Insuficiente control de la calidad de sueño en pacientes con cáncer avanzado en cuidados paliativos

Introducción: Los trastornos del sueño son frecuentes en los pacientes con cáncer avanzado en atención paliativa. Objetivos: Cuantificar la cantidad-calidad del sueño en pacientes con cáncer avanzado en cuidados paliativos. Material y Métodos: Estudio descriptivo, transversal en pacientes >60 años. Se determinó la cantidad-calidad del sueño, dolor y ansiedad utilizando el cuestionario Pittsburgh Sleep Quality Index y escalas EVA. Resultados: Se incluyeron 138 pacientes, 63,8% hombres, con 70,9±1,1 años, con cáncer terminal: gastrointestinal 28,3%, mama-ginecológico 15,9%, pulmonar 13%, urinario 12,3%, hígado 6,5%, sistema nervioso central 4,3%, páncreas 1,4%, y otros un 18,1%. Los pacientes fueron tratados con quimioterapia 12,3%, radioterapia 5,1%, terapia hormonal 3,6%, inmunoterapia 0,7% y sin tratamiento oncológico 78,3%. El 81,2% presentó trastornos del sueño. Sólo el 54,3% recibió benzodiacepinas, zolpidem o clormetiazol. El 65,2% de los pacientes precisó más de tres veces medicación hipnótica de rescate durante la última semana. Los pacientes con peor calidad de sueño mostraron significativamente mayor intensidad del dolor, astenia, tristeza, ansiedad, náuseas, disnea y malestar general. Discusión: Los trastornos del sueño pueden ser primarios o, más comúnmente, un síntoma secundario del proceso de la enfermedad avanzada grave. Su abordaje farmacológico y las intervenciones no farmacológicas son múltiples y se pueden usar para la gestión de los trastornos del sueño en la medicina paliativa. Muchos pacientes en esta circunstancia no buscan atención médica para los trastornos del sueño, y los profesionales de atención de la salud tienden a infra-diagnosticar e infra-tratar esta complicación cuando se diagnostica, perdiendo así una oportunidad para mejorar la calidad de vida de los pacientes que ya sufren de la carga de la enfermedad terminal. La diversidad de los pacientes bajo cuidados paliativos hace que la gestión de los trastornos del sueño sea particularmente muy difícil deba ser individualizada. Conclusión: Los pacientes bajo cuidados paliativos recibieron medicación hipnótica insuficiente.Ayuda del Plan Propio de Investigación de la UMA. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Avatars and Cartoons reduce anxiety in pediatric inpatients

Avatars and Cartoons reduce anxiety in pediatric inpatients I Bellido1, MV Bellido2, A Gomez-Luque3. 1University of Malaga, Pharmacology and Clinical Therapeutics, Spain, 2Regional University Hospital, Malaga, Surgery Service, Spain, 3Virgen de la Victoria University Hospital, Malaga, Anaesthesia Service, Spain Background and aim: Pain induces fear, stress and anxiety in young children. Avatars and cartoons explaining analgesic and sedative drugs administration routes may reduce children’s anxiety in young children. We quantify the possible antianxiety effect of avatars and cartoons explaining analgesic and sedative drug’s administration routes to inpatients children. Methods: A prospective, aleatorized, controlled study (blinded for the analyser) in inpatients children (< 6 years old) was done. Clinical stage, diagnostic, surgery, anaesthesia and all treatment procedures were recorded. Anxiety (STAIC test) was recorded before and 5 h and 24 h after drugs administration. A 15 minutes movie with avatars and cartoons explaining how the analgesic and sedative drugs were going to be administered was use in 120 children (movie group) and was compared to other group that could not see the movie (control group n=120). Results: Children, N=240, aged 3-6 years, 4.5±1 years old, 55% male, treated in emergency 50%, surgery (31.3%) and intensities care unit (18.8%) were enrolled. The drugs routes administration were oral (25%), intramuscular (29.6%), intravenous (39.6%), inhalatory (3.8%), others (2.1%). Children saw part or the full movie an average of 5.2±2.1 times. At 24 h of follow-up anxiety was higher in control than in movie group (8.5±3 vs. 4.3±1.6, p<0.05, Student t test). Children of the control group wept, complained, and called their parents during more time than movie group. Conclusion: The use of avatars and cartoons to explain analgesics and sedative drugs routes administration to inpatients young children reduced children’s anxiety.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Risk and protective factors for release in outpatients with schizophrenia

eposterWe aim to determine risk and protective factors influencing relapse incidence in outpatient with schizophrenia. A longitudinal, observational study was done with outpatients with schizophrenia (F20) or schizoaffective disorder (F25)(DMS-IV and ICD-10), without hospitalization during the previous 6 months. The patients were consecutively included into the study to received oral (O-A) or long-acting injectable (depot-A) antipsychotics. Clinical stage evolution, compliance, efficacy and safety assessments (including PANSS, CGI-SSI, hospitalization rates, and adverse events) were recorded before and after 6 and 12 months of treatment. Results: 60 outpatients (aged 34.5±8.9, male 73%), 75% schizophrenia and 25% schizoaffective disorder diagnosis, 68.3% fewer than 15 years of schizophrenia evolution, 76.7% fewer than 5 times previous hospitalizations were treated with O-A (41.7%) or depot-A (58.3%) antipsychotics for at least one year. Depot-A treated patients showed a significant higher compliance compared to O-A patients during the all following time, lower PANSS (total, positive and negative) scores and CGI-SSI score (p<0.01), and a delayed relapse incidence and re-hospitalization to more than 1 year in the 48% of patients (relapse % depot/% oral) after 6 months 22.9%/52.0%, and after 12 months 48.6%/4.0%. Conclusion: There were protective factors which delayed relapse incidence in schizophrenia: Use of sustained-release preparations, family support. There were risk factors for occurrence of relapse in schizophrenia: cocaine, heroin and alcohol consumption, absence of family support, greater severity of patients assessed through CGI-SI, male sex, age older than 25 years and long-term evolution of the disorder.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Flipped classroom based on objective structured clinical examinations analysis by undergraduate students of Pharmacology course from the Podiatry Degree improve their learning and assessment communication skills about medicines

Comunicación cartel con defensa oralWe aim to evaluate the impact of the individual and in-group analysis of OSCEs (filmed by other students) looking for correct and incorrect behaviours and contents in their learning of pharmacology. Summary of work and outcomes: A 5-year prospective study in which students of Pharmacology course from the Podiatry Degree analysed filmed OSCEs individually and in a group in a flipped classroom. Each group (max 5 students) analysed along 1 week a filmed OSCE, prepare a summary of correct and incorrect items related to clinical events, medicines uses, and people behaviours. The students presented their analysis results to the rest of the class. After each presentation, the other students of the class were encouraged to ask questions and after that, the students voluntarily answered a satisfaction survey. Result and Discussion: 405 students, 65.2% female, 20±5.3 years old were included. Students spend 13.4±5.4 h on making the filmed-OSCE analysis. The percentage of students satisfied with this way of studying pharmacology was 96.5%. OSCEs analysis by students increased their percentage of success in the final assessment in both OSCEs-related and OSCEs-non-related questions (+18.5% and +10.1%). Conclusion: Filmed Objective Structured Clinical Examinations analysis by undergraduate students on the Pharmacology course of Podiatry Degree improved their knowledge about medicines use and their communication skills during the assessment.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Underuse of indicated medications in elderly

Introduction: Treatment omissions are very important to value the quality of pharmacological therapy. In fact, suboptimal prescribing has been defined as overuse (polypharmacy), inappropriate prescribing (drug whose risks are greater than the benefits in older adults) and underuse of indicated medications. This omission of drug therapy may be linked to certain health outcomes in older patients, such as, for instance, the greater risk of cardiovascular events and mortality Material and methods: A cross-sectional study was performed. The study population comprised 407 community-dwelling residents over the age of 65 on Lanzarote (Canary Islands, Spain), where there are 15 primary healthcare centres. Data recorded included socio-demographic characteristics, clinical status, functional and cognitive assessment, and complete information about drugs intake. Potential prescribing omissions (PPO) were evaluated according to Screening Tool to Alert doctors to Right Treatment (START). Results: A total of 1844 medications were prescribed to the patients included in our study (median number per patient: 4.5 drugs; range: 0-14: polypharmacy prevalence: 45%). Omeprazole was the most frequently used drug followed by aspirin, furosemide and enalapril. START identified PPO in 170 (41.8%) subjects. Sixteen of the 22 START criteria (72.7%) were used to identify these PPO. The endocrine system accounted for over half the omissions (51.8%), followed by the cardiovascular system (26.7%), where the main omission was anticoagulants in the presence of chronic atrial fibrillation. Multiple logistic regression analysis revealed that the risk of PPO increased by 60% for every additional point in the Charlson Comorbidity Index (OR 1.60, 95% CI 1.35-1.91). Increasing numbers of medications also independently predicted the odds of at least one PPO according to START criteria (OR 2.19, 95% CI 1.36-3.55). Conclusions: Our findings show high rates of polypharmacy and PPO, as well as a clear relationship between these two concepts.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Factores de riesgo cardiovascular en pacientes ancianos diabéticos que acuden a urgencias

Comunicación en formato cartel con defensa oralOBJETIVO: Son escasas las evidencias clínicas disponibles sobre los factores de riesgo cardiovascular en los pacientes ancianos diabéticos. Nuestro objetivo fue determinar los principales factores de riesgo cardiovasculares de los pacientes diabéticos ancianos en urgencias. MATERIAL Y MÉTODOS: Diseño, ámbito de realización y marco o nivel de atención sanitaria, criterios de selección, número de sujetos incluidos, número de sujetos que responden y abandonos, intervenciones (si procede), variables y métodos de evaluación de la respuesta. Análisis estadístico, limitaciones, aspectos ético-legales. Estudio descriptivo observacional, retrospectivo, transversal y quasiexperimental en pacientes diabéticos ≥65 años de ambos géneros que acudieron a urgencias durante 1 año. Criterios inclusión: tratamiento hipoglucemiante, HbA1c >6,5% durante el año previo, sin comorbilidades graves. RESULTADOS: Se han incluido 146 pacientes diabéticos tipo 2, 39,7% hombres,76,4±7,2 años. Un 24,2% presentó síndromes geriátricos, 93,2% presentó comorbilidades asociadas, 22,6% presentó afectación renal, 89% utilizaba normoglucemiantes orales (hombres 91,4% >mujeres 86,4%): Biguanidas 78,8%, IDPP-4 22,5%, sulfonilureas 2ª-generación 18,5%. El 61% tratado con metformina 850 mg, seguido de gliclazida 30 mg 13% y metformina 1 g 11%. Tratamientos para comorbilidades más usados: Antihipertensivos 88,40%, normocolesterolemiantes 58,90%, antiagregantes 56,80%, benzodiacepinas 45,90%, calcioantagonistas 37,7%, betabloqueantes adrenérgicos 37%, antidepresivos 26,70% y opiáceos 24%. CONCLUSION: Ser mujer, tener mayor edad, más comorbilidades y de ellas hipertensión arterial y fibrilación auricular se relacionó con el mayor número de ictus isquémicos y el mayor tiempo de evolución del accidente isquémico transitorio. La prevalencia de reacciones adversas a medicamentos fue el doble en las mujeres que en los hombres y mayor en los pacientes menores de 80 años.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Does the resolving of clinical problems and doubts about medicines using WhatsApp by medicine and podiatry undergraduate students improve their learning and assessment?

We aim to evaluate the impact of resolving clinical problems and doubts through WhatsApp in the learning of medicines used by undergraduate students on the Anaesthesia course and Pharmacology course of Medicine and Podiatry Degrees. Methods. Prospective controlled study with students of Anaesthesia course from the Medicine Degree and Pharmacology course from the Podiatry Degree which were invited to voluntarily participate into a WhatsApp group to asking clinical questions and doubts about analgesic/anaesthetic drugs and to answer them. Clinical problems and doubts were formulated by the students and they were most commonly delivered by other students or, in non-answer case by teachers. All WhatsApp's comments were controlled by teachers. WhatsApp user group was compared with a non-WhatsApp user group. Results and Discussion. Students of Anaesthesia course from the Medicine Degree and Pharmacology course from the Podiatry Degree, N 235, 75.7% female, 20±3.1 years old, were enrolled. The percentage of questions answered and failed of the test final assessment after having been reviewed in WhatsApp and those obtained in WhatsApp not-reviewed questions were compared. Contributions' mean to issues raised-resolved through WhatsApp was 31.2± 17 (Min 3 times/Max 73 times). The correct answered questions (in percentage) at the student's final assessment test were 71.4% in the question reviewed by the WhatsApp group vs. 47.4% in the non-reviewed by the WhatsApp-group (control) (p<0.5). If you cannot against technology, at least use it to your advantage and to your students' advantage. Conclusion. Resolving clinical problems and doubts through WhatsApp improved the assessment final score of questions about medicines used in undergraduate students on the Anaesthesia course of Medicine Degree and on the Pharmacology course of Podiatry Degrees.Subvencionado: Ayuda del Plan Propio de Investigación de la UMA. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech