Paternalism vs. autonomy: are they alternative types of formal care?

This study has been supported by MINECO Project: PSI2014-52464-P-ICESE

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

Background. Pharmacological non-adherence in chronic diseases is 40–65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. Methods. This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky–Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April–December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. Results. Non-adherence was 48.4% (95% confidence interval (CI): 47.2–49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. Conclusions. It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle

Length of stay in patients admitted for acute heart failure

Objective: To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Methods: Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. Results: We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay <= 7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p < 0.001). Conclusions: A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure

Centenario de Elie Metchnikoff (1845-1916)

Celebramos en este año de 2016 el centenario de la muerte de una de las grandes figuras de la medicina, surgidas a finales del siglo xix y a principios del xx, Elias Metchnikoff, Premio Nobel con Paul Ehrlich en 1908. El objetivo de este trabajo es el de rendir un homenaje a su figura con motivo de este aniversario. Metchnikoff fue quien descubrió y describió el fenómeno de la fagocitosis y en función de ello ha sido considerado como el «padre de la inmunidad celular». En paralelo fue quien acuñó la palabra «gerontología», aplicándola al estudio del envejecimiento en toda su extensión y en cualquiera de sus formas, lo que le convirtió en un pionero del trabajo interdisciplinar. Consideraba que las bacterias intestinales generaban una autointoxicación que envenenaba nuestro organismo y que la acidificación del mismo a través de los bacilos ácidos que contienen los yogures podría contribuir a mantener la salud y a prolongar la vida

La enseñanza médica teórica y en la cabecera del paciente

Lo que corresponde básicamente a la educación pregraduada es formar a médicos de cara al futuro, focalizando esta enseñanza en aquellas materias esenciales que debe conocer cualquier profesional, con independencia de lo que vaya a ser su vía posterior de especialización. Enseñar a saber cómo aprender. Hay que instruir pero, sobre todo, hay que educar. Ser capaces de desarrollar las capacidades y habilidades del estudiante de manera que pueda encontrar por sí mismo las respuestas a los problemas planteados. La función del docente es motivar y potenciar este tipo de actitud en el estudiante. Con la presente revisión se pretende analizar, a través de unas reflexiones basadas en 6 preguntas interrelacionadas, las posibilidades que ofrecen hoy la facultades de medicina para conseguir estos objetivos

Evolución de la enseñanza de Geriatría en las facultades de Medicina españolas

Resumen: Objetivo: Determinar la evolución reciente de la enseñanza de la Geriatría en el pregrado en España tras el aumento de facultades de Medicina y el cambio del plan de estudios. Metodología: Se compararon las características de la enseñanza de la Geriatría en las facultades de Medicina españolas mediante dos encuestas nacionales realizadas en 2008 y 2015. En ambos casos se analizaron la inclusión de contenidos de Geriatría, el año y la materia en la que se imparte, las características del profesorado responsable y la duración de la misma. Resultados: La prevalencia de docencia de Geriatría en las facultades de Medicina de las universidades españolas era del 75% en el 2008 y 77,5% en el 2015. Esta docencia se ha ido haciendo con mayor frecuencia obligatoria (66,7 vs. 96,8%, p < 0,005) pero se ha reducido su carácter de asignatura independiente (71,4 vs. 35,5%, p < 0,01). En ambos años aproximadamente el 50% de las facultades contemplaban aspectos teóricos y prácticos y en el 90% las prácticas tenían un carácter obligatorio. Se ha observado un incremento de la participación de los Servicios de Geriatría (27,3 vs. 47,1%) y de los propios geriatras como docentes directos (38,1 vs. 74,2%, p = 0,03). El tiempo medio programado para esta enseñanza era de 36 y 32 h respectivamente. No se han producido cambios significativos en más de la mitad de las facultades existentes en lo que respecta a inclusión de la Geriatría en el plan de estudios de pregrado, docencia independiente, incorporación de contenidos prácticos, estatus de las prácticas y participación de geriatras. Conclusiones: La docencia de Geriatría ha presentado una evolución ligeramente positiva en muchas características, sin lograr una incorporación universal o los niveles alcanzados en otros países de nuestro entorno. Abstract: Objective: To analyse the recent evolution of Geriatric teaching at undergaduate level in Spain after the recent increase in the number of medical schools and the introductions of changes in the offical curricula. Methodology: A comparison of several characteristics of Geriatrics teaching at Spanish medical schools was done through two national surveys carried out in 2008 and 2015. The inclusion of Geriatric contents, the year when they are taught, faculty in charge and teaching hours were compared at both time points. Results: The prevalence of Geriatric training was 75% in 2008 and 77.5% in 2015. This training has become compulsory more frequently (66.7 vs. 96.8%, p < .005) but the independence of Geriatrics related to other matters has decreased (71.4 vs. 35.5%, p < .01). In both surveys 50% of medical schools included theoretical and practical contents and in 90% of practices were compulsory. We found an increased of Geriatrics departments (27.3 vs. 47.1%) and geriatricians (38.1 vs. 74.2%, p= .03) in teaching. The mean duration of this training was 36 and 32 hours respectively. In more than half of the medical schools existing in both years there were no significant changes in any of the characteristics surveyed. Conclusions: The teaching of Geriatrics at pregraduate level shows some positive changes, but universal teaching with standards approaching close countries has not yet been achieved. Palabras clave: Pregrado, Enseñanza, Geriatría, Keywords: Undergraduate, Training, Geriatric