[Impact of COVID-19 lockdown on the prescription of benzodiazepines]. / Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas.

OBJECTIVE: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN: Longitudinal observational study. LOCATION: Primary care. Asturias (Spain) health district V. PARTICIPANTS: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico.

BACKGROUND: Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. OBJECTIVE: To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. MATERIAL AND METHODS: Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. RESULTS: A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. CONCLUSIONS: A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

ANTECEDENTES: Una prescripción potencialmente inapropiada (PPI) constituye un riesgo de presentar efectos adversos por un fármaco que superan los beneficios de este, pudiendo considerarse como uso inadecuado de medicamentos. OBJETIVO: Describir la prevalencia de prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna de un hospital de referencia en México. MATERIAL Y MÉTODOS: Diseño descriptivo transversal, con asignación simple de expedientes clínicos de pacientes hospitalizados mayores de 65 años, entre enero de 2016 y agosto de 2017. Se aplicaron los criterios STOPP y START para identificar el número de PPI, cantidad de medicamentos prescritos, presencia, cantidad y tipo de comorbilidades, así como días de estancia hospitalaria. RESULTADOS: Se encontró una prevalencia de 73.3 % de PPI y las principales comorbilidades fueron hipertensión arterial y diabetes mellitus tipo 2. Se cuantificaron 1885 medicamentos prescritos; la estancia hospitalaria media fue de 6.3 días. CONCLUSIONES: Se identificó alta prevalencia de PPI en los pacientes geriátricos hospitalizados, de ahí la importancia de aplicar los criterios STOPP y START y del papel del farmacéutico en la validación de la prescripción antes de la administración de medicamentos.

[Antibiotic consumption in primary care in the adult population of Asturias during 2014-2020 period]. / Consumo de antibióticos en atención primaria en población adulta de Asturias durante el periodo 2014-2020.

Trend study of the consumption of systemic antibiotics in the adult population in of Primary Care of the Health Service of the Principality of Asturias (SESPA) during the period 2014̶2020. Retrospective observational study. SESPA, Primary Care. Population from the Individual Health Card database. Data were collected on the prescription of antibiotics, carried out in the family medicine consultations, dispensed in the pharmacy offices with charge of SESPA. Antibiotic use and consumption variables were analyzed using linear regression models. Prevalence of antibiotic use (population percentage); consumption rate of systemic antibiotics (DTD), relative consumption of narrow-spectrum antibiotics (percentage DDD). The average prevalence of the use of antibiotics for the 2014̶2019 period was 32.2% and 23.9% in 2020. The rate of consumption of systemic antibiotics decreased from 21.4 DTD in 2014 to 12.7 DTD in 2020. The consumption of narrow-spectrum antibiotics remained stable (19.4% DDD in 2014 and 19.3% DDD in 2020) (CI95: -0.10, 0.26). In the period from March to December 2020, the consumption of antibiotics decreased by 28.6% compared to the same period in 2019. In 2014̶2020, the consumption of antibiotics decreased, especially since the COVID-19 pandemic, with stabilization of the consumption of narrow-spectrum antibiotics compared to the total. There is variability in consumption by therapeutic subgroups.

[Facing a dilemma in elderly complex and vulnerable patients: to stop or not to stop prevention?] / Dilemas en la enfermedad crónica avanzada: ¿prevención o desprescripción?

OBJECTIVES: 1-To know the preventive prescription (statin, antiplatelet drugs, bisphosphonates, calcium and vitamin D and Vit B12) of elderly patients previously identified as a CCD (with a complex chronic disease) and ACD (with advanced chronic disease and lifetime expectancy of less than 12 months) who died during 2015. 2-To assess the correct indication of Proton Pump Inhibitors (PPI) to determine potentially avoidable medication. DESIGN: Retrospective observational study. LOCATION: Four Primary Health Centres, Castellar del Vallès (Barcelona). PARTICIPANTS: 128 patients, 70 ACD and 58 PCC. MAIN MEASUREMENTS: Number of drugs at the time of death from the 6 selected group, deprescription (6 months prior to death due to advanced chronic disease), primary or secondary prevention and inappropriate prescription of PPI. RESULTS: Average age of 85'3 years (10,3). 40% took an antiplatelet drug, avoidable in 60% of the ACD, since they did not present any previous cardiovascular episode. 20% of the patients took statins, in which 48% of the cases were primary prevention. The PPI prescription was 67% with inadequate indication for use in 49% of these cases. 20% took calcium / Vitamin D and 1,6% of the ACD a bisphosphonate. There was a 16% deprescription. CONCLUSIONS: A high percentage of our patients with advanced chronic disease and short life expectancy still continue to take preventive and avoidable treatments, potentially dangerous due to their side effects. There is a need to reflect on what we do with these vulnerable patients.

Anticonvulsant prescription patterns in patients covered by the Colombian Health System. / Patrones de prescripción de antiepilépticos en pacientes colombianos afiliados al Sistema General de Seguridad Social en Salud.

INTRODUCTION: Epilepsy is a group of long-term neurological disorders characterised by seizures that may respond to pharmacological treatment. OBJECTIVE: Determine the prescribing patterns of anticonvulsants for patients covered by the healthcare system in Colombia. METHODS: Cross-sectional study using a database containing 6.5 million people. From among residents in 88 Colombian cities, we selected patients of both sexes and all ages who were treated continuously with anticonvulsants between June and August 2012. We designed a drug consumption database and performed multivariate analysis for combination treatment and co-medication using SPSS 20.0. RESULTS: A total of 13,793 patients with mean age of 48.9±22.0 years were studied; 52.9% of the participants were women. Of the patient total, 74.4% were treated in monotherapy and 25.6% received two or more anticonvulsants. Globally, 72.9% of the patients were initially treated with classic anticonvulsants and 27.1% with new drugs. The most frequently used drugs were valproic acid (33.3%), carbamazepine (30.2%), clonazepam (15.7%), pregabalin (10.3%), phenytoin (10.0%) and levetiracetam (7.9%). Most agents were used in higher doses than recommended. The most common combinations were valproic acid+clonazepam (10.9%), valproic acid+carbamazepine (10.0%), carbamazepine+clonazepam (5.6%), valproic acid+phenytoin (4.4%). The most frequently prescribed co-medications were antihypertensives (61.0%), lipid-lowering drugs (45.8%), antidepressants (36.7%), antipsychotics (20.1%), anxiolytics (7.9%), and lithium (1.8%). DISCUSSION: Doctors predominantly prescribe drugs with a high therapeutic value and favour anticonvulsant monotherapy. Most agents were used in higher doses than recommended. This underlines the need to design educational strategies addressing these prescribing habits, and to undertake research on the effectiveness of treatment.

[Variability and suitability of anti-asmathic treatment in pediatric primary health care]. / Variabilidad e idoneidad del tratamiento antiasmático en pediatría de atención primaria.

OBJECTIVE: To analyse the use patterns and the characteristics of anti-asmathic prescriptions in pediatric primary health care. DESIGN: Observational and retrospective study. LOCATION: Pediatric primary health care, Asturias, Spain. PARTICIPANTS: Drug prescriptions in respiratory diseases in children (<14years old) during 2011. PRINCIPAL MEASUREMENTS: Data obtained from the billing database of the Regional Health Service of Asturias and analysed by sanitary district and primary health centres, calculating the number of DDD/1.000 children/day (DHD). Clinical records audit in 6 paediatric surgeries of sanitary district V to evaluate the suitability of the drug prescriptions to the current recommendations. RESULTS: The main group were bronchodilators (17.14DHD) with predominance of the inhaled route (14DHD). We observe more use of inhaled corticoids (4.83DHD), with an important use of fluticasone. We considered un-suitable 94.3% oral bronchodilators, and >50% of mepiramine prescriptions. We registered off-label prescriptions, 17.8% of them were about oral salbutamol, being used in children <2years old. CONCLUSIONS: The use of anti-asthmatic drugs in our region is high, maybe it's related to the asthma prevalence. We observed variability between sanitary districts and health centres. The prescription patterns are closed to the current recommendation, except in the case of oral bronchodilators.

Drug utilisation study in patients receiving antiepileptic drugs in Colombia.

INTRODUCTION: This study examines the indications according to which antiepileptic drugs are prescribed and used in a population of patients enrolled in the Colombian national health system (SGSSS). METHODS: Retrospective cross-sectional study. From the pool of individuals in 34 Colombian cities who used antiepileptic drugs between 18 July, 2013 and 31 August, 2014 during a period of no less than 12 months, we obtained a random sample stratified by city. Socio-demographic, pharmacological and comorbidity variables were analysed. Continuous and categorical variables were compared, and logistic regression models were used. RESULTS: Our patient total was 373 patients, with 197 women (52.1%) and a mean age of 41.9 ± 21.7 years; 65.4% of the patients were treated with monotherapy. The most frequently used drugs were valproic acid (53.1%) and carbamazepine (33.2%). Epilepsy was the most frequent indication (n=178; 47.7%); however, 52.3% of the patients were prescribed antiepileptics for different indications, especially neuropathic pain (26.8%), affective disorders (14.2%) and migraine prophylaxis (12.3%). A total of 81 patients with epilepsy (46.6%) displayed good seizure control while another 25 (14.4%) had drug-resistant epilepsy. In the multivariate analysis, medication adherence was associated with a lower risk of treatment failure in patients with epilepsy (OR: 0.27; 95%CI, 0.11-0.67). CONCLUSIONS: In Colombia, antiepileptic drugs are being used for indications other than those originally intended. Monotherapy is the most commonly used treatment approach, together with the use of classic antiepileptic drugs.

[Drug prescriptions study in the outpatient setting: assessment of off-label uses in children]. / Estudio de las prescripciones farmacológicas en niños a nivel de atención primaria: evaluación de los usos off-label o fuera de ficha técnica.

OBJECTIVE: to evaluate the prescription profile and to assess the off-label and unlicensed uses of medicines among non-hospitalised pediatric patients. DESIGN: cross-sectional study. SETTING: pediatric units in two urban health centers and general emergency room (Hospital Materno-Infantil, Málaga). MAIN MEASUREMENTS: sociodemographics variables, reasons for consultation and information about therapeutic medications. The classification of prescriptions was established according to information requirements contained in the Summary of Products Characteristics (SPC). RESULTS: A total of 388 children were included (a subsample of 105 treated in the emergency room). Four hundred sixty-two prescriptions (involving 74 different active ingredients) were evaluated. Each infant received and average of 1,7 drugs (95% CI: 1,6-1,9). The most prescribed medicines were ibuprofen, paracetamol, amoxicillin-clavulanate and budesonide. The therapeutic group with the greatest variety of drugs was the respiratory group. 27,4% (95% CI: 23,5-31) of prescriptions were off-label and the main cause was different age (60%; 95% CI: 54,1-63), followed by different dose (21,5%; 95% CI: 18-25), different indication (12%; 95% CI: 9,2-15) and different route of administration (7%; 95% CI: 5,4-10). CONCLUSIONS: The rate of off-label uses presents intermediate figures. Around one third of the paediatric outpatients in our sample are exposed to at least one off-label or unlicensed prescription. We should, however, point out that such usage is based on scant official, quality information, although it is not necessarily incorrect. Evidence-based medicine should be encouraged to improve drug therapy in children, as well as following the rules on drugs in special situations.

Use of ergotamine: do physicians in Colombia know how to prescribe it?

INTRODUCTION: Ergot derivatives are drugs with vasoconstrictor effects that are used to abort migraine attacks. This study aims to determine how ergot derivatives are prescribed by physicians in Colombia, find variables associated with inappropriate prescribing, and review potential interactions in our patients. METHODS: We reviewed 86 411 formulas during April 2012, identifying the prescription by drug, dose, interval, duration of use, and indication. We interviewed 288 randomly selected patients in whom we also investigated concomitant use of a) antihypertensive agents b) ischaemic heart disease treatments c) antiretrovirals d) other antimigraine drugs, and e) macrolides, because of their potential for interactions. RESULTS: We identified 801 prescriptions from patients in 27 cities with a mean age of 35.1±14.1 years; 82.5% of the prescriptions were for women, 96.5% were written by primary care physicians, and 65.4% (n=524) corresponded to migraine treatments. There were 26 different prescription types and 797 prescriptions were incorrect with regard to usage recommendations (99.5%). Inappropriate prescribing was significantly associated with the health centre providing patient care (P=.005). Of the patients who were interviewed by telephone, 266 (92.4%) took the drug according to the erroneous indication. A total of 54 patients (6.7%) were treated with antihypertensive drugs, 24 (2.9%) with macrolides, and 5 (0.6%) with another concomitant antimigraine drug. DISCUSSION: Most patients take ergotamine improperly, apart from the fact that potential interactions may increase the risk of health problems such as ergotism and coronary events. Physicians will require assessment measures, updated information, and continuous training.

Falls in older adults hospitalized in tertiary centers in Colombia. Clinical description and complications.

OBJECTIVE: The incidence of falls in elderly patients in the hospital environment is three times higher than that in the community. The aim was to determine the characteristics of patients who suffered in-hospital falls and their complications. METHODS: This was a cross-sectional study with patients older than 64 years of age, admitted between 2018 and 2020 to four clinics in Colombia who presented a fall during their stay. Clinical data, reasons for the fall, complications and use of drugs with a known risk for causing falls and with an anticholinergic load were reviewed. RESULTS: A total of 249 patients were included. The mean age was 77.5 ± 7.4 years, and there was a predominance of males (63.9%). The patients were hospitalized mainly for community-acquired pneumonia (12.4%) and heart failure (10.4%). Falls occurred most frequently in hospitalization wards (77.1%) and emergency departments (20.9%). Falls were related to standing alone (34.4%) and on the way to the bathroom (28.9%), with 40.6% (n = 102) of falls resulting in trauma, especially to the head (27.7%); the incidence of fractures was low (3.2%). Ninety-two percent of patients had polypharmacy (≥5 drugs), 88.0% received psychotropic drugs, and 37.3% received drugs with an anticholinergic load ≥3 points. CONCLUSIONS: Hospitalized adults over 65 years of age suffered falls, mainly in hospitalization wards and emergency departments, especially during the process of solitary ambulation. Most had received psychotropic drugs and medications with a high anticholinergic load. These results suggest that it is necessary to improve risk prevention strategies for falls in this population.

Perfil de prescripciones de nutrición parenteral y evolución ponderal en prematuros menores de 36 semanas en un hospital de los andes peruanos. Un estudio descriptivo / Profile of parenteral nutrition prescriptions and weight evolution inpremature infants under 36 weeks in a hospital in the Peruvian Andes. A descriptive study

Introducción: Las guías reúnen los mejores niveles de evidencia científica y mediante su uso se mejora la calidad de atención, por ello es importante describir el perfil de prescripción de nutrición parenteral en prematuros de un hospital peruano y su evolución ponderal al 14vo día.Objetivo del estudio: Describir las prescripciones médicas de nutrición parenteral neonatal y su adherencia a las guías de referencia local basadas en ESPGHAN, ESPEN, ESPR; así como mostrar la evolución ponderal al 14vo día. Material y Métodos: Estudio observacional, descriptivo, retrospectivo en la unidad de cuidados intensivos neonatales del Hospital Nacional “Ramiro Prialé Prialé”, periodo 2022. Se consideró las prescripciones de nutrición parenteral que cumplan criterios de inclusión, exclusión y se comparó con las recomendaciones de la guía local; También se midió la ganancia ponderal al 14vo día mediante una fórmula validada previamente.Resultados: Se estudiaron 68 pacientes con edad gestacional mínima de 27 y máxima de 36 semanas; peso mínimo de 1000 gr y máxima de 3500 gr. Se halló que el primer día el promedio de prescripción energética fue 60,58 kcal/kg/día, aporte proteico 2,57 gr/kg/día y lipídico 2,18 gr/kg/día; correspondiendo a 72,06%, 69,12% y 57,35% de apego a las guías, al quinto día estos valores fueron incrementándose, a su vez ello correspondió a una adherencia de 100%, 94,12% y 97,06% según las guías de referencia. La ganancia ponderal promedio fue de 12,29 gr/kg/día al 14vo día.Conclusiones: La adherencia a las guías ESPGHAN, ESPEN, ESPR, en la prescripción de nutrición parenteral son aceptables, siendo ésta mucho mayor al quinto día. Es probable que ello tenga relación a la evolución ponderal encontrada.(AU)

Introduction: The guidelines bring together the best levelsof scientific evidence and through their use the quality of careis improved, therefore it is important to describe the parenteralnutrition prescription profile in premature infants in a Peruvianhospital and their weight evolution on the fourteenth day. Objective of the study: To describe medical prescriptionsfor neonatal parenteral nutrition and their adherence to localreference guidelines based on ESPGHAN, ESPEN, ESPR; aswell as showing the weight evolution on the fourteenth day. Material and Methods: Observational, descriptive, retro-spective study in the neonatal intensive care unit of the“Ramiro Prialé Prialé” National Hospital, period 2022 Parenteral nutrition prescriptions that meet inclusion and ex-clusion criteria were considered and compared with the rec-ommendations of the local guide; Weight gain on the 14thday was also measured using a previously validated formula. Results: 68 patients with a minimum gestational age of 27and maximum of 36 weeks were studied; minimum weight of1000 gr and maximum of 3500 gr. It was found that on the firstday the average energy prescription was 60.58 kcal/kg/day,protein intake 2.57 gr/kg/day and lipid intake 2.18 gr/kg/day;corresponding to 72.06%, 69.12% and 57.35% of adherenceto the guidelines, on the fifth day these values increased, inturn this corresponded to an adherence of 100%, 94.12% and97.06 % according to reference guides. The average weightgain was 12.29 gr/kg/day on the fourteenth day. Conclusions: Adherence to the ESPGHAN, ESPEN, ESPRguidelines in the prescription of parenteral nutrition is accept-able, with this being much higher on the fifth day. It is likelythat this is related to the weight evolution found:(AU)

Prescrição de antidepressivos na atenção primária: um estudo descritivo acerca da confiança dos profissionais médicos / Prescription of antidepressants in primary care: a descriptive study on medical professionals' confidence / Prescripción de antidepresivos en atención primaria: un estudio descriptivo acerca de la confianza de los profesionales médicos

Resumo: Os antidepressivos são a terceira classe medicamentosa mais prescrita, sendo que a maioria das prescrições não é realizada por especialistas. O objetivo do estudo é avaliar a autopercepção de confiança na prescrição de antidepressivos por médicos da atenção primária à saúde (APS). Foi realizado estudo de corte transversal de médicos atuantes na APS da cidade de Salvador, Bahia, Brasil. Foram excluídos psiquiatras ou residentes de psiquiatria. A autoavaliação da confiança, assim como a coleta de características dos participantes foi realizada por meio de questionário online. Variáveis categóricas foram descritas em termos de frequência absoluta e relativa. Variáveis contínuas foram descritas como média ou mediana, conforme distribuição de normalidade. No contexto total de 447 médicos, a amostra foi composta por 55 participantes. A média de idade foi de 37,2 (±12,8) anos. A maioria dos médicos (75%) reconheceu-se confiante na prescrição de antidepressivos. A autopercepção de confiança manteve-se predominante em cenários de pacientes idosos (69,2%) e portadores de comorbidades gerais (65,4%). A minoria mostrou confiança para prescrever antidepressivos a crianças/adolescentes (19,2%) e gestantes (26,9%). Para 80,4% dos participantes, os inibidores seletivos da recaptação de serotonina foram a classe farmacológica de maior confiança. O encaminhamento para o Centro de Atenção Psicossocial foi a estratégia mais referida em casos de insegurança na prescrição (32%). Até onde se sabe, esse é o primeiro estudo a abordar tal questão. Por essa razão, ele pode contribuir para a construção de ações de educação em saúde mais assertivas voltadas a médicos da APS.

Abstract: Antidepressants are the third most prescribed drug class, and most prescriptions are not performed by specialists. This study aimed to evaluate primary health care (PHC) physicians' self-perceived confidence in prescribing antidepressants. This is a cross-sectional study with PHC physicians in the municipality of Salvador, Bahia State, Brazil. Psychiatrists or psychiatry residents were excluded. The self-assessment of confidence and the collection of participants' characteristics was carried out by an online questionnaire. Categorical variables were presented in absolute and relative frequencies. Continuous variables were described as means or medians according to their normality distribution. Of 447 physicians, the sample consisted of 55 participants. Their mean age was 37.2 ± 12.8 years. Most physicians (75%) claimed confidence in prescribing antidepressants. Self-perceived confidence remained predominant in scenarios with older adults (69.2%) and patients with general comorbidities (65.4%). A minority showed confidence to prescribe antidepressants to children/adolescents (19.2%) and pregnant women (26.9%). For 80.4% of participants, selective serotonin reuptake inhibitors were the most trusted pharmacological class. Referral to the Psychosocial Care Center was the most reported strategy in cases of insecure prescription (32%). To the best of our knowledge, this is the first study to address such an issue. Thus, it can contribute to more assertive health education actions for PHC physicians.

Resumen: Los antidepresivos son la tercera clase de medicamentos más prescritos, y la mayoría de las prescripciones no son realizadas por especialistas. El objetivo del estudio es evaluar la autopercepción de confianza en la prescripción de antidepresivos por parte de los médicos de atención primaria de salud (APS). Corte transversal de médicos que trabajan en la APS de la ciudad de Salvador, Bahia, Brasil. Se excluyeron a los psiquiatras o residentes de psiquiatría. La autoevaluación de la confianza, así como la recolección de las características de los participantes, fue realizada a través de un cuestionario online. Las variables categóricas se describieron en términos de frecuencia absoluta y relativa. Las variables continuas se describieron como media o mediana, según la distribución de normalidad. En el contexto total de 447 médicos, la muestra estaba formada por 55 participantes. La edad promedio fue de 37,2 (±12,8) años. La mayoría de los médicos (75%) se reconocieron confiados en la prescripción de antidepresivos. La autopercepción de confianza se mantuvo predominante en los escenarios de pacientes ancianos (69,2%) y portadores de comorbilidades generales (65,4%). La minoría mostró confianza para prescribir antidepresivos a niños/adolescentes (19,2%) y mujeres embarazadas (26,9%). Para el 80,4% de los participantes, los inhibidores selectivos de la recaptación de serotonina eran la clase farmacológica de mayor confianza. El encaminamiento para el Centro de Atención Psicosocial fue la estrategia más mencionada en los casos de inseguridad en la prescripción (32%). Hasta donde se sabe, este es el primer estudio que aborda este tema. Por esa razón, puede contribuir para la construcción de acciones de educación en salud más asertivas dirigidas a los médicos de la APS.

Prescripción de insulina Neutral Protamine Hagedorn en Atención Primaria de Salud, municipio Santa Clara, 2023

Introducción: La diabetes es una enfermedad de carácter crónico, que se origina cuando el organismo pierde su capacidad de producir insulina necesaria para utilizarla de manera eficaz. La diabetes mellitus tipo 1 se caracteriza por la destrucción autoinmune de las células beta del páncreas, que conlleva a una deficiente producción de insulina. Mientras que, la diabetes mellitus tipo 2 resulta de la combinación de resistencia a la insulina junto con inadecuada secreción de la misma. En ambos casos, se utiliza el medicamento insulina para garantizar un control de la enfermedad. Objetivo: Caracterizar la prescripción del medicamento insulina Neutral Protamine Hagedorn bulbo, en una farmacia comunitaria perteneciente a la Atención Primaria de Salud del municipio Santa Clara. Métodos: Se realizó una investigación observacional, descriptiva y transversal, que se corresponde con un estudio de uso de medicamentos del tipo prescripción-indicación del medicamento insulina Neutral Protamine Hagedorn bulbo en septiembre 2023. El universo estuvo conformado por 852 pacientes, que tenían prescripción por certificado para medicamentos controlados vigentes. La muestra no probabilística quedó conformada por 26 pacientes. El tipo de muestreo fue aleatorio simple y los resultados se presentaron en tablas mediante números absolutos y porcentaje. Se respetó el principio a la confidencialidad de la información revisada y los certificados para medicamentos controlados. Resultados: Predominaron los pacientes del sexo femenino (76,92 %), mayores de 50 años (84,62 %), hipertensión arterial como comorbilidad (76,92 %), presentaban cuatro o más medicamentos (61,54 %) y la combinación con glibenclamida, metformina, enalapril, captopril, carvedilol, ácido acetilsalicílico, hidroclorotiazida y levotiroxina sódica fueron las interacciones medicamentosas de mayor importancia clínica. Conclusiones: La frecuencia en la prescripción de insulina Neutral Protamine Hagedorn bulbo, es similar a la encontrada en algunos estudios previos, es más representativa a partir de la quinta década de la vida y más frecuente en el sexo femenino.

Introduction: Diabetes is a disease of a chronic nature which occurs when the body loses its ability to produce the insulin needed to use it effectively. Type 1 diabetes mellitus is characterized by destruction of pancreatic beta cells in genetically predisposed individuals and the consequent deficiency in insulin production while type 2 diabetes mellitus results from the combination of insulin resistance along with inadequate secretion of it. In both cases, the insulin medication is used to ensure control of the disease. Objective: To characterize the prescription profile of Neutral Protamine Hagedorn insulin vial in Santa Clara Community Pharmacy. Methods: An observational, retrospective, descriptive and cross-sectional investigation was conducted that corresponded with a medications use study, of prescription-indication type of the medication Neutral Protamine Hagedorn insulin vial in September 2023. The universe was 852 patients and the sample was 26 patients with NPH insulin vial prescription, the sampling was simple random and the results were presented in tables using absolute numbers and percentages. The principle of confidentiality of the reviewed information and certificates for controlled medications was respected. Results: The female sex predominated (76.92 %), older than 50 years (84.62 %), arterial hypertension as a comorbidity (76.92 %), 4 or more medications (61.54 %) and the combination with glibenclamide, metformin, enalapril, captopril, carvedilol, acetylsalicylic acid, hydrochlorothiazide and levothyroxine sodium were the most clinically important drug interactions. Conclusions: The prevalence in the prescription of Neutral Protamine Hagedorn insulin vial is similar to that found in some previous studies, being more representative from the 5th decade of life and more frequent in the female sex.

Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas / Impact of COVID-19 lockdown on the prescription of benzodiazepines

Objetivo: Evaluar el efecto del confinamiento por COVID-19 sobre la prescripción de benzodiacepinas según edad, sexo y zona básica de salud. Diseño: Estudio observacional longitudinal. Emplazamiento: Atención primaria. Área V de Salud del Principado de Asturias. Participantes: Mayores de 15 años a los que se prescribieron benzodiacepinas entre 2017 y 2020. Mediciones principales: Diferencia de las medias de dosis diaria definida por 1.000 habitantes (DHD) mensual de benzodiacepinas entre el periodo definido como preconfinamiento y el confinamiento. Además, se ajusta la diferencia por edad, sexo y zona básica de salud, así como por la interacción entre ellas. Resultados: La DHD media preconfinamiento fue 131,3 y 139,5 durante el confinamiento; en el análisis crudo, esta diferencia fue estadísticamente significativa (IC 95% 4,1 a 12,1). Se objetivó un aumento de DHD media en el grupo de 60-74 años (IC 95% 2,28 a 21,42) y en el de 90 años o más (IC 95% 21,31 a 40,63), así como en las mujeres (IC 95% 3,51 a 14,59). Finalmente, se observó una disminución de DHD media en las zonas básicas V11 (IC 95% -29 a -0,66) y V14 (IC 95% -54,28 a -25,04). Conclusiones: Determinados subgrupos muestran un cambio en la tendencia de dispensación de benzodiacepinas sin poder atribuirse completamente al confinamiento. Creemos que pueda existir una inercia terapéutica en la prescripción de psicofármacos, según las características biopsicosociales del paciente, que es importante detectar para evitar la medicalización de cuadros psicológicos.(AU)

Objective: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. Design: Longitudinal observational study. Location: Primary care. Asturias (Spain) health district V. Participants: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. Main measurements: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. Results: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1–12.1). There was an increase in the DHD mean in the 60–74 age group (95% CI: 2.28–21.42), in the group over 90 years old (95% CI: 21.31–40.63) and in women (95% CI: 3.51–14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed.Conclusions: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.(AU)

Análisis de las prescripciones y dispensaciones de psicofármacos en una oficina de farmacia de la provincia de Mendoza, Argentina / Prescriptions and dispensations analysis of psychotropic drugs in a pharmacy office of Mendoza province, Argentina

El Uso Racional de Medicamentos refiere a prácticas adecuadas en cada componente de la cadena de utilización. En este trabajo, nuestro objetivo radicó en determinar el perfil de las prescripciones de psicofármacos recibidas y dispensadas en una oficina de farmacia de la provincia de Mendoza (Argentina), evaluar posibles errores, medir la magnitud del consumo e identificar los psicofármacos de primera elección. Se efectuó un análisis observacional, transversal y retrospectivo de prescripciones dispensadas entre el 1 de enero y el 30 de junio de 2020. Los datos se obtuvieron directamente desde las prescripciones. Los fármacos se codificaron según el sistema de clasificación ATC y los diagnósticos según la Clasificación Internacional de Enfermedades, ambos propuestos por la OMS. La prueba del Chi-cuadrado se utilizó para comparar las variables. Una probabilidad de p<0,05 fue considerada estadísticamente significativa. Se registraron 7.836 prescripciones en 7.041 recetas (media por paciente = 1,11±0,32). Hubo mayor prescripción de psicofármacos a pacientes femeninos (χ2 p<0,001). Las especialidades médicas que más prescribieron los psicofármacos dispensados fueron Clínica, Medicina Familiar y Psiquiatría. Los fármacos psicolépticos fueron los mayormente prescritos, seguido de los antiepilépticos, psicoanalépticos y analgésicos. El 43,76% del total correspondió a benzodiacepinas, principalmente clonazepam, alprazolam y bromazepam. Clonazepam fue el fármaco más prescrito en el período analizado (21,75%), principalmente para diagnósticos de trastornos de ansiedad, hipertensión arterial y depresión. Los registros obtenidos muestran un elevado consumo de ciertos psicofármacos, resultando coincidente con estudios semejantes, hallándose idéntica relación con los fármacos más prescritos, sexo y especialidad del profesional prescriptor. (AU)

The Rational Use of Medicines it refers to adequate practices in each component of the utilization chain. In this work, our objective was to determinate profile of psychotropic drugs prescriptions received and dispensed in a pharmacy office of Mendoza province (Argentina), with evaluation of possible errors, determination of the magnitude consumption and identification of first-choice psychotropic drugs. It was performed an observational, cross-sectional, and retrospective analysis of the prescriptions dispensed between January 1 and June 30, 2020. Data were obtained directly from prescriptions. Drugs were coded according to the ATC classification system and diagnoses according to the International Classification of Diseases, both proposed by the WHO. The Chi-square test was used to compare the variables. A probability of p<0.05 was considered significant statistically. It was registered 7,836 prescriptions in 7,041 prescriptions (mean per patient = 1.11±0.32). There was a greater prescription of psychotropic drugs to female patients (χ2 p<0.001). The clinical medical did result the professional that more prescribed the psychotropic drugs dispensed followed by Family Medicine and Psychiatry specialties. Psycholeptic drugs were the most prescribed, followed by antiepileptic, psychoanaleptic and analgesic drugs. 43.76% of the total corresponded to benzodiazepines, mainly clonazepam, alprazolam and bromazepam. Clonazepam was the most prescribed drug in the analyzed period (21.75%), mainly for diagnosing anxiety disorders, arterial hypertension, and depression. The records obtained show a high consumption of certain psychotropic drugs groups, which coincides with similar studies, finding an identical relationship with the most prescribed drugs, sex, and specialty of the prescribing professional. (AU)

Prescripción del ejercicio en paciente post operatorio de cirugía bariátrica 2010-2020: Revisión exploratoria

El ejercicio sigue siendo una intervención necesaria para la pérdida y mantenimiento del peso en pacientes postquirúrgicos de cirugía bariátrica. Sin embargo, los principios básicos de su prescripción luego de este tipo de intervenciones son aún controversiales en la literatura. En este contexto, el objetivo de este estudio fue describir los principales componentes de la prescripción del ejercicio en pacientes postquirúrgicos de cirugía bariátrica y sus beneficios asociados. Se realizó una revisión exploratoria usando las bases de datos Pubmed, PEDro, Springer, Science Direct, y Scielo. Se utilizó un algoritmo de búsqueda con los términos clave "cirugía bariátrica", "obesidad", "ejercicio", "post-quirúrgico", "prescripción del ejercicio" y "actividad física", en inglés y español. Fueron incluidos ensayos clínicos y estudios observacionales publicados entre 2010-2020, donde hubo prescripción del ejercicio posterior a cirugía bariátrica. Un total de 13 estudios fueron analizados. Los parámetros recomendados incluyeron la frecuencia de 3 a 5 veces por semana, intensidad aeróbica entre el 60-85% de la FCmáx o 60-70% de VO2máx, intensidad anaeróbica entre el 60-85% de 1 repetición máxima (1RM), y duración entre 12 y 18 semanas. El ejercicio es una herramienta importante para mantener y reducir el peso, atenuar el sedentarismo y mejorar la calidad de vida en paciente postquirúrgicos de cirugía bariátrica con resultados seguros y eficaces siempre y cuando se garanticen los niveles de intensidad, frecuencia, duración, tipo y progresión sugeridos.

Exercise remains a necessary intervention for weight loss and weight maintenance in post-bariatric surgery patients. However, the basic principles of its prescription after this type of interventions are still controversial in the literature. In this context, our objective was to describe the main components of exercise prescription in post-bariatric surgery patients and its associated benefits. A scoping review was carried out using the Pubmed, PEDro, Springer, Science Direct, and Scielo databases. A search algorithm was used with the terms "bariatric surgery", "obesity", "exercise", "post-surgical", "exercise prescription" and "physical activity", in English and Spanish. Clinical trials and observational studies published between 2010-2020, where there was exercise prescription after bariatric surgery, were included. A total of13 studies were analyzed. The recommended parameters included frequency 3 to 5 times per week, aerobic intensity between 60-85% of HRmax or 60-70% of VO2max, anaerobic intensity between 60-85% of 1 repetition maximum (1RM), and duration period between 12 and 18 weeks. Exercise is an important tool to maintain and reduce weight, attenuate sedentary lifestyle and improve quality of life in post-bariatric surgery patients with safe and effective results as long as the suggested levels of intensity, frequency, duration, type and progression are guaranteed.

[Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)]. / Prescripción facultativa y consentimiento informado ante el uso de restricciones físicas en centros geriátricos de las Islas Canarias.

OBJECTIVE: To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. METHODS: A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. RESULTS: 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). CONCLUSIONS: Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results.

Prescripción de fármacos cardiotóxicos en pacientes con enfermedades cardiovasculares / Prescription of cardiotoxic drugs in patients with cardiovascular diseases

Introducción: El uso de fármacos con potencial cardiotóxico para tratar enfermedades no cardiovasculares coexistentes resulta un agravante evitable. Objetivo: Evaluar la prescripción de 5 fármacos cardiotóxicos en pacientes con enfermedades cardiovasculares. Métodos: Se realizó un estudio descriptivo transversal (enmarcado en los estudios de utilización de medicamentos) de marzo a diciembre de 2020 en el Policlínico Santa Cruz (Artemisa, Cuba), en una población de 234 sujetos con enfermedades cardiovasculares que habían sido tratados con domperidona, azitromicina, ciprofloxacina, ibuprofeno y diclofenaco. Las variables estudiadas fueron: sexo, edad, consumo de fármacos cardiotóxicos, motivo de indicación, enfermedades cardiovasculares, forma farmacéutica, dosis diaria, intervalo de las dosis y duración del tratamiento. Se realizó un análisis estadístico descriptivo. Resultados: Los fármacos más prescritos fueron la azitromicina (n= 63), el ibuprofeno (n= 59) y la ciprofloxacina (n= 57). Sus principales motivos de indicación fueron, respectivamente, la neumonía adquirida en la comunidad (38,1 por ciento), las infecciones de piel y tejidos blandos (28,8 por ciento), y las infecciones del tracto urinario (43,8 por ciento). La principal enfermedad cardiovascular fue la hipertensión arterial. Para los 5 fármacos seleccionados se reportó su esquema terapéutico (forma farmacéutica, dosis diaria, intervalo de dosis y duración del tratamiento). Conclusiones: Aunque en todos los casos el motivo de indicación es el adecuado, los fármacos pueden sustituirse por otros de menor riesgo cardiovascular. En su mayoría, los esquemas terapéuticos son correctos, salvo en los casos de la domperidona (duración prolongada) y el diclofenaco (altas dosis)(AU)

Introduction: The use of drugs with cardiotoxic potential to treat coexisting noncardiovascular diseases results in avoidable aggravation. Objective: To assess the prescription of 5 cardiotoxic drugs in patients with cardiovascular disease. Methods: A cross-sectional descriptive study (framed in the studies of drug utilization) was carried out from March to December 2020 in the Policlínico Santa Cruz (Artemisa, Cuba), in a population of 234 subjects with cardiovascular diseases who had been treated with domperidone, azithromycin, ciprofloxacin, ibuprofen and diclofenac. The variables studied were: sex, age, consumption of cardiotoxic drugs, reason for indication, cardiovascular disease, pharmaceutical form, daily dose, dose interval, and duration of treatment. Descriptive statistical analysis was performed. Results: The most prescribed drugs were azithromycin (n= 63), ibuprofen (n= 59) and ciprofloxacin (n= 57). Their main reasons for indication were, respectively, community-acquired pneumonia (38.1 percent), skin and soft tissue infections (28.8 percent), and urinary tract infections (43.8 percent). The main cardiovascular disease was arterial hypertension. For the 5 selected drugs, their therapeutic scheme (pharmaceutical form, daily dose, dose interval and duration of treatment) was reported. Conclusions: Although in all cases the reason for indication was adequate, the drugs can be substituted by others of lower cardiovascular risk. For the most part, the therapeutic regimens are correct, except in the cases of domperidone (prolonged duration) and diclofenac (high doses)(AU)

Prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna en un hospital de referencia en México / Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico

Resumen Antecedentes: Una prescripción potencialmente inapropiada (PPI) constituye un riesgo de presentar efectos adversos por un fármaco que superan los beneficios de este, pudiendo considerarse como uso inadecuado de medicamentos. Objetivo: Describir la prevalencia de prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna de un hospital de referencia en México. Material y métodos: Diseño descriptivo transversal, con asignación simple de expedientes clínicos de pacientes hospitalizados mayores de 65 años, entre enero de 2016 y agosto de 2017. Se aplicaron los criterios STOPP y START para identificar el número de PPI, cantidad de medicamentos prescritos, presencia, cantidad y tipo de comorbilidades, así como días de estancia hospitalaria. Resultados: Se encontró una prevalencia de 73.3 % de PPI y las principales comorbilidades fueron hipertensión arterial y diabetes mellitus tipo 2. Se cuantificaron 1885 medicamentos prescritos; la estancia hospitalaria media fue de 6.3 días. Conclusiones: Se identificó alta prevalencia de PPI en los pacientes geriátricos hospitalizados, de ahí la importancia de aplicar los criterios STOPP y START y del papel del farmacéutico en la validación de la prescripción antes de la administración de medicamentos.

Abstract Background: Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. Objective: To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. Material and methods: Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. Results: A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. Conclusions: A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

Utilización de medicamentos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de alta complejidad español. Estudio descriptivo / Off-label and unlicensed drug use in a pediatric intensive care unit of a tertiary care Spanish hospital. A descriptive study

Introducción. En las unidades de cuidados intensivos pediátricos, se utiliza gran cantidad de medicamentos, muchos prescritos fuera de las condiciones establecidas en su ficha técnica (prescripciones off-label y unlicensed). El objetivo de este estudio fue describir el uso de medicamentos y estimar la prevalencia de fármacos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de tercer nivel español. Población y métodos. Estudio transversal, observacional, de una cohorte de niños ingresados en una unidad de cuidados intensivos pediátricos. El estudio se llevó a cabo en 2017. Se revisó cada fármaco prescrito, sus condiciones de uso y administración. Además, se analizaron las fichas técnicas de los fármacos implicados con la finalidad de identificar si el uso de los medicamentos se realizaba según sus condiciones de autorización, o bien se hacía fuera de prospecto (off-label) o como unlicensed. Resultados. La muestra fue de 97 pacientes. El 74,2 % (n = 72) de los pacientes recibieron algún fármaco off-label o unlicensed. El 23,8 % (n = 243) de las prescripciones fueron off-label y el 8,7 % (n = 89), unlicensed. El subanálisis realizado por grupos de edad mostró que el grupo de edad que recibió mayor número de prescripciones totales (n = 611) y el mayor porcentaje de fármacos prescritos en condiciones off-label y/o unlicensed (38,4 %) fue el de menores de 2 años. Conclusiones. La prescripción de fármacos off-label y/o unlicensed es una práctica habitual en la unidad de cuidados intensivos pediátricos. Este estudio permite documentar la complejidad de la terapéutica en niños.

Introduction. In pediatric intensive care units, a large number of drugs are used, many of which are prescribed for condition beyond those established in their summary of product characteristics (off-label and unlicensed drug prescriptions). The objective of this study was to describe drug use and estimate the prevalence of off-label and unlicensed drugs in a pediatric intensive care unit of a tertiary care Spanish hospital. Population and methods. Cross-sectional, observational study with a single cohort of children admitted to a pediatric intensive care unit. The study was conducted in 2017. Each drug prescription, its conditions of use and administration were reviewed. In addition, the summary of product characteristics of drugs used were analyzed in order to identify whether they were used according to their conditions of authorization, or whether they were used in an off-label or unlicensed manner. Results. The sample included 97 patients. At least one off-label or unlicensed drug was administered to 74.2% (n = 72) of patients; 23.8% (n = 243) corresponded to off-label prescriptions and 8.7% (n = 89), unlicensed prescriptions. A sub-analysis by age group showed that the age group that received a higher number of total prescriptions (n = 611) and a higher percentage of off-label and/or unlicensed drug prescriptions (38.4%) was under 2 years of age. Conclusions. Off-label and/or unlicensed drug prescription is a common practice in the pediatric intensive care unit. This study allowed us to document the complexity of therapeutics in children.