Sociodemographic, clinical and pharmacological factors influencing early readmission in mental health settings.

Early readmissions (between 24 hours and 30 days after discharge) can be disruptive for psychiatric patients and their families.

Network meta-analysis of tofacitinib versus biologic treatments in moderate-to-severe rheumatoid arthritis patients.

WHAT IS KNOWN AND OBJECTIVE: Rheumatoid arthritis (RA) is an autoimmune disease characterized primarily by inflammation and pain in the joints. Tofacitinib is an oral drug recently approved for RA treatment; it inhibits Janus protein kinases (JAK) that reduces RA symptoms when conventional DMARDs do not trigger a response. This study aimed to compare the efficacy of biological DMARDs in monotherapy or combined with methotrexate in RA patients and compare the treatments. METHODS: We reviewed the literature for articles published up to June 2017, evaluating the efficacy and safety of the biological DMARDs indicated for RA in patients with inadequate responses to conventional DMARDs and naïve to biological DMARDs, in similar populations, considering ACR50 as the efficacy variable. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each drug combination, and these parameters were transformed into differences in responses to assess the effectiveness of the alternative medicines. Equivalence therapeutic alternatives (ETA) were ensured to assess the possibility of considering these medications with equivalent efficacy. A network meta-analysis (NMA) was performed using Bayesian approaches and the fixed-effects model. RESULTS AND DISCUSSION: Twenty-seven randomized clinical trials (RCTs) that met the pre-established criteria were identified. The 95% CI of biological DMARDs was higher than that of placebo without methotrexate, except for certolizumab, golimumab-m, anakinra-m and adalimumab monotherapy. These DMARDs performed significantly better than the placebo, except for etanercept, certolizumab, tofacitinib and golimumab. Certolizumab-m was better than anakinra-m and adalimumab, and tocilizumab alone or combined with methotrexate was superior to adalimumab. Etanercept-m yielded a higher difference in responses compared with the other biological DMARDs, which presented more homogeneous responses, except for adalimumab and anakinra-m, which yielded worse results. None of the biological DMARDs displayed ETA to etanercept-m; however, they displayed ETA with certolizumab-m, except for adalimumab and anakinra-m. WHAT IS NEW AND CONCLUSION: All biological DMARDs used in combination with methotrexate, except for etanercept, anakinra, certolizumab and tocilizumab without methotrexate, were displayed ETA on using ACR50 at week 24 in patients naïve to biological DMARDs. Etanercept displayed a greater difference in responses, although the high uncertainty of the comparative results prevented the confirmation of the increased efficacy of this drug.

Factores sociodemográficos, clínicosy farmacológicos asociados alreingreso precoz en pacientesde salud mental / Socio-demographic, clinical and pharmacological factors associated with early admission in mental health patients

Introducción: Los reingresos precoces (entre las 24 horasy 30 días tras el alta) pueden ser traumáticos para los pacientes psiquiátricos y sus familias, por lo que determinar losfactores que lo predisponen es esencial desde un punto devisto tanto terapéutico como económico.Metodología. Se llevó a cabo un estudio de casos y controles retrospectivo para el periodo entre 2015-2017. Se emparejaron los casos con los controles según edad, diagnóstico, sexo y fecha de ingreso. Se recogieron variables sociodemográficas, clínicas y farmacológicas de interés.Resultados. Se analizaron 86 controles y 86 casos. El grupo mayoritario fue F20-29 (70,9%). En el análisis bivarianteresultaron estadísticamente significativas (ES)las variables“entorno urbano vs. rural” (p=0,011), mala adherencia farmacológica (AdFa) subjetiva (p=0,048), mala AdFa objetiva(p=0,023), ausencia de red de apoyo (p=0,019), seguimiento deficiente en consultas externas de psiquiatría (p=0,021),falta de empleo (p=0,046) y un mayor número de ingresos en el año previo (p<0,001). En el análisis multivariantefueron ES las variables: número de reingresos el año previo(OR=1,536; IC95%:1,174–2,009; p=0,002), habitar en un entorno “urbano” (OR=2,791; IC95%:1,017–7,663; p=0,046),ausencia de red de apoyo OR=2,255; IC95%:1,160–4,384;p=0,017) y un seguimiento ambulatorio inestable (OR=2,156;IC95%:1,101–4,223; p=0,025). Conclusiones. El habitar en un entorno urbano, una bajaAdFa, la ausencia de red de apoyo, un seguimiento deficiente enconsultas externas de psiquiatría, la falta de empleo y un altonúmero de reingresos en el año previo se relacionan de formadirecta con el reingreso precoz en pacientes psiquiátricos. (AU)

Background: Early readmissions (between 24 hours and30 days after discharge) can be disruptive for psychiatric patients and their families. The aim of this study is to determinethe factors influencing this early readmission.Methods. A retrospective case-control study was carriedout from 2015 to 2017. Cases were matched with controlswith a similar age (± 10 years), admission date (± 30 days),ICD-10 diagnosis and sex. Sociodemographic, clinical andpharmacological factors were examined.Results. 86 cases and 86 controls were chosen. The largest ICD-10 group was F20-29 (70,9%). Statistically significant (SS) factors according to the bivariate analysis were:urban vs. rural living environment (p=0.011); poor subjectivepharmacological adherence (AdFa, p=0.048); poor objective AdFa (p=0.023); poor social or family support (p=0.019);poor follow-up in psychiatric outpatient consultations (p=0.021); unemployment (p=0.046); and a higher numberof readmissions during the previous year (p<0.001). In themultivariate analysis, SS factors were: urban living environment (OR=2.791; 95% CI, 1.017–7.663; p=0.046); poorsocial or family support (OR=2.255; 95% CI, 1.160–4.384;p=0.017); poor follow-up in psychiatric outpatient consultations (OR=2.156; 95% CI, 1.101–4.223; p=0.025); anda higher number of readmissions during the previous year(OR=1.536; 95% CI, 1.174–2.009; p=0.002).Conclusions. Living in an urban environment; poor AdFa;poor social or family support; poor follow-up in psychiatric outpatient consultations; unemployment; and a highernumber of readmissions during the previous year were all directly related to early readmissions for psychiatric patients. (AU)