[In processu astricti contra Dominicum et Martinum Barrachina infantiones super criminali : en favor de los acusados : initium a domino]

Enc. per. con correillas.Tít. tomado de p. 1 y menc. de resp. de p. 16.En p. 16 texto fechado en Caesaraugustae ... 1632.Inic. grab. xil.Sello: "Instituto y Provª de Huesca. Biblioteca

Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences

1 Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain 2 Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain 3 Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010, Alicante, Spain 4 Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain 5 Clinical Pharmacology Department, Dr. Balmis General University Hospital, ISABIAL c/ Pintor Baeza, 12, 03010 Alicante, Spain More than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taking into account the impact of sex and pharmacogenetics on the inter-individual variability. A cross-sectional study was carried out from October 2019 to June 2020 on CNCP patients who had previously undergone an opioid deprescription (n = 119 patients). Demographic, clinical (pain, relief and adverse events) and therapeutic (analgesic use) outcomes were collected. Effectiveness (< 50 mg per day of morphine equivalent daily dose without any aberrant opioid use behaviour) and safety (number of side-effects) were analysed in relation to sex differences and pharmacogenetic markers impact [OPRM1 genotype (rs1799971) and CYP2D6 phenotypes]. Long-term opioid deprescription was achieved in 49 % of the patients with an increase in pain relief and a reduction of adverse events. CYP2D6 poor metabolizers showed the lowest long-term opioid doses. Here, women showed a higher degree of opioid deprescription, but increased use of tramadol and neuromodulators, as well as an increased number of adverse events. Long-term deprescription was successful in half of the cases. Understanding sex and gender interaction plus a genetic impact could help to design more individualized strategies for opioid deprescription

Non-pharmacological therapy in chronic musculoskeletal pain

BACKGROUND: Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. Non-pharmacological therapies, as relaxation and exercise, may have specific benefits in reducing the severity of chronic non-cancer pain improving functioning. Although there is low evidence of their effectiveness, they are usually included as a first approach in consensus guidelines on chronic pain. The aim of this study was to investigate whether standard non-pharmacological therapies are effective in relieving chronic non-cancer pain and improving its disabling consequences in real world. METHODS: Pain Unit ambulatory patients, chronically treated with opioids, were included between 2012 and 2017, in four different non-pharmacological therapies: Jacobson progressive muscular relaxation (N.=58), occupational therapy (N.=43), physiotherapy (N.=34) and relaxing yoga (N.=41) sessions. Pain intensity (Visual Analogue Scale), sleep (Medical Outcomes Study Sleep), functionality (Barthel Index and International Physical Activity Questionnaire) and adherence, were evaluated pre- and postinterventions. Hospital Ethics Committee approved the study and data was analyzed with GraphPad Prism v. 5.02 software (GraphPad Inc., La Jolla, CA, USA) and R. 3.2.4 (R Foundation for Statistical Computing, Vienna, Austria). RESULT S: A total of 147 patients (55±13 years old; 69% female) were included mostly with moderate to severe chronic low back pain (89%, VAS 68±22.7 mm) and under long-term use of opioids. Results showed a lower pain intensity postintervention in all group treatments, especially in patients with severe pain intensity and upon physiotherapy. Pain relief was associated with an improvement on quantity and quality of sleep. All interventions had no adverse events and a high self-rated adherence to the recommended exercise training. CONCLUSIONS: Findings support the effectiveness, tolerability, and acceptability of non-pharmacological interventions for reducing pain perception and improve sleep with minimal therapist time, especially physiotherapy for chronic non-cancer pain

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

MINDFULNESS BASED STIMULATION FOR ELDERLY PEOPLE WITH ALZHEIMER’S DISEASE OR OTHER TYPES OF DEMENTIA

Psychological treatments are a common practice in healthcare centres for elderly dependent people. Recently, mindfulness practice is being introduced in these settings. However, it is difficult to carry out mindfulness practice in residential or day care centres due to the cognitive impairment of the elderly users. This paper shows how a mindfulness based stimulation program for activities of daily life (ADLs) has been developed. This intervention aims to train care assistants to the elderly together with the elderly people themselves so that afterwards, within the routine at the centre, daily life activities can be carried out with conscious presence. The ultimate purpose of this intervention is to strengthen functional coherence and personal integration through the practice of mindfulness in action with basic, instrumental and advanced activities

ESTIMULACIÓN BASADA EN MINDFULNESS PARA PERSONAS MAYORES CON ENFERMEDAD DE ALZHEIMER U OTRAS DEMENCIAS

Los tratamientos psicológicos son una práctica habitual en el contexto sociosanitario de atención a personas mayores dependientes. En los últimos años se está introduciendo la práctica de mindfulness para personas mayores. Sin embargo, estas prácticas presentan dificultades para su aplicación en residencias y centros de día por el deterioro cognitivo que presentan los usuarios de estos servicios. En este artículo se muestra cómo se desarrollo un programa de estimulación basado en mindfulness en el entrenamiento de las actividades de vida diaria (AVD). Esta intervención se fundamenta en el entrenamiento del personal auxiliar y/o cuidador de forma simultánea con los usuarios de los servicios para, posteriormente en la rutina del centro, realizar un entrenamiento de la presencia consciente en la acción durante las AVD. El objetivo final de esta intervención es potenciar la coherencia funcional y la integración personal mediante prácticas de mindfulness en acción en actividades básicas, instrumentales o avanzadas

Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients

The threats involved in the long-term opioid treatment of chronic non-cancer pain (CNCP) have increased notably. Strategies to identify at-risk patients are important because there is no clear evidence showing which screening or deprescription programmes are appropriate. Our aim was to evaluate the evidence provided by pharmacogenetics applied to predict an analgesic toxicity profile in prescription opioid use disorder (POUD) patients participating in an opioid deprescription programme. Pharmacogenetic markers were analysed in an observational, prospective deprescription programme for POUD patients (n = 88) treated for CNCP. It consisted of monitoring visits (baseline, follow-up and final), opioid rotation or discontinuation and the recording of adverse events and suspected adverse drug reactions (ADRs). Variants in OPRM1 (A118G), ABCB1 (C3435T), COMT (G472A), OPRD1 (T921C) and ARRB2 (C8622T) genes were tested by real-time PCR. Ethics committee approved the study. Wild-type OPRM1-AA genotype carriers reported a significantly higher number of adverse events than OPRM1-AG/GG (median [p25-75], 7 [5-11] vs 5 [3-9]), particularly gastrointestinal system events (90% vs 63%) such as nausea (33% vs 0%). Suspected ADRs (affecting 17% of the patients) were three times higher in males than in females (30% vs 11%). The deprescription programme was effective and safe, and it achieved a significant progressive reduction in the morphine equivalent daily dose, strong opioids and other analgesics' use, without causing any changes in pain intensity or opiate abstinence syndrome. OPRM1 gene polymorphisms could identify the risk of gastrointestinal adverse events in POUD patients. Deprescription programmes including pharmacogenetic analysis should be considered during the follow-up of this population

Global Pain State Questionnaire: Reliability, Validity, and Gender Gap

Objective: To quantify patients’ pain more objectively is essential to guide an individualized therapy, all the more so in patients under long-term opioid-use. Only a thoughtful and objective understanding of risks and benefits could improve an individualized standard of care. Our aim was to assess metric reliability and validity of an integrated and self-report Global Pain Status questionnaire to quantify the impact of pain on patient’s health in a more precise manner. Methods: A cross-sectional study was conducted to analyse the reliability, agreement, and validity of an integrated questionnaire compared to isolated scales, due to kappa statistics, intra- class and other correlation coefficients. Level of pain (intensity and relief), quality of life, most prevalent analgesic adverse events and hospital frequentation were registered in a total of 38 cases (pain unit patients) and 52 painless matched-controls.. A reduced multitrait-multimethod matrix and a canonical-correlation analysis were developed together with a multiple linear regression. Results: Cases (56 ± 10 years old, 63% females, pain intensity 66 ± 23 mm, incidence rate of 5 adverse events) represented a regular pain population. A high intraobserver correlation (r0.75- 0.88, weighted-κ 0.41–0.51, unweighted-κ 0.66-0.82) was evidenced together with significant correlation coefficients in test-retest reliability, and for validity, even more, in a reduced multitrait-multimethod matrix (>0.8) and canonical-correlation (>0.95). A gender gap was evidenced in cases’ companions, mostly middle-aged females (78%), who experienced negative effects on their health. Conclusions: The Global Pain Status questionnaire is an evaluation instrument with enough reliability and validity, being a low-cost method to determine the multidimensional pain management at clinical routine. A gender-gap within pain caregivers was found that affect their health outcomes. Support interventions for pain patients’ companions should consider specific gender risk factors

Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences

More than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taking into account the impact of sex and pharmacogenetics on the inter-individual variability. A cross-sectional study was carried out from October 2019 to June 2020 on CNCP patients who had previously undergone an opioid deprescription (n = 119 patients). Demographic, clinical (pain, relief and adverse events) and therapeutic (analgesic use) outcomes were collected. Effectiveness (< 50 mg per day of morphine equivalent daily dose without any aberrant opioid use behaviour) and safety (number of side-effects) were analysed in relation to sex differences and pharmacogenetic markers impact [OPRM1 genotype (rs1799971) and CYP2D6 phenotypes]. Long-term opioid deprescription was achieved in 49 % of the patients with an increase in pain relief and a reduction of adverse events. CYP2D6 poor metabolizers showed the lowest long-term opioid doses. Here, women showed a higher degree of opioid deprescription, but increased use of tramadol and neuromodulators, as well as an increased number of adverse events. Long-term deprescription was successful in half of the cases. Understanding sex and gender interaction plus a genetic impact could help to design more individualized strategies for opioid deprescription