Falta de Adherencia al tratamiento en paciente asmática con resultado negativo asociado a la medicación.

  La falta de adhrencia al tratamiento en pacientes crónicos se ha convertido en un problema de primer orden. La paciente de este caso no era adherente aunque no había abandonado el tratmiento a pesar de haber manifestado dos reacciones adversas diferentes. La actuación de la farmacia, en Proyectos como pueden ser AdherenciaMED ponen en valor la nececisad de acompañar a los pacientes crónicos con medicamentos complejos a lo largo de todo el desarrollo de la enfermeda

Falta de Adherencia al tratamiento en paciente asmática con resultado negativo asociado a la medicación.

  La falta de adhrencia al tratamiento en pacientes crónicos se ha convertido en un problema de primer orden. La paciente de este caso no era adherente aunque no había abandonado el tratmiento a pesar de haber manifestado dos reacciones adversas diferentes. La actuación de la farmacia, en Proyectos como pueden ser AdherenciaMED ponen en valor la nececisad de acompañar a los pacientes crónicos con medicamentos complejos a lo largo de todo el desarrollo de la enfermeda

Caso clínico de seguimiento farmacoterapéutico: paciente hipertensa no controlada

Paciente habitual de la farmacia que acude a retirar su medicación durante un episodio claro de crisis hipertensiva.HT

Caso clínico de seguimiento farmacoterapéutico: paciente hipertensa no controlada

Paciente habitual de la farmacia que acude a retirar su medicación durante un episodio claro de crisis hipertensiva.HT

Efficacy of a Strategy for Implementing Guidelines for the Control of Cardiovascular Risk in Primary Healthcare

Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.Funding for the trial was provided by the Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (I+D+I). Instituto de Salud Carlos III—Fondo de Investigación Sanitaria. Expediente N˚ 031216.S

Preoperative psychological profile of women with increased risk of breast cancer

Aim: analyze depressive and anxiety symptomatology, body image and quality of life in a group of women with genetic vulnerability to breast cancer who were going to undergo a riskreducing mastectomy. Method:184 women participated in this study, all of whom had an increased risk of breast cancer, either because they were BRCA1/2 mutation carriers or because they had several affected relatives. The psychological instruments used were: Hospital Anxiety and Depression Scale, Body Image Scale, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and BR23. Results: The results of this study showed that the participants presented clinical anxiety symptomatology and subclinical depressive symptomatology. However, all the sample were at normative levels in body image and quality of life. Participants with previous diagnosis of cancer showed, higher dissatisfaction with their body image, lower levels on the scales of physical, and cognitive and global functioning on quality of life, as well as higher fatigue, more general pain also in the breast and in the arm compared to women without diagnosis. Conclusions: BRCA1/2 non-mutation carriers showed more symptomatology in the breast and in the arm fatigue than BRCA1/2 mutation carriers. BRCA1/2 mutation carriers had more economic difficulties than non-carriers. It is highly recommended a psychological intervention before a risk-reducing surgery.Objetivo: analizar los niveles de sintomatología ansiosa y depresiva, imagen corporal y calidad de vida en un grupo de mujeres con vulnerabilidad genética de cáncer de mama que se iban a someter a una mastectomía reductora de riesgo. Método: 184 mujeres participaron en este estudio, todas ellas tenían riesgo aumentado de cáncer de mama, bien por ser portadoras de una mutación BRCA1/2 o por agregación familiar. Los instrumentos utilizados fueron: Escala de Ansiedad y Depresión Hospitalaria, Escala de Imagen Corporal, European Organisation for Research and Treatment of Cancer calidad de vida oncológica C30 y BR23. Resultados: Los resultados de este estudio mostraron que las participantes presentaban niveles clínicos en sintomatología ansiosa y subclínicos en sintomatología depresiva. Sin embargo, se encontraban en niveles normativos en imagen corporal y calidad de vida. Las participantes con antecedentes oncológicos manifestaban, mayor insatisfacción con la imagen corporal, niveles inferiores en las escalas de funcionamiento físico, cognitivo y global de la calidad de vida, así como mayor fatiga, dolor general, en el brazo y en la mama en comparación con las mujeres sin diagnósticos previos. Conclusiones: Las mujeres sin mutación poseían mayor sintomatología en la mama y en el brazo que las mujeres con mutación, las cuales presentaban más dificultades económicas que las mujeres no portadoras. Evidenciando la necesidad de realizar una intervención psicológica antes de la cirugía especialmente en este colectivo

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

V Premio Nacional de Educación para el Desarrollo “Vicente Ferrer” 2014 : buenas prácticas

Ed. especial 25 aniversario de la AECIDTít. de la cubierta: V Premio Nacional de Educación Para el Desarrollo "Vicente Ferrer"La AECID junto con el Ministerio de Educación, Cultura y Deporte convoca anualmente los premios de educación para el desarrollo que están dirigidos a todos los centros docentes españoles sostenidos con fondos públicos que impartan educación infantil, educación primaria, educación secundaria obligatoria, bachillerato y formación profesional. Se recogen las buenas prácticas de los docentes premiados en esta sexta edición. Docentes que en el ejercicio de su función educadora han convertido el proceso educativo en un proceso dinámico e interactivo que permite al alumnado desarrollar un conocimiento crítico de nuestro mundo. Profesores y profesoras que han estimulado la participación del alumnado en la construcción de estructuras sociales más justas y solidarias, y han promovido actuaciones basadas en el principio de la corresponsabilidad de todos los actores implicados. El premio reconoce el esfuerzo realizado por centros educativos que establecen y creen en un modelo educativo que propone resaltar el papel de las personas y generar conciencias de carácter global que permitan al alumnado ser pieza clave de la ciudadanía del futuro, con un dinamismo que afronte las nuevas realidades desde una perspectiva más humana y responsable con el territorio en el que se ubican.ES

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective