de efectividad y toxicidad / Medicines in exceptional circumstances for solid tumours: focusing on evidence, effectiveness, and toxicity profiles

Objetivo: Analizar las solicitudes de medicamentos en situaciones especiales(uso compasivo, uso fuera de indicación y medicamentos extranjeros) paratumores sólidos, y evaluar el nivel de evidencia que avala dichas solicitudes,así como la efectividad y seguridad de los medicamentos más frecuentes.Método: Estudio transversal que incluyó las solicitudes de medicamentosen situaciones especiales durante el período 2018-2019 en un centrorepresentativo español de tercer nivel. Se recogieron datos sobre principiosactivos, indicaciones clínicas y nivel de evidencia aportado en la solicitud.Asimismo, la respuesta tumoral fue evaluada mediante criterios ResponseEvaluation Criteria in Solid Tumours versión 1.1, supervivencia libre de progresióny supervivencia global. La seguridad fue evaluada con la versión5.0 de los criterios de toxicidad Common Terminology Criteria for AdverseEvents del National Cancer Institute de Estados Unidos.Resultados: Un total de 2.273 medicamentos en situaciones especialesfueron aprobados entre enero de 2018 y diciembre de 2019. El19% (431) se aprobaron para el tratamiento de tumores sólidos. De estos431, 291 (67,5%) solicitudes fueron de medicamentos fuera de indicación,76 (18%) extranjeros y 64 (15%) en uso compasivo. La mayoría son avaladas por estudios clínicos aleatorizados en fase III (47%) o fase II(33%). La mayor parte de los efectos adversos fueron de grado 1 y soloen 6/67 casos el tratamiento fue interrumpido por toxicidad.Conclusiones: Un porcentaje importante de medicamentos en usosespeciales se prescriben a pacientes oncológicos. La mayoría de lassolicitudes fueron avaladas por algún estudio clínico aleatorizado. Laexperiencia en vida real mostró un perfil de efectividad y tolerancia similaral descrito en los estudios clínicos aleatorizados.

Objective: To analyse the applications for drugs in special situations(compassionate use, off-label use and foreign drugs) for solid tumours, andto assess the level of evidence supporting these applications, as well asthe effectiveness and safety of most frequent drugs.Method: We performed a cross-sectional study of all applications fordrugs in special situations during 2018 and 2019 in a representativethird-level centre. We collected data about generic names of drugs,clinical indications, and level of evidence provided on the applicationform. Furthermore, tumour response was assessed according to the ResponseEvaluation Criteria in Solid Tumours version 1.1., Progression FreeSurvival and Overall Survival. Safety was evaluated with the NationalCancer Institute Common Terminology Criteria for Adverse Events, version5.0.Results: 2,273 drugs in special situations were approved betweenJanuary 2018 and December 2019. In 431 cases (19%), they were usedto treat solid tumours. Out of 431, 291 (67.5%) applications were offlabeldrugs, 76 (18%) foreign drugs, and 64 (15%) were compassionate use ofdrugs. Most of them were supported by phase 3 (47%) or phase 2 (33%) clinical trials. The majority of adverse effects were grade 1 and only in6/67 cases the treatment was discontinued due to toxicity.Conclusions: A significant number of drugs in special situations areprescribed to Oncology patients. The majority of applications of thesedrugs was supported by clinical trials. The real-life experience showed aneffectiveness and tolerance profile similar to those described in randomisedclinical trials.

Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics.

AIM: Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. METHODS: With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. RESULTS: Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. CONCLUSION: Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials.

Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project).

PURPOSE: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario. METHODS: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers. RESULTS: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138. CONCLUSIONS: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.

Psychiatric Disorders and Montelukast in Children: A Disproportionality Analysis of the VigiBase(®).

INTRODUCTION: In 2008, the US FDA issued an alert about an increased risk of psychiatric events associated with montelukast. Recent national pharmacovigilance analyses in Sweden, France and Spain detected a potential increase in reporting risk of the association. AIM: Our objective was to analyse spontaneous reports of psychiatric events in children and adolescents worldwide treated with montelukast. METHODS: We conducted a retrospective analysis of Individual Case Safety Reports (ICSRs) recorded up to 1 January 2015 in the World Health Organization (WHO) database (VigiBase(®)), in which montelukast was associated with 'psychiatric disorders'. We used the Bayesian Confidence Propagation Neural Network (BCPNN) approach for signal generation. RESULTS: A total of 14,670 ICSRs for montelukast were recorded, of which 2630 corresponded to psychiatric disorders in people aged <18 years. The main symptoms reported for infants (aged <2 years) were sleep disorders, for children (aged 2-11 years) the main symptoms were depression/anxiety, and for adolescents (aged 12-17 years) they were suicidal behaviour and depression/anxiety. Suicidal behaviour was over-represented in all age groups with information component (IC) values that reached 5.01 in children and 3.85 in adolescents. Unexpectedly, completed suicides were reported more frequently for children (IC: 3.15; IC025: 1.98) than for adolescents (IC: 3.11; IC025: 2.61) or the total population (IC 1.95; IC025: 1.73). CONCLUSIONS: Neuropsychiatric disorders as side effects of montelukast were more frequently reported for children than for adults. Infants and children seem to be more prone to sleep disturbances, whereas adolescents present symptoms of depression/anxiety and psychotic reactions more often. Suicidal behaviour and completed suicide appear to be more frequently reported than previously thought in practice. Risk management plans and epidemiological studies are needed to quantify the risk. Practitioners should be aware of the risk of neuropsychiatric events associated with montelukast use, and should advise the patient and report new cases.

Puntos de corte de la versión española del Cuestionario de Cualidades y Dificultades (SDQ) / Cutt-offs of the Spanish version of the Strength and Difficulties Questionnaire (SDQ)

INTRODUCCIÓN: El Cuestionario de Cualidades y Dificultades (SDQ) es un instrumento breve de evaluación de trastornos mentales en la infancia y la adolescencia. Ha sido desarrollado en el Instituto de Psiquiatría de Londres en los años 90. Se administra a padres y profesores con una única versión para ambos. Consta de 25 ítems y valora 5 aspectos: hiperactividad, síntomas emocionales, problemas de comportamiento, problemas de relaciones con iguales y conducta prosocial. Su sencilla administración e interpretación lo convierte en una herramienta muy útil en pediatría. Se encuentra traducido y validado en muchos idiomas, incluido el español. Es muy utilizado para estudios epidemiológicos, de despistaje y clínicos. Sus propiedades psicométricas han demostrado ser adecuadas para estos aspectos. MATERIAL Y MÉTODOS: Se recogieron las contestaciones del SDQ de padres y profesores de una muestra comunitaria de 597 niños entre 7 y 10 años, estando igualmente representados ambos sexos. Se realizó el análisis estadístico para identificar los puntos de corte. Para cada escala se determinaron los rangos de normalidad, límite y anormalidad. RESULTADOS: Los resultados obtenidos en la presente investigación revelan unos puntos de corte sensiblemente distintos a los obtenidos para las versiones en otros idiomas distintos al español. CONCLUSIONES: La traducción española se presenta como un instrumento igual de útil que el Cuestionario inglés original y el traducido a otros idiomas

INTRODUCTION: The Strengths and Difficulties Questionnaire (SDQ) was developed by Professor Robert Goodman at the Institute of Psychiatry (UK) in the 1990's. It is a brief behavioural screening instrument internationally used for the screening of mental health problems in children and adolescents. It consists in a 25 item questionnaire with 5 different scales: emotional symptoms, conduct problems, hyperactivity / inattention peer relationship problems and prosocial behaviours. Its simple administration and interpretation has made it a very useful tool in paediatrics. The SDQ has been translated and validated in more than 70 languages, these includes a Spanish version. It is widely used as an adequate tool for epidemiological, early detection and clinical studies, as demonstrated by its psychometric properties. MATERIAL AND METHODS: Parents and teachers ratings of SDQ were collected for a community-based sample of 597 children between 7 and 10 years, in which both genders were equally represented. Statistical evaluation of cutt-offs were performed. Bandings identifying normal, borderline, and clinical ranges were defined for each scale. RESULTS: The present study reveal cut off results sensibly different to those obtained in other languages.CONCLUSIONS: The Spanish translation seems to be a similarly useful tool as the original English and other languages questionnaire

Estrategias de manejo de los antidepresivos desde la perspectiva de los pacientes: luchando interna y externamente / Antidepressant management strategy from the patient perspective: Struggling internally and externally

Objetivo: Identificar la trayectoria de consumo y las estrategias de manejo de los antidepresivos desde la perspectiva de los pacientes. Diseño: Estudio cualitativo. Emplazamiento: Tenerife. Participantes y/o contextos: Muestreo teórico hasta alcanzar la saturación. Método: Se incluyeron 17 entrevistas abiertas a personas que consumían antidepresivos con o sin ansiolíticos. El rango de edad osciló entre 35-85 años, de los cuales 13 eran mujeres. Diez vivían en un contexto más urbano y el resto en zona rural. Las entrevistas se grabaron en audio, fueron transcritas verbatim y analizadas según el método de Grounded Theory modificado con el apoyo del programa ATLAS. ti. Resultados: El proceso identificado de manejo de los antidepresivos se denominó «luchando interna y externamente». Consiste en la evaluación personal de los beneficios y riesgos del consumo del medicamento (lucha interna), frente al estigma y presión ambiental (lucha externa). El resultado del proceso de evaluación que realizan los pacientes puede dar lugar a diferentes estrategias de adaptación al tratamiento farmacológico: «aceptación incondicional», «aceptación resignada» o bien «aceptación forzada». Conclusiones: Entender el proceso de evaluación que el paciente necesita hacer, dada la lucha interna y externa en la que se ve inmerso, es útil para poder realizar intervenciones que mejoren el consumo de medicamentos. De hecho, los médicos tienen un papel muy relevante, aunque no siempre explícitamente buscado, en la resolución del dilema que se plantean los pacientes acerca del consumo de los fármacos antidepresivos; y, por tanto, en la reducción del tiempo de sufrimiento de los pacientes(AU)

Objective: To identify the consumption pathway and strategies of coping with antidepressants use from the patients perspective. Design: Qualitative research. Setting: Tenerife. Sampling: Theoretical sampling until saturation. Method: A total of 17 open interviews with patients who consumed antidepressants whether combined with tranquilisers or not. The age range was between 35-85 years, and there were 13 women. Ten lived in a more urban setting and the rest in rural areas. Interviews were audio-recorded, transcribed verbatim and analysed using a modified Grounded Theory supported by the software program ATLAS. ti. Results: The process identified as coping with antidepressants, was called "struggling internally and externally". It consisted of the individual assessment of the benefits and risks of medication use (internal struggle), addressing stigma and social pressure (external struggle). The outcome of the assessment made by patients may lead to different strategies for adjusting to drug treatment: "unconditional acceptance", "resigned acceptance" or "forced acceptance". Conclusions: Understanding the evaluation process that the patient needs to go through, given the internal and external struggle in which they are immersed, can be useful to develop interventions that improve medication use. In fact, physicians have an important role, although not always explicitly sought in resolving the dilemma posed by patients using antidepressant drugs and, therefore, reducing the length of patient suffering(AU)

Comparando las perspectivas de los médicos de atención primaria de Canarias y Alberta. ¿Es más bonito el jardín del vecino que el mío? / Comparing the perspectives of Primary Care doctors in the Canary Islands and Alberta (Canada)

Objetivo: Examinar desde la perspectiva del médico de atención primaria (AP) las ventajas e inconvenientes de 2 formas diferentes de organización del sistema sanitario. Diseño: Estudio cualitativo basado en análisis de documentos elaborados para el estudio a modo de diarios. Emplazamiento: Atención Primaria de Canarias (España) y Alberta (Canadá). Participantes y/o contextos: Muestreo intencionado con el fin de identificar diferentes perfiles de médicos. Método: A los participantes se solicitó que escribieran un documento en el que hicieran una descripción de su actividad laboral, incluyendo un análisis del impacto en su vida personal como de la organización del sistema. Se solicitó a 2 representantes del sistema sanitario que hicieran una descripción detallada de cómo se organiza la atención primaria en su país. Se obtuvieron 9 diarios de médicos (5 de Canarias y 4 de Alberta). Se utilizó el marco de Ritchie y Spencer para el análisis. Resultados: En Alberta los médicos tienen acceso a más pruebas complementarias; pueden ofrecer asistencia en el hospital; tienen que ocuparse de la gestión; pueden establecerse donde consideren; y pueden especializarse por áreas. En Canarias los médicos disponen de vacaciones y no depende de ellos la responsabilidad de la administración de los servicios; los pacientes tienen un médico asignado; y tienen más apoyo institucional. Conclusiones: Los resultados de este estudio permiten hacer una crítica constructiva sobre el papel del médico en atención primaria, valorar las ventajas y replantearnos los inconvenientes relacionados con nuestra forma de trabajar con el fin de aprender de otros sistemas organizativos(AU)

Objective: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. Design: Qualitative research based on the analysis of documents written as diaries for the study. Setting: Primary Care in the Canary Islands (Spain) and Alberta (Canada). Context and participants: Intentional sample to identify different profiles of physicians. Method: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. Results. In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. Conclusions: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems(AU)

[Antidepressant management strategy from the patient perspective: struggling internally and externally]. / Estrategias de manejo de los antidepresivos desde la perspectiva de los pacientes: luchando interna y externamente.

OBJECTIVE: To identify the consumption pathway and strategies of coping with antidepressants use from the patients perspective. DESIGN: Qualitative research. SETTING: Tenerife. SAMPLING: Theoretical sampling until saturation. METHOD: A total of 17 open interviews with patients who consumed antidepressants whether combined with tranquilisers or not. The age range was between 35-85 years, and there were 13 women. Ten lived in a more urban setting and the rest in rural areas. Interviews were audio-recorded, transcribed verbatim and analysed using a modified Grounded Theory supported by the software program ATLAS.ti. RESULTS: The process identified as coping with antidepressants, was called "struggling internally and externally." It consisted of the individual assessment of the benefits and risks of medication use (internal struggle), addressing stigma and social pressure (external struggle). The outcome of the assessment made by patients may lead to different strategies for adjusting to drug treatment: "unconditional acceptance", "resigned acceptance" or "forced acceptance". CONCLUSIONS: Understanding the evaluation process that the patient needs to go through, given the internal and external struggle in which they are immersed, can be useful to develop interventions that improve medication use. In fact, physicians have an important role, although not always explicitly sought in resolving the dilemma posed by patients using antidepressant drugs and, therefore, reducing the length of patient suffering.

[Comparing the perspectives of primary care doctors in the Canary Islands and Alberta (Canada)]. / Comparando las perspectivas de los médicos de atención primaria de Canarias y Alberta. ¿Es más bonito el jardín del vecino que el mío?

OBJECTIVE: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. DESIGN: Qualitative research based on the analysis of documents written as diaries for the study. SETTING: Primary Care in the Canary Islands (Spain) and Alberta (Canada) CONTEXT AND PARTICIPANTS: Intentional sample to identify different profiles of physicians. METHOD: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. RESULTS: In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. CONCLUSIONS: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems.