Influence of non-osteoporotic treatments in patients on active anti-osteoporotic therapy: evidence from the OSTEOMED registry

Producción CientíficaPurpose To evaluate the effect of different non-osteoporotic drugs on the increase or decrease in the risk of incident fragility fractures (vertebral, humerus or hip) in a cohort of patients diagnosed with osteoporosis on active anti-osteoporotic therapy. Methods For this retrospective longitudinal study, baseline and follow-up data on prescribed non-osteoporotic treatments and the occurrence of vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression models. The drugs evaluated with a possible beneficial effect were thiazides and statins, while the drugs evaluated with a possible harmful effect were antiandrogens, aromatase inhibitors, proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, GnRH agonists, thyroid hormones, and oral and inhaled corticosteroids. Results Logistic regression analyses indicated that no treatment significantly improved fracture risk, with the only treatments that significantly worsened fracture risk being letrozole (OR = 0.18, p-value = 0.03) and oral corticosteroids at doses ≤ 5 mg/ day (OR = 0.16, p-value = 0.03) and > 5 mg/day (OR = 0.27, p-value = 0.04). Conclusion The potential beneficial or detrimental effects of the different drugs evaluated on fracture risk are masked by treatment with anabolic or antiresorptive drugs that have a more potent action on bone metabolism, with two exceptions: letrozole and oral corticosteroids. These findings may have important clinical implications, as patients receiving these treat- ments are not fully protected by bisphosphonates, which may imply the need for more potent anti-osteoporotic drugs such as denosumab or teriparatide.Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED

Producción CientíficaAntecedentes y objetivo: La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteración de la resistencia ósea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales características clínicas de los pacientes que acuden a la consulta de los médicos internistas en Espa˜na. Conocer estas características podría facilitar la puesta en marcha de planes de actuación para mejorar la atención de estos pacientes de manera más eficaz y eficiente. Material y métodos: A través del análisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales características clínicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios espa˜noles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitométricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados: En total se evaluó a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ± 12,1 a˜nos (mujeres, 64,7 ± 11,5 a˜nos; hombres, 61,2 ± 14,2 a˜nos). No hubo diferencia entre sexos en la historia de caídas recientes (9,1-6,7%), mientras que sí se apreció en la ingesta diaria de calcio de lácteos (553,8 ± 332,6 mg en mujeres vs. 450,2 ± 303,3 mg en hombres; p < 0,001) y en causas secundarias de osteoporosis(13% de hombres vs. 6,5% de mujeres; p < 0,001). En la muestra se observaron un total de 404fracturas (20%), destacando el número de fracturas vertebrales confirmadas (17,2%, 35,6% enhombres vs. 15,2% de las mujeres; p < 0,001). Una gran parte de los pacientes no recibía eltratamiento indicado y presentaba bajos niveles de actividad física y exposición solar. Un por-centaje importante de pacientes presentó comorbilidades asociadas, siendo las más frecuentesla hipertensión (32%) y la dislipidemia (28%).Conclusiones: Estos resultados definen el perfil del paciente con osteoporosis que acude a laconsulta de Medicina Interna en Espa˜na. Además, ponen de manifiesto el carácter multisistémicode esta entidad que junto con su elevada prevalencia determinan que las consultas específicasde Medicina Interna dedicadas a su manejo son el lugar adecuado para la atención de estos pacientes

Calidad de vida relacionada con la salud y sobrecarga de cuidadores de pacientes ingresados con insuficiencia cardiaca

• Introduction: Heart failure (HF) progression involves an important reduction in the quality of life, with a progressive functional impairment and a high consumption of socio-sanitary resources. The aim of this study is to describe the profile of patients with HF and of their caregivers, the social demography, the overload, the depression and the healthrelated quality of life of both. • Methods: An analytical cross-sectional study was conducted at the public agency Costa del Sol. The study population was constituted by patients hospitalized for HF, with identified main caregiver. Patients were selected from their admission into the hospital. • Results: The caregiver’s profile in this setting corresponds to a woman about 50-years old who takes care of a patient averaged 70-years old and who is usually his daughter or partner. Women suffering from HF were more dependent than men, with a significant difference (p: 0.01) of 22.77 scores in the Barthel index. Daughters or wives of highly dependent patients suffer from a higher overload and display a deteriorated state of mental health (p: 0.02). A significant, moderate and inverse relationship was seen between the patient’s mental health-related quality of life (HRQL) and the caregiver’s effort level r: 0.453; p<0.0001. An inverse correlation was seen between the caregivers’ level of depression and the mental component of quality of life r: 0.362; p<0.0001. • Conclusions: Caregivers under this mental health condition, along with the overload, show symptoms of depression, which could adversely affect their endurance as caregivers.• Introducción y objetivos: La progresión de la insuficiencia cardiaca (IC) implica una importante reducción de la calidad de vida con deterioro funcional progresivo y un elevado consumo de recursos sociosanitarios. El propósito de este estudio es describir el perfil de pacientes con IC y de sus cuidadores desde el punto de vista sociodemográfico, la sobrecarga, la depresión y la calidad de vida relacionada con la salud de ambos. • Material y Método: Estudio transversal de corte analítico en la Agencia Pública Costa del Sol. La población de estudio la constituían pacientes ingresados por IC con cuidador principal identificado. Los pacientes se seleccionaron a partir del ingreso en el hospital. • Resultados: El perfil de cuidador en este medio es de mujer con unos 50 años que cuida de un paciente, que suele ser su padre o pareja con una edad media de 70 años. Las mujeres con IC presentaron más dependencia que los hombres con diferencia significativa en el índice de Barthel (p=0,01) de 22,77 puntos. Las hijas o esposas de pacientes con niveles de dependencia elevados tienen mayor sobrecarga y reflejan una salud mental deteriorada (p=0,02). Se observó una relación significativa moderada e inversa entre la calidad de vida relacionada con la salud (CVRS) mental del paciente y el índice de esfuerzo del cuidador: r=-0,453; p<0,0001. El nivel de depresión de los cuidadores mostró una correlación inversa con el componente mental de la calidad de vida r=0,362; p<0,0001. • Conclusiones: Las cuidadoras con esta salud mental, unida a la sobrecarga, presentan síntomas depresivos que pueden influir negativamente en su resistencia como cuidadora

Calidad de la sedación con propofol administrada por personal no anestesiólogo en una unidad de endoscopia digestiva, resultados tras un año de implantación

RESUMEN Introducción: existe evidencia de que un equipo formado por endoscopista y enfermera puede hacerse cargo de la sedación de un paciente con propofol de forma eficaz, segura y eficiente. Para ello, es fundamental una adecuada formación y entrenamiento específico que les otorgue las competencias necesarias. El objetivo principal de este estudio fue realizar, tras un año de implantación, una evaluación de la calidad del procedimiento de sedación administrada por personal no anestesiólogo en una unidad de endoscopia digestiva. Métodos: se realizó un estudio de cohortes prospectivo sobre los pacientes que recibieron sedación con propofol por personal no anestesiólogo. Posteriormente, se seleccionó una muestra aleatoria de registros clínicos para evaluar la adherencia de los profesionales a diferentes criterios de calidad, así como la aparición de eventos adversos relacionados con la sedación. Resultados: en el periodo de estudio se realizaron un total de 595 procedimientos bajo sedación con propofol. La tasa de eventos adversos fue del 2,4% (n = 507), principalmente episodios de hipotensión e hipoxemia. Los porcentajes de adherencia al procedimiento de sedación se situaron por encima del 80% en la mayoría de los criterios, aunque fue menor en la cumplimentación de la valoración del riesgo ASA. Conclusión: los resultados del estudio sugieren que el propofol puede ser administrado con seguridad y eficacia por un equipo cualificado de endoscopista y enfermera, en pacientes con un riesgo ASA I-II. Las auditorías sobre la adherencia de los profesionales al procedimiento permiten identificar necesidades de mejora para poder seguir trabajando sobre aspectos aún no consolidados

Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study

Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.Ye

Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy

<div><p>In the current public health framework, the importance of medication as a determinant of citizens’ health has emerged as a factor warranting special attention. Most studies investigating the relationship between medication and quality of life do so from the perspective of adherence. However, other medication-related factors identified at home visits may be associated with health-related quality of life.</p><p>Methods and design</p><p>Objective: To describe the relationship between medication-related factors and the health-related quality of life in patients older than 65 years who use multiple medications (polypharmacy).</p><p>Design: Cross-sectional descriptive study.</p><p>Setting: Primary care.</p><p>Participants: Patients older than 65 years who use multiple medications (n = 375).</p><p>Measurements: The main outcome measure was health-related quality of life according to the EuroQol-5D instrument. Sociodemographic, clinical and medication-related variables were recorded during home interviews.</p><p>Results</p><p>Mean age was 74.72 ± 5.59 years, and 65.5% of our participants were women. The global level of health-related quality of life according to the EQ-5D visual analog scale was 59.25 ± 20.92. Of the five EuroQol dimensions, anxiety/depression and pain were the most frequently reported, while mobility and self-care were the dimensions with the greatest impact on self-reported quality of life. Multivariate analysis indicated that functional independence was the factor most strongly associated (β = 14.27 p < 0.001) with better health-related quality of life, while illiteracy (β = −13.58 p < 0.001), depression (β = −10.13 p < 0.001), social risk (β = −7.23 p = 0.004) and using more than 10 medicines (β = −4.85 p = 0.009) were strongly associated with a poorer health-related quality of life.</p><p>Conclusions</p><p>Factors inherent within the patient such as functional incapacity, cognitive impairment and social and emotional problems were the main constraints to quality of life in our study population. The number of medicines taken was negatively related with quality of life.</p></div

Development of a Clinical Prediction Rule for Adverse Events in Multimorbid Patients in Emergency and Hospitalisation

(1) Background: There is currently a global consensus that the quality of comprehensive care for acutely hospitalised elderly people should include addressing functionality and mobility, cognitive status, prevention of pressure ulcers, urinary incontinence, falls and delirium, as well as pain control and medication-related problems. The aim of this study is to develop and validate a clinical prediction rule for multimorbid patients admitted to an acute care hospital unit for any of the five adverse events included in our vulnerability pentad: falls, pressure ulcers, urinary incontinence, pain and delirium. (2) Methods: Longitudinal analytical clinimetric study, with two cohorts. The study population will consist of multimorbid patients hospitalised for acute care, referred from the Emergency Room. A clinical prediction rule will be proposed, incorporating predictive factors of these five adverse outcomes described. This study has received funding, awarded in November 2020 (PI-0107-2020), and was approved in October 2019 by the Research Ethics Committee &Prime;Costa del Sol&Prime;. (3) Conclusions: Preventing adverse events in hospitalised patients is particularly important for those with multimorbidity. By applying a clinical prediction rule to detect specific risks, an estimate can be obtained of their probability of occurrence

Spanish transcultural adaptation of the 4AT score for the evaluation of delirium in the emergency department: a prospective diagnostic test accuracy study

Abstract Background Delirium is one of the most common adverse events in older people during hospitalization, especially in the emergency department. Reliable, easy-to-use instruments are necessary to properly manage delirium in this setting. This study aims to evaluate the diagnostic validity of the Spanish version of the 4 ‘A’s Test (4AT) in the ED. Methods A diagnostic accuracy study was conducted in patients over 65 years old admitted to the Emergency Department who did not have a formal diagnosis of dementia or a severe mental health disorder. Face and content validity were evaluated by an expert panel. Emergency nurses performed the evaluation with 4AT, whilst blinded and trained researchers assessed patients with the Revised Delirium Rating Scale as the gold standard. The content validity index, sensitivity, specificity, positive and negative predictive values, likelihood ratios, Youden’s Index and ROC curves were calculated to evaluate the diagnostic accuracy of the instrument. Results Of 393 eligible patients, 380 were finally analyzed. Content validity yielded a median content validity index of 4 (interquartile range: 0). The Spanish 4AT sensitivity (95.83%; 95% ECI: 78.9–99.9%), specificity (92.98%; 95% CI: 89.8–95.4%), positive predictive value (47.92%) and negative predictive value (99.7%) were satisfactory. Youden’s index was 0.89. Positive likelihood ratio was 13.65, and negative likelihood ratio 0.045. The area under the curve was 0.97. Conclusions The Spanish version of the 4AT for use in the Emergency Departments is easy-to-use and applicable. The validation results indicate that it is a valid instrument with sufficient predictive validity to identify patients at risk of delirium in the Emergency Departments. Moreover, it is a tool that facilitates the management of an adverse event that is associated with increased mortality and morbidity

Study variables related to quality of life (multiple linear regression).

<p>Study variables related to quality of life (multiple linear regression).</p

Results on the EQ-Index (0–1) and EQ-VAS (0–100) according to the study variable.

<p>Results on the EQ-Index (0–1) and EQ-VAS (0–100) according to the study variable.</p