Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba

ABSTRACT Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba. The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs. The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type scale to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version. The findings demonstrated that the instrument can be used at any level of health care.

Perforación esofágica por cuerpo extraño en una anciana / Esophageal perforation with foreign body in an aged woman

Se describe el caso clínico de una anciana de 65 años de edad, con demencia e internada en un hogar de ancianos, quien fuera asistida en el Servicio de Urgencias del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, en enero del 2013, por presentar disnea súbita y deterioro del estado general. Se efectuaron radiografías de tórax y se comprobó la existencia de un clavo en el tercio inferior del esófago, por lo que fue intervenida quirúrgicamente; sin embargo, en su evolución posoperatoria se produjeron una mediastinitis, un choque séptico y fallo multiorgánico. Falleció 12 días después del ingreso.

The case report of a 65 year aged woman, with dementia and treated in a home for elderly, who was attended in the Emergency Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, in January, 2013 is described, to present sudden dyspnea and deterioration of her general state. Thorax x-rays were made and the existence of a nail in the inferior third of the esophagus was proven, so she was surgically treated; however, in her postoperative clinical course a mediastinitis, a septic shock and multi-organs failure took place. She died 12 days after her admission.

Tromboembolismo pulmonar y enfermedad cerebrovascular isquémica embólica en un anciano boliviano / Lung thromboembolism and embolic ischemic cerebrovascular disease in a Bolivian aged man

Se describe el caso clínico de un paciente de 71 años de edad, quien en el 2008, luego de un episodio de tromboembolismo pulmonar, fuera ingresado en la Unidad de Cuidados Intensivos del Hospital Integral Comunitario de Chacaltaya en Bolivia, por presentar una enfermedad cerebrovascular isquémica embólica de tipo paradójica, como consecuencia de un agujero oval permeable. Como tratamiento se indicó, primero, heparina de bajo peso molecular y, posteriormente, dicumarínicos, con lo cual el paciente evolucionó satisfactoriamente.

The case report of a 71 year patient is presented who in 2008, after an episode of lung thromboembolism, was admitted in the Intensive Care Unit of the Community Comprehensive Hospital of Chacaltaya, Bolivia, he presented an ischemic embolic cerebrovascular disease in a paradoxical way, as consequence of a permeable oval foramen. Heparin of low molecular weight was indicated first as treatment and later, dicumarinics, with which the patient had a satisfactory clinical course.

Hemoptisis por enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria en un paciente joven / Hemoptysis due to Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia in a young patient

Se presenta el caso clínico de un joven de 20 años de edad, con el diagnóstico de hemoptisis moderada, quien fue ingresado en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, donde se le realizaron múltiples exámenes, cuyos resultados permitieron llegar al diagnóstico definitivo de enfermedad de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria. Luego de la aplicación de otros procederes, el paciente evolucionó satisfactoriamente y egresó de la institución.

The case report of a 20 years young patient is presented, with the diagnosis of moderate hemoptysis who was admitted in the Intensive Care Unit from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, where multiple tests were carried out whose results allowed to arrive to the definitive diagnosis of Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia. After the indication of other procedures, the patient had a satisfactory clinical course and he was discharged from the institution.

Traqueotomía precoz en pacientes ventilados / Early tracheotomy in ventilated patients

Se efectuó una investigación analítica de casos y controles en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, del segundo semestre de 2009 al primer semestre de 2010, con vistas a determinar las ventajas potenciales de la realización precoz de la traqueotomía en pacientes ventilados mecánicamente. El grupo de estudio estuvo conformado por 23 afectados y el de control, por 39. Para facilitar la comparación entre ambos grupos se utilizaron porcentajes, proporciones y tasas de morbilidad. Se obtuvo que con el empleo precoz de la traqueotomía disminuyeran considerablemente las complicaciones en los casos; no obstante, aún no existe un suficiente consenso respecto al momento de aplicar la técnica, ni esta se realiza tempranamente en la mayoría de los pacientes ventilados.

An analytic investigation of cases and controls was carried out in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, from the second semester of 2009 to the first semester of 2010, aimed at determining the potential advantages of the early tracheotomy in mechanically ventilated patients. The study group was formed by 23 affected patients and the control group by 39. To facilitate the comparison between both groups percentages, proportions and morbidity rates were used. It was obtained that with the early tracheotomy, complications considerably decreased in the cases; nevertheless, there is neither enough consent yet regarding the moment to apply the technique, nor it is early carried out in most of the ventilated patients.

Una mirada crítica sobre el conocimiento de ética de la investigación en profesionales de la salud / A critical look at the knowledge of research ethics in health professionals

Se realizó un estudio descriptivo de 30 profesionales (médicos, licenciados en enfermería y tecnólogos de la salud) participantes en investigaciones clínicas del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde septiembre del 2011 hasta igual mes del 2012, a fin de evaluar sus conocimientos sobre la ética de la investigación. La muestra se seleccionó a través de un diseño estratificado proporcional a las unidades de análisis, de un listado de profesionales con proyectos inscritos en el Registro de Investigaciones de la institución, y la información se obtuvo mediante la aplicación de una encuesta. En la casuística primaron los médicos y las categorías docentes de profesor auxiliar e investigador agregado; asimismo se constató un bajo índice de producción científica en los encuestados. Se concluyó que existían insuficiencias en los conocimientos básicos relacionados con la ética de la investigación, lo que pudiera tener consecuencias contraproducentes en el desarrollo de estudios clínicos.

A descriptive study was conducted in 30 professionals (physicians, nursing graduates and health technicians) involved in clinical research of "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital of Santiago de Cuba, from September 2011 to the same month of 2012, in order to evaluate their knowledge of research ethics. The sample was selected through a stratified design proportional to the units of analysis, from a list of professionals with projects included in the Register of Research of the institution, and the information was obtained by applying a survey. Physicians and teaching categories of assistant professor and adjunct researcher prevailed in the case material; it was also found a low rate of scientific production in the respondents. It was concluded that there were deficiencies in basic skills related to research ethics, which could have counterproductive consequences in developing clinical trials.