Oropharyngeal dysphagia in elderly people with degenerative dementia

Trabajo fin de grado en EnfermeríaIntroducción: La Disfagia orofaríngea es un trastorno deglutorio que prevalece en personas mayores con demencia degenerativa. Un protocolo para el abordaje y la detección precoz mediante correcta evaluación diagnóstica constituye un pilar fundamental para evitar las graves complicaciones derivadas del trastorno. Objetivo: Analizar la bibliografía científica disponible acerca del manejo de la disfagia orofaríngea en personas mayores con demencia degenerativa. Se ha considerado oportuno reconocer las características de la evaluación diagnóstica, e investigar sobre la implicación de los profesionales sanitarios, en concreto los cuidados brindados por parte de los profesionales de enfermería. Material y método: Se ha realizado una búsqueda en las Bases de datos :Pubmed, CuidenPlus, Scielo, Google Académico, PscycINFO y Dialnet, utilizando lenguaje controlado y estrategias de búsqueda con operadores boléanos, utilizando filtros, limitando a menos de 10 años, tipología de literatura, en inglés, español y portugués. Resultados: Se han seleccionado 27 artículos, que respondían al objetivo principal. Se establecieron 5 categorías: Evaluación diagnóstica, consecuencias derivadas, abordaje terapéutico ,educación sanitaria a cuidadores y formación de profesionales sanitarios. Conclusiones: Dado el infradiagnóstico del trastorno, se ve necesario sensibilizar sobre este trastorno en la detección temprana mediante protocolos de evaluación diagnóstica, cuidados individualizados y educación sanitaria a cuidadores y profesionales sanitarios.Introduction: Oropharyngeal dysphagia is a deglutition disorder that prevails among the elderly people with degenerative dementia. Protocol for approaching the disorder and early detection through an appropiate diagnosis assesment, constitutes an important cornerstone to avoid suffering the seriously consequences resulting from this disorder. Goals: To analyze the available scientific bibliography about oropharyngeal dysphagia management in the elderly people with degenerative dementia. It has been considered appropiate to inquire into the patient´s needs , to recognize the diagnosis assesment´s characteristics and research about the implication of the health professionals, specifically the nursing care . Sources and method: A research has been done in database: Pubmed, CuidenPlus, Scielo, Google Académico, PscycINFO and Dialnet, using controlled language and search strategies with bolean operators, using filters, by limiting research less tan 10 years, type of literature, in english, spanish and portuguese. Results: 27 articles have been selected, that answer the principal aim . 5 categories have been established: Diagnosis assesment, consequences resulting from the disorder, therapeutic approaches, health education to caregivers.and professional training. Conclusions: In view of the underdiagnosis of this disorder, make the people be aware of early detection it is necessary through diagnosis assesment protocol, individualized care, and health education to caregivers and professionals

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio