Estudio de intervención para comprobar el efecto de la música clásica en directo durante hemodiálisis sobre la calidad de vida de pacientes con enfermedad renal crónica / Intervention study to verify the effect of live classic music during hemodialysis on the quality of life of patients with chronic kidney disease

Introducción y objetivo: La música ha estado estrechamente unida a la medicina desde la antigüedad, y ha aportado numerosos beneficios a la salud de los pacientes. El paciente con enfermedad renal crónica en tratamiento de hemodiálisis (HD), generalmente, presenta una calidad de vida relacionada con la salud (CVRS) inferior a los valores de referencia de la población general. El objetivo del presente estudio es verificar si la intervención de música clásica en directo e in situ’ durante el tratamiento de HD tiene efectos sobre la CVRS de los pacientes.Materiales y métodos: Se realizó un estudio de intervención, prospectivo y aleatorizado por grupos, en pacientes con enfermedad renal crónica en tratamiento con HD. Durante 4 semanas un grupo de pacientes recibía la intervención con música clásica en directo 30 o 40min durante las sesiones de HD, mientras el grupo control realizaba el tratamiento habitual. Variables descriptivas: edad, sexo, meses en tratamiento, Kt/V, hemoglobina y albúmina. Variable resultado: CVRS, se midió con el cuestionario de salud Kidney Diseasse Quality of life (KDQOL-SF) antes y después de la intervención musical. (AU)

Introduction and objective: Music has been closely linked to medicine since ancient times, and has brought numerous benefits to the health of patients. Patients with chronic kidney disease undergoing hemodialysis (HD) generally have a health-related quality of life (HRQL) lower than the reference values of the general population. The objective of the present study is to verify if the intervention of classical music live and “in situ” during the treatment of HD has effects on the HRQL of the patients.Materials and methods: A prospective, group-randomized intervention study of 4 weeks’ duration was carried out in patients with chronic kidney disease undergoing HD. Descriptive variables are included for data analysis: age, sex, months in treatment, Kt/V, hemoglobin and albumin. Result variable: HRQL, measured with the Kidney Disease health questionnaire Quality of Life (KDQOL-SF) before and after the musical intervention. (AU)

Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis.

BACKGROUND: Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. MATERIALS AND METHODS: Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. RESULTS: The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. CONCLUSION: The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Cohort study with patients older than 80 years with stage 5 chronic kidney failure on hemodialysis vs conservative treatment: Survival outcomes and use of healthcare resources.

Renal replacement treatment has not been generalized to the elderly for different reasons. The main objective of the present cohort study is to compare survival in patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment with those on conservative treatment. The use of healthcare resources is compared too. A Cox proportional hazards regression analysis was run with the outcome variable death during the follow-up period. The independent variables were treatment type, age, gender, smoking habit, serum albumin, hemoglobin, Charlson Index, diabetes mellitus, arterial hypertension, ischemic cardiopathy, and neoplasm. For outcome variable "death," renal replacement treatment obtained a hazard ratio of 0.273 (P .006, CI95% 0.108-0.686) vs conservative treatment. In conclusion, patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment presented a lower mortality risk than those receiving conservative treatment. Comorbidity and age are both associated with mortality, but do not cancel out the survival advantage. In healthcare resources, the renal replacement treatment group made greater use of tests, medical visits and consumption of hospital dispensing drugs, but there were no differences with respect to the days of hospital admission or assistance in home hospitalization.

Patterns in medication incidents: A 10-yr experience of a cross-national anaesthesia incident reporting system.

BACKGROUND: Medication-related adverse events (MRE) in anaesthesia care are frequent and require a deeper understanding if we are to prevent medication harm. METHODS: We searched for reported MRE from the Spanish Anaesthesia Incident Reporting System (SENSAR) database over a 10-yr period. SENSAR is a cross-national, multicentre system focused on perioperative and critical care. A descriptive analysis of independent variables, phase of medication process, type of MRE, and medication group involved, and their relationships with morbidity was conducted. RESULTS: A total of 1970 MRE were identified from 7072 reported incidents. Patient harm was reported in 31% of the MRE. The administration phase was more frequent (42%) and showed the highest harm rate (44%) compared with other medication process phases. The most frequent types of MRE were wrong treatment regimen and wrong medication (55% of cases). The medication groups most commonly reported were those that alter haemostasis (18%), vasoconstrictor agents (13%), and opioids (10%). Vasoconstrictor agents, benzodiazepines, and neuromuscular blocking agents were the medication groups involved in patient harm four-fold more, and opioids three-fold more, than medications that alter haemostasis. The 1970 incidents were investigated and led to implementation of 4223 local corrective patient safety and quality improvement measures. CONCLUSIONS: Patient harm in the perioperative setting from medications remains a major issue for patients, hospital leaders, and clinicians. We found patterns and specific causes that can be mitigated through proven systems solutions, and should be taken into consideration in designing sustainable solutions for safe perioperative care. CLINICAL TRIAL REGISTRATION: NCT03615898.