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1.
Enferm. clín. (Ed. impr.) ; 30(2): 108-113, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-3073

RESUMO

Objetivo: Evaluar si el conocimiento de la enfermedad asmática puede ser un factor protector frente al riesgo de neumonía adquirida en la comunidad (NAC) en las personas con asma mayores de 18 años que reciben tratamiento inhalado. Método: Estudio observacional de casos y controles en población con asma. Se reclutaron 123 personas con asma diagnosticadas de neumonía por criterios clínicos y radiológicos (casos) y 246 personas con asma no diagnosticados de neumonía durante el último año (controles), apareados por edad. El principal factor de estudio fue la valoración del conocimiento sobre la enfermedad asmática mediante un cuestionario ad hoc, de 7 preguntas con 2 posibles respuestas (conoce, no conoce). Resultados: El análisis bivariado muestra que el conocimiento de la enfermedad asmática tiene una asociación estadísticamente significativa como factor protector de NAC. En el análisis multivariante muestra una asociación del conocimiento de la enfermedad asmática como factor protector de NAC (OR = 0,24), independientemente de la edad, nivel de estudios, funcionalidad y gravedad del asma. Conclusiones: Un buen conocimiento de la enfermedad asmática permite reducir el riesgo de NAC en pacientes asmáticos con tratamiento inhalado


Objective: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. Method: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). Results: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. Conclusions: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment

2.
Nutrients ; 11(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374909

RESUMO

Critically ill patients often require life support measures such as mechanical ventilation or haemodialysis. Despite the essential role of nutrition in patients' recovery, the inappropriate use of medical nutrition therapy can have deleterious effects, as is the case with the use of respiratory, circulatory, or renal support. To increase awareness and to monitor the effects of inappropriate medical nutrition therapy, we propose to introduce the concept of nutritrauma in clinical practice, defined as metabolic adverse events related to the inappropriate administration of medical nutrition therapy or inadequate nutritional monitoring.


Assuntos
Estado Terminal/terapia , Doença Iatrogênica , Apoio Nutricional/efeitos adversos , Terminologia como Assunto , Humanos , Medição de Risco , Fatores de Risco
3.
Nutrients ; 11(8)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405072

RESUMO

Water, the main component of the body, is distributed in the extracellular and intracellular compartments. Water exchange between these compartments is mainly governed by osmotic pressure. Extracellular water osmolarity must remain within very narrow limits to be compatible with life. Older adults lose the thirst sensation and the ability to concentrate urine, and this favours increased extracellular osmolarity (hyperosmotic stress). This situation, in turn, leads to cell dehydration, which has severe consequences for the intracellular protein structure and function and, ultimately, results in cell damage. Moreover, the fact that water determines cell volume may act as a metabolic signal, with cell swelling acting as an anabolic signal and cell shrinkage acting as a catabolic signal. Ageing also leads to a progressive loss in muscle mass and strength. Muscle strength is the main determinant of functional capacity, and, in elderly people, depends more on muscle quality than on muscle quantity (or muscle mass). Intracellular water content in lean mass has been related to muscle strength, functional capacity, and frailty risk, and has been proposed as an indicator of muscle quality and cell hydration. This review aims to assess the role of hyperosmotic stress and cell dehydration on muscle function and frailty.


Assuntos
Metabolismo Energético , Fragilidade/metabolismo , Contração Muscular , Força Muscular , Músculo Esquelético/metabolismo , Equilíbrio Hidroeletrolítico , Desequilíbrio Hidroeletrolítico/metabolismo , Animais , Composição Corporal , Fragilidade/fisiopatologia , Humanos , Músculo Esquelético/fisiopatologia , Estado de Hidratação do Organismo , Pressão Osmótica , Desequilíbrio Hidroeletrolítico/fisiopatologia
6.
Gac. sanit. (Barc., Ed. impr.) ; 33(2): 106-111, mar.-abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-183671

RESUMO

Objective: To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). Method: An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure. Results: 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (−14.3% vs.−7.7%; p=0.041). Total annual drug expenditure decreased 233.75 Euros/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 Euros would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 Euros per patient a year on average. Conclusions: The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment


Objetivo: Evaluar los ahorros monetarios resultantes de la intervención de un farmacéutico orientada a mejorar la adecuación de los fármacos prescritos en ancianos (≥70 años) polimedicados (≥8 medicamentos) de la comunidad. Método: Se evaluó la reducción del gasto farmacéutico en el marco de un ensayo clínico aleatorizado y multicéntrico. La intervención del estudio consistió en una evaluación de todos los fármacos prescritos a cada paciente utilizando el algoritmo Good Palliative-Geriatric Practice y los criterios Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START). El grupo control siguió la práctica clínica habitual. Se consideró un horizonte temporal de un año y los elementos de costes incluyeron los recursos humanos y el gasto en medicamentos. Resultados: Se analizaron 490 pacientes (245 por grupo). La disminución del gasto farmacéutico a los 12 meses fue significativamente mayor en el grupo de intervención que en el grupo control (−14,3% vs.−7,7%; p=0,041). El gasto anual en medicamentos disminuyó 233,75 Euros por paciente (intervalo de confianza del 95% [IC95%]: 169,83-297,67) en el grupo de intervención y 169,40 € por paciente (IC95%: 103,37-235,43) en el grupo control, indicando un ahorro farmacéutico de 64,30 Euros por paciente/año atribuible a la intervención del estudio. Se ha estimado un retorno de 2,38 Euros por cada euro invertido en el programa. Conclusiones: La intervención en estudio es una alternativa rentable a la atención estándar, que podría generar un retorno positivo de la inversión


Assuntos
Humanos , Idoso , Reconciliação de Medicamentos/organização & administração , Polimedicação , Assistência Farmacêutica/organização & administração , Prescrição Inadequada/prevenção & controle , Poupança para Cobertura de Despesas Médicas/organização & administração , Custos de Medicamentos/tendências , Avaliação de Eficácia-Efetividade de Intervenções , Estudos de Casos e Controles , Atenção Primária à Saúde/organização & administração
7.
Nutrients ; 11(3)2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30893821

RESUMO

High intracellular water (ICW) content has been associated with better functional performance and a lower frailty risk in elderly people. However, it is not clear if the protective effect of high ICW is due to greater muscle mass or better muscle quality and cell hydration. We aimed to assess the relationship between ICW content in lean mass (LM) and muscle strength, functional performance, frailty, and other clinical characteristics in elderly people. In an observational cross-sectional study of community-dwelling subjects aged ≥75 years, ICW and LM were estimated by bioelectrical impedance, and the ICW/LM ratio (mL/kg) calculated. Muscle strength was measured as hand grip, frailty status was assessed according to Fried criteria, and functional status was assessed by Barthel score. For 324 recruited subjects (mean age 80 years), mean (SD) ICW/LM ratio was 408 (29.3) mL/kg. The ICW/LM ratio was negatively correlated with age (rs = -0.249; p < 0.001). A higher ICW/LM ratio was associated with greater muscle strength, better functional capacity, and a lower frailty risk, even when adjusted by age, sex, nº of co-morbidities, and LM. ICW content in LM (including the muscle) may influence muscle strength, functional capacity and frailty. However, further studies are needed to confirm this hypothesis.


Assuntos
Água Corporal , Fragilidade , Vida Independente , Força Muscular , Músculo Esquelético/química , Músculo Esquelético/fisiologia , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Estudos Transversais , Feminino , Humanos , Masculino
10.
Gac Sanit ; 33(2): 106-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29162290

RESUMO

OBJECTIVE: To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). METHOD: An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure. RESULTS: 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (-14.3% vs.-7.7%; p=0.041). Total annual drug expenditure decreased 233.75 €/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 € would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 € per patient a year on average. CONCLUSIONS: The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment.


Assuntos
Redução de Custos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Polimedicação , Medicamentos sob Prescrição/economia , Idoso , Feminino , Humanos , Masculino , Espanha
11.
BMJ Open ; 8(12): e022775, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552255

RESUMO

INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients. METHODS AND ANALYSIS: A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured. ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018099977.


Assuntos
Transtornos de Deglutição/economia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/economia , Custos e Análise de Custo , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Desidratação/diagnóstico , Desidratação/economia , Desidratação/terapia , Assistência à Saúde/economia , Diagnóstico Precoce , Intervenção Médica Precoce , Humanos , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/economia , Desnutrição Proteico-Calórica/terapia
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(9): 479-485, nov. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-176439

RESUMO

Objectives: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. Patients and methods: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. Results: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). Conclusions: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy


Objetivos: Determinar las características clínicas de pacientes con neuroartropatía de Charcot (NC) en España e identificar predictores de complicaciones relacionadas. Materiales y métodos: Estudio retrospectivo llevado a cabo en 5 hospitales terciarios de España con unidad de pie diabético. Se recopilaron datos de 83 pacientes incluyendo perfil demográfico, datos provenientes de la exploración podológica, características de la diabetes y presencia de comorbilidad micro y macro vascular. Para determinar los predictores significativos de acontecimientos clínicos predefinidos se utilizaron análisis de regresión logística. Resultados: Casi todos los pacientes (98,9%) tenían signos de neuropatía diabética en la evaluación inicial, aproximadamente la mitad tenían retinopatía o nefropatía diabética (61,5 y 51,8%, respectivamente) y la enfermedad arterial periférica era infrecuente (8,6%). Treinta y ocho pacientes (47,5%) experimentaron uno o más acontecimientos clínicos relevantes: 22 (27,5%) una nueva úlcera en el pie, 7 (8,7%) una amputación mayor, 20 (25%) fueron hospitalizados y 4 (5%) murieron. Solamente la presencia de nefropatía diabética se encontró independientemente asociada al desarrollo de alguna de las complicaciones estudiadas (p = 0,009; odds ratio = 3,37; 95% CI: 1,12-10,1). Conclusiones: Casi la mitad de los pacientes con NC atendidos en unidades de cuidado del pie diabético en hospitales terciarios experimentaron complicaciones asociadas a NC a corto plazo, y el riesgo entre aquellos sujetos con historia de úlcera previa era 3 veces mayor


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Artropatia Neurogênica/complicações , Pé Diabético/complicações , Centros de Atenção Terciária , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/epidemiologia , Deformidades do Pé/etiologia , Comorbidade , Fatores de Risco , Estudos Retrospectivos , Espanha/epidemiologia
13.
Endocrinol Diabetes Nutr ; 65(9): 479-485, 2018 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30108031

RESUMO

OBJECTIVES: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.


Assuntos
Artropatia Neurogênica/complicações , Doenças do Pé/etiologia , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária , Fatores de Tempo
14.
Med. clín (Ed. impr.) ; 150(12): 455-459, jun. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173646

RESUMO

Introducción y objetivo: El asma es una enfermedad crónica que precisa tratamiento inhalado y que, a su vez, es factor de riesgo (FR) de neumonía. En la cavidad orofaríngea existen numerosas especies de bacterias que podrían ser arrastradas a nivel broncoalveolar. Objetivo: determinar si la salud bucodental es un FR de neumonía adquirida en la comunidad (NAC) en pacientes asmáticos que realizan tratamiento inhalado y determinar si la frecuencia de utilización de los dispositivos de inhalación y el tipo de fármaco inhalado son FR de NAC. Pacientes y método: Estudio de casos y controles en población asmática con tratamiento inhalado. Se seleccionaron 126 pacientes asmáticos diagnosticados de neumonía por criterios clínicos y radiológicos (casos) y 252 asmáticos no diagnosticados de neumonía durante el último año (controles), emparejados por edad. El principal factor de estudio fue la puntuación del General Oral Health Assessment Index (GOHAI). Resultados: El análisis bivariado muestra una asociación estadísticamente significativa de la NAC con un índice de GOHAI≤57 puntos (mala salud bucodental) (OR 1,69), el tratamiento anticolinérgico (OR 2,41), realizar 6 o más inhalaciones al día (OR 3,23), el uso de cámara (OR 1,62), el FEV1 (OR 0,98), una alteración de la funcionalidad (OR 2,08) y los trastornos psiquiátricos o la depresión (OR 0,41). El análisis multivariante muestra una asociación independiente de realizar 6 o más inhalaciones al día (OR 2,74) y de las alteraciones de la funcionalidad (OR 1,67). Conclusiones: Los resultados evidencian que una mala salud bucodental podría ser un FR de NAC


Introduction and objective: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. Objective: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. Patients and method: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. Results: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). Conclusions: The results suggest that poor oral health may be a CAP RF


Assuntos
Humanos , Masculino , Feminino , Higiene Bucal/efeitos adversos , Pneumonia Bacteriana/etiologia , Asma/complicações , Estudos de Casos e Controles , Fatores de Risco , Administração por Inalação , Nebulizadores e Vaporizadores , Infecções Comunitárias Adquiridas
15.
Med. clín (Ed. impr.) ; 150(6): 209-214, mar. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171542

RESUMO

Objetivo: Determinar la prevalencia de ingresos por reacciones adversas a medicamentos (RAM) y si el ingreso era evitable o no, y qué fármacos y factores de riesgo estaban implicados. Diseño: Estudio observacional transversal. Muestra de estudio Todos los pacientes hospitalizados en una unidad geriátrica de agudos durante el período de enero de 2001 a diciembre de 2010 fueron estudiados. Mediciones: Para determinar si los ingresos se debieron a RAM se utilizaron los criterios de la World Health Organization-Uppsala Monitoring Centre y la escala de Naranjo. Para detectar los medicamentos potencialmente inadecuados se utilizaron los criterios de Beers. Resultados: Se estudió un total de 3.292 pacientes (edad media 84,7 años, 60,1% mujeres). De estos, 197 (6%) fueron ingresos por RAM, de los cuales 152 (76,4%) se consideraron ingresos evitables. Los 5 grupos de fármacos más frecuentemente asociados a los ingresos por RAM fueron digoxina, antiinflamatorios no esteroideos, benzodiacepinas, diuréticos y antibióticos. Los factores de riesgo independientes de ingreso por RAM fueron el sexo femenino (OR 1,84; IC 95% 1,3-2,61), la medicación inadecuada según los criterios de Beers (OR 4,2; IC 95% 2,9-6,03), la polifarmacia (>5 fármacos) (OR 1,5; IC 95% 1,04-2,13), el filtrado glomerular<30ml/min (OR 3; IC 95% 2,12-4,23) y el uso de sedantes (OR 1,4; IC 95% 1-1,91). Conclusión: Las RAM fueron responsables del 6% de los ingresos en una unidad geriátrica de agudos, considerándose evitables tres cuartas partes de estos ingresos. El sexo femenino, la medicación inadecuada, la polifarmacia, la insuficiencia renal y el uso de sedantes fueron factores de riesgo independientes de ingreso por RAM (AU)


Objective: To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. Design: Cross-sectional observational study. Study sample: All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. Measurement: To determine whether admissions were due toADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. Results: A total of 3,292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The 5 most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI 1.30-2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI 2.90-6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI 1.04-2.13), glomerular filtration rate<30mL/min (OR 3; 95% CI 2.12-4.23) and sedative use (OR 1.40; 95% CI 1-1.91). Conclusion: ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Instituição de Longa Permanência para Idosos/organização & administração , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Hospitalização , Fatores de Risco , Prescrição Inadequada/efeitos adversos , Serviços de Saúde para Idosos/organização & administração , Prescrição Inadequada/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição , Análise Estatística
16.
Telemed J E Health ; 24(10): 773-781, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29323628

RESUMO

BACKGROUND: A change in healthcare systems is needed, due to the increased prevalence of chronic diseases. Patient empowerment improves results in terms of patient quality of life (QoL) and satisfaction. INTRODUCTION: We have developed a telehealth program Control Telehealth Claudication Intermittent (CONTECI) for patients with peripheral arterial disease (PAD), aimed at enhancing patient satisfaction and QoL, while improving health system efficiency. MATERIALS AND METHODS: We conducted a randomized clinical trial of patients with PAD, at the intermittent claudication stage. Study subjects were randomized into either (1) an intervention arm (IA), which utilized our CONTECI program for promoting patient self-management, or (2) a control arm (CA), utilizing the familiar system of in-person patient visits. All patients were followed up at 1 year. RESULTS: The trial included 150 patients, 75 in each arm. Complications were diagnosed more quickly in the IA (7.85 days standard deviation (SD) 9.95 vs. 53.89 days SD 41.56; p = 0.016) compared with the CA. Rest pain decreased (1.4% vs. 8.4%; p = 0.05) in the IA group, as did the number of scheduled visits-decreased by 95.95%-and the number of emergency visits (p = 0.017). QoL scores in IA patients improved from baseline (67.87 vs. 72.25; p = 0.047), as did patient satisfaction (67.36 vs. 76.78; p = 0.03). DISCUSSION: Telemedicine can improve health results and aid communication and visit scheduling. Our e-Health programs are financially viable. CONCLUSIONS: Self-management using the CONTECI telehealth program is feasible for patients with PAD. The program promotes patient expertise, encourages proactivity, increases QoL and satisfaction with disease control, and improves health resource use, with no evidence of clinical inferiority to conventional practices.


Assuntos
Claudicação Intermitente/terapia , Participação do Paciente/métodos , Satisfação do Paciente , Qualidade de Vida/psicologia , Autogestão/métodos , Doença Crônica , Feminino , Humanos , Masculino , Telemedicina/métodos
17.
Med Clin (Barc) ; 150(6): 209-214, 2018 03 23.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28992984

RESUMO

OBJECTIVE: To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. DESIGN: Cross-sectional observational study. STUDY SAMPLE: All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. MEASUREMENT: To determine whether admissions were due toADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. RESULTS: A total of 3,292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The 5 most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI 1.30-2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI 2.90-6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI 1.04-2.13), glomerular filtration rate<30mL/min (OR 3; 95% CI 2.12-4.23) and sedative use (OR 1.40; 95% CI 1-1.91). CONCLUSION: ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Serviços de Saúde para Idosos , Hospitalização/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Unidades Hospitalares , Humanos , Hipnóticos e Sedativos/efeitos adversos , Prescrição Inadequada , Masculino , Polimedicação , Insuficiência Renal/complicações , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
18.
Med Clin (Barc) ; 150(12): 455-459, 2018 06 22.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28947297

RESUMO

INTRODUCTION AND OBJECTIVE: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. OBJECTIVE: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. PATIENTS AND METHOD: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. RESULTS: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). CONCLUSIONS: The results suggest that poor oral health may be a CAP RF.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Infecções Comunitárias Adquiridas/etiologia , Saúde Bucal , Pneumonia/etiologia , Administração por Inalação , Idoso , Antiasmáticos/administração & dosagem , Asma/complicações , Asma/fisiopatologia , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/epidemiologia , Inquéritos de Saúde Bucal , Placa Dentária/microbiologia , Suscetibilidade a Doenças , Relação Dose-Resposta a Droga , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Boca/microbiologia , Nebulizadores e Vaporizadores/estatística & dados numéricos , Pneumonia/epidemiologia , Prevalência , Utilização de Procedimentos e Técnicas , Risco , Fatores Socioeconômicos
19.
Enferm Clin ; 2018 Dec 29.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30600151

RESUMO

OBJECTIVE: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. METHOD: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). RESULTS: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. CONCLUSIONS: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

20.
Respiration ; 94(3): 299-311, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28738364

RESUMO

We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Humanos , Estudos Observacionais como Assunto , Fatores de Risco
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