[Chemotherapy at the end of life: Uncommon clinical practice?] / Quimioterapia al final de la vida: ¿práctica clínica poco frecuente?

BACKGROUND: In view of the apparent increase in the aggressiveness of palliative chemotherapy, the purpose of this study was to find out and analyse the characteristics of cancer patients treated in our hospital, and who received chemotherapy near the end of life. PATIENTS AND METHODS: Retrospective, observational study in oncology-haematological patients who received chemotherapy between January 2016 and May 2017, and who died in that same period. Data on sociodemographic and clinical variables were collected. In order to determine the risk factors for receiving chemotherapy in the last month of life, a multivariate logistic regression model was developed and subsequently validated using "bootstrap" re-sampling techniques. RESULTS: A total of 293 patients who received chemotherapy during the study period died. The median time between the last cycle of chemotherapy and death was 52 (0-459) days. Chemotherapy was received in their last month of life in 98 (33.4% of patients. the multivariate analysis indicated that the low chemo-sensitivity of the tumour, the particular medical oncologist, and the fact of dying in the hospital setting, were associated with an increased risk of receiving chemotherapy in the last month of life. CONCLUSIONS: A worrying percentage of patients receive chemotherapy near the end of life. This makes it difficult to receive high-quality palliative care, as well as to die in a familiar environment. It is necessary to review the decision-making process in advanced cancer patients.

Prescripción electrónica de Atención Primaria, ¿una herramienta fiable para conciliar medicación al ingreso hospitalario? / Electronic prescription for Primary Care: a reliable tool to conceal medication at hospital admission?

Objetivo: Analizar la fiabilidad de un programa de prescripción electrónica en receta de atención primaria (Medoracyl®) para conciliar la medicación al ingreso hospitalario. Método: Estudio prospectivo comparativo del tratamiento domiciliario validado de pacientes al ingreso, con el prescrito en Medoracyl®. La medicación al ingreso se obtuvo mediante entrevista clínica, informes médicos y revisión de la medicación aportada; la medicación activa en Medoracyl®, mediante consulta a la aplicación el día del ingreso. Se analizaron las discrepancias entre ambos tratamientos. Resultados: Se incluyeron 47 pacientes con 273 líneas de tratamiento domiciliario validado y 274 líneas de tratamiento Medoracyl®. Resultaron 48/273 líneas discrepantes (17,6% [IC95%: 13,1-21,6]). Se consideraron justificadas 27/48, resultando un riesgo final de no concordancia del 7,8% [IC95%: 4,6-11,0]. Conclusiones: Medoracyl® es una herramienta útil y de fácil acceso que permite conocer más del 90% de la medicación domiciliaria de los pacientes (AU)

Objective: To analyze the reliability of an electronic prescription software at primary care (Medoracyl®) to conceal the medication at hospital admission. Method: Prospective, comparative study of the home-based validated treatment of patients admitted to the hospital as compared to the one prescribed through Medoracyl®. The medication at admission was gathered by medical interview, medical records, and revision of the medication brought by the patients; the medication active in Medoracyl® by consulting the application the admission day. The discrepancies between both therapies were analyzed. Results: 47 patients were included with 273 lines of home validated treatments and 274 lines of Medoracyl®treatment. 48 out of 273 lines were in discrepancy (17.6% [95% CI: 13.121.6]). 27 out of 48 were justified, whereas 7.8% represented a discrepancy risk [95% CI: 4.6-11.0]. Conclusions: Medoracyl® is a useful tool and easy to access that allows knowing more than 90% of the home medication of the patients (AU)

[Electronic prescription for Primary Care: a reliable tool to conceal medication at hospital admission?]. / Prescripción electrónica de Atención Primaria, ¿una herramienta fiable para conciliar medicación al ingreso hospitalario?

OBJECTIVE: To analyze the reliability of an electronic prescription software at primary care (Medoracyl®) to conceal the medication at hospital admission. METHOD: Prospective, comparative study of the home-based validated treatment of patients admitted to the hospital as compared to the one prescribed through Medoracyl®. The medi cation at admission was gathered by medical interview, medi cal records, and revision of the medication brought by the patients; the medication active in Medoracyl® by consulting the application the admission day. The discrepancies between both therapies were analyzed. RESULTS: 47 patients were included with 273 lines of home validated treatments and 274 lines of Medoracyl® treatment. 48 out of 273 lines were in discrepancy (17.6% [95% CI: 13.1- 21.6]). 27 out of 48 were justified, whereas 7.8% represented a discrepancy risk [95% CI: 4.6-11.0]. CONCLUSIONS: Medoracyl® is a useful tool and easy to access that allows knowing more than 90% of the home medication of the patients.

Objetivo: Analizar la fiabilidad de un programa de prescripción electrónica en receta de atención primaria (Medoracyl®) para conciliar la medicación al ingreso hospitalario. Método: Estudio prospectivo comparativo del tratamiento domiciliario validado de pacientes al ingreso, con el prescrito en Medoracyl®. La medicación al ingreso se obtuvo mediante entrevista clínica, informes médicos y revisión de la medicación aportada; la medicación activa en Medoracyl®, mediante consulta a la aplicación el día del ingreso. Se analizaron las discrepancias entre ambos tratamientos. Resultados Se incluyeron 47 pacientes con 273 líneas de tratamiento domiciliario validado y 274 líneas de tratamiento Medoracyl ®. Resultaron 48/273 líneas discrepantes (17,6% [IC95%: 13,1-21,6]). Se consideraron justificadas 27/48, resultando un riesgo final de no concordancia del 7,8% [IC95%: 4,6-11,0]. Conclusiones: Medoracyl® es una herramienta útil y de fácil acceso que permite conocer más del 90% de la medicación domiciliaria de los pacientes.

Conocimiento de los tratamientos en pacientes hospitalarios: herramienta necesaria para la seguridad asistencial / Knowledge of treatments in hospital patients: a necesary tool for safety in health care

Objetivo. Determinar la cantidad y calidad de información sobre medicamentos que reciben los pacientes atendidos en un hospital. Método. Estudio descriptivo transversal realizado durante febrero de 2011, mediante diseño de una encuesta y entrevista a 60 pacientes: 30 ingresados y 30 externos. Análisis descriptivo de los resultados: número y grado de conocimiento de los medicamentos respecto al tratamiento «real», analizado de forma global, por edad y por vía de administración. Resultados. En el grupo de pacientes ingresados se analizaron 234 medicamentos «reales». Según los resultados de la encuesta, 45/234 (19,2%; IC95%:14-25) fueron conocidos de forma adecuada por los pacientes. En los pacientes externos esta cifra ascendió a 29/42 (69,0%; IC95%:53-82). El 33,3% de los pacientes verificó su medicación antes de ser administrada o dispensada. Los pacientes ingresados conocían mejor los medicamentos administrados por vía oral: el 28,6% frente al 5,1% de los parenterales. El 45,3% de los ingresados y el 2,4% de los externos desconocían la medicación. La edad media de los pacientes con conocimiento nulo de su medicación fue de 68,5 años (DE=10,1) y tenían 8,7 medicamentos prescritos (DE=3,0). El 53,3% y el 93,3% de los pacientes ingresados y externos respectivamente, consideraban haber sido informado correctamente. El 96,7% dijeron estar satisfechos con la información recibida. Conclusiones. Los resultados obtenidos muestran un potencial de mejora importante respecto a la información que se da a los pacientes, especialmente ingresados, en el hospital. Informarles permitiría su participación como filtro ante posibles errores de medicación y como pieza necesaria para la mejora de la seguridad asistencial(AU)

Objective. To determine the quantity and quality of drug information that patients receive in hospital. Method. Cross-sectional study conducted in February 2011, by designing and conducting a structured questionnaire on 60 patients: 30 inpatients and 30 outpatients. Descriptive analysis of the results was performed including, number and level of knowledge of medication treatment versus the "real" one, globally analysed by age and route of administration. Results. A total of 234 drugs were analysed in the inpatient group. It was considered that 45/234 (19.2%;95% CI: 14-25) were known properly by patients. In outpatients, this rises to 29/42 (69.0%;95% CI: 53-82). One third (33.3%) of patients check the medication before it is administered or provided. Inpatients are more aware of orally administered drugs, they knew 28.6% vs 5.1% of parenteral treatments. Just under half (45.3%) of inpatients and 2.4% of outpatients completely unknown the medication. The average age of patients with no knowledge of their medication was 68.5 years (SD=10.1) and had 8.7 drugs prescribed (SD=3.0). A total of 53.3% of inpatients and 93.3% of outpatients, considered to have been properly informed. Most of patients (96.7%) were satisfied with the information received. Conclusions. The results show an opportunity for improvement in the information given to patients, particularly to inpatients. To inform them, would enable them to act as a filter to potential medication errors, and as a necessary part to improve the safety of care(AU)

[Knowledge of treatments in hospital patients: a necesary tool for safety in health care]. / Conocimiento de los tratamientos en pacientes hospitalarios: herramienta necesaria para la seguridad asistencial.

OBJECTIVE: To determine the quantity and quality of drug information that patients receive in hospital. METHOD: Cross-sectional study conducted in February 2011, by designing and conducting a structured questionnaire on 60 patients: 30 inpatients and 30 outpatients. Descriptive analysis of the results was performed including, number and level of knowledge of medication treatment versus the "real" one, globally analysed by age and route of administration. RESULTS: A total of 234 drugs were analysed in the inpatient group. It was considered that 45/234 (19.2%;95% CI: 14-25) were known properly by patients. In outpatients, this rises to 29/42 (69.0%;95% CI: 53-82). One third (33.3%) of patients check the medication before it is administered or provided. Inpatients are more aware of orally administered drugs, they knew 28.6% vs 5.1% of parenteral treatments. Just under half (45.3%) of inpatients and 2.4% of outpatients completely unknown the medication. The average age of patients with no knowledge of their medication was 68.5 years (SD=10.1) and had 8.7 drugs prescribed (SD=3.0). A total of 53.3% of inpatients and 93.3% of outpatients, considered to have been properly informed. Most of patients (96.7%) were satisfied with the information received. CONCLUSIONS: The results show an opportunity for improvement in the information given to patients, particularly to inpatients. To inform them, would enable them to act as a filter to potential medication errors, and as a necessary part to improve the safety of care.

[A protocol of assessment, follow-up and nutritional action at a nursing home]. / Protocolo de valoración, seguimiento y actuación nutricional en un centro residencial para personas mayores.

OBJECTIVE: 1) To assess the nutritional status of able elderly, institutionalized at a nursing home; 2) To propose the required nutritional interventions; 3) To establish a consensus protocol for nutritional assessment and follow-up at the Center. METHOD: Cross-sectional study on all able residents, carrying out: 1) Mini Nutritional Assessment Test; 2) Anthropometrical assessment; 3) Biochemical assessment; and 4) an additional questionnaire (gathering information on dental prostheses, swallowing difficulties, and special diets or oral supplements). Analysis of these data to implement appropriate recommendations and elaborating a nutritional protocol. RESULTS: The mean age of the 50 residents assessed was 84 years [66-97], mean weight 62 kg [35-87], mean height 154 cm [140-175], mean body mass index 26 [15.6-36], mean tricipital fold 18.1 mm [4-36], and mean muscle arm circumference 20.6 cm [14.7-27.1]. By using the Mini Nutritional Assessment Test we identified 3/50 (6% [95% CI: 1-16]) malnourished residents, and 6/50 (12% [95% CI: 4-24]) residents at risk for malnourishment. The body mass index allowed to identify 11/50 (22% [95% CI: 11-35]) overweighed residents-body mass index 27-29-, 10/50 (20% [95% CI: 10-33]) with grade I obesity -body mass index 30-35 and 1/50 (2% [95% CI: 0-10]) with grade II obesity-body mass index > 35-. None of them presented values below the 5th percentile for both the tricipital fold and the muscle arm circumference. Values above the 95th percentile were found in 10/50 (20% [95% CI: 10-33]) residents for the tricipital fold and in 7/50 (14% [95% CI: 5-26]) for the muscle arm circumference, both criteria being present in 3 residents. In all of them the body mass index mayor was > 27. When analyzing the biochemical parameters, the results were not concordant, since laboratory workups analyzed were not always done at the same time as the interview. After analyzing the data obtained, a nutritional assessment and follow-up protocol was elaborated in collaboration with the physicians in charge of the Center, in which five categories were defined according to the nutritional status. CONCLUSIONS: 1) 3/50 malnourished residents were identified, 6/50 at risk for malnourishment, and 22/50 with overweight. 2) We proposed the performance of a whole laboratory work-up in these residents, reviewed their dietary habits in order to correct them or prescribe oral supplements, and recommended adapted physical exercise. 3) A nutritional assessment and follow-up protocol was elaborated.

Protocolo de valoración, seguimiento y actuación nutricional en un centro residencial para personas mayores / A protocol of assessment, follow-up and nutricional action at a nursing home

Objetivo: 1) Evaluar el estado nutricional de los ancianos válidos institucionalizados en un Centro Residencial de la Tercera Edad; 2) Proponer las intervenciones nutricionales necesarias, y 3) Establecer un protocolo consensuado de valoración y seguimiento nutricional en el Centro. Método: Estudio transversal sobre la totalidad de los residentes válidos, realizando: 1) Test Mini Nutricional Assessment; 2) Valoración antropométrica; 3) Valoración bioquímica, y 4) cuestionario adicional (informativo sobre prótesis dentales, problemas de deglución, y dietas especiales o suplementos orales). Análisis de estos datos para la realización de las recomendaciones oportunas y la elaboración del protocolo nutricional. Resultados: La edad media de los 50 residentes valorados fue de 84 años [66-97], con un peso medio de 62 kg [35-87], una talla de 154 cm [140-175], un índice de masa corporal medio de 26 [15,6-36], un pliegue tricipital medio de 18,1 mm [4-36] y una circunferencia muscular del brazo media de 20,6 cm [14,7-27,1]. Mediante el test Mini Nutricional Assessment se identificó a 3/50 (6%; [IC95%:1-16]) residentes mal nutridos, y 6/50 (12% [IC95%: 4-24]) en riesgo de malnutrición. El índice de masa corporal permitió identificar a 11/50 (22% [IC 95%: 11-35]) residentes con sobrepeso -índice de masa corporal entre 27 y 29-, a 10/50 (20% [IC 95%: 10-33]) con obesidad de grado I -índice de masa corporal entre 30 y 35- y a 1/50 (2% [IC 95%: 0-10]) con obesidad de grado II -índice de masa corporal mayor de 35-. Ningún residente tuvo valores inferiores al percentil 5 ni en el pliegue tricipital y en la circunferencia muscular del brazo. Tuvieron valores superiores al percentil 95 en el pliegue tricipital 10/50 (20% [IC 95%: 10-33]) y en la circunferencia muscular del brazo 7/50 (14% [IC 95%: 5-26]) coincidiendo ambos criterios en 3 residentes. Todos ellos tenían índice de masa corporal mayor de 27. En el análisis de los parámetros bioquímicos se encontraron resultados no concordantes ya que la analítica valorada no era siempre coincidente con el momento de la entrevista. Tras el análisis de los datos obtenidos, se elaboró junto con los médicos responsables del Centro un protocolo de valoración y seguimiento nutricional, en el que se definen cinco categorías en función del estado nutricional. Conclusiones: 1/Se identificaron 3/50 residentes mal nutridos, 6/50 en riesgo de malnutrición y 22/50 con sobrepeso. 2/Se propuso la realización de una bioquímica completa a estos residentes, la revisión de sus hábitos dietéticos para su modificación o para la prescripción de suplementos orales y la recomendación de realizar ejercicio físico adaptado. 3/Se elaboró un protocolo de valoración y seguimiento nutricional (AU)

Objective: 1) To assess the nutritional status of able elderly, institutionalized at a nursing home; 2) To propose the required nutritional interventions; 3) To establish a consensus protocol for nutritional assessment and follow-up at the Center. Method: Cross-sectional study on all able residents, carrying out: 1) Mini Nutritional Assessment Test; 2) Anthropometrical assessment; 3) Biochemical assessment; and 4) an additional questionnaire (gathering information on dental prostheses, swallowing difficulties, and special diets or oral supplements). Analysis of these data to implement appropriate recommendations and elaborating a nutritional protocol. Results: The mean age of the 50 residents assessed was 84 years [66-97], mean weight 62 kg [35-87], mean height 154 cm [140-175], mean body mass index 26 [15.6-36], mean tricipital fold 18.1 mm [4-36], and mean muscle arm circumference 20.6 cm [14.7-27.1]. By using the Mini Nutritional Assessment Test we identified 3/50 (6% [95% CI: 1-16]) malnourished residents, and 6/50 (12% [95% CI: 4-24]) residents at risk for malnourishment. The body mass index allowed to identify 11/50 (22% [95% CI: 11-35]) overweighed residents-body mass index 27-29-, 10/50 (20% [95% CI: 10-33]) with grade I obesity -body mass index 30-35 and 1/50 (2% [95% CI: 0-10]) with grade II obesity-body mass index > 35-. None of them presented values below the 5th percentile for both the tricipital fold and the muscle arm circumference. Values above the 95th percentile were found in 10/50 (20% [95% CI: 10-33]) residents for the tricipital fold and in 7/50 (14% [95% CI: 5-26]) for the muscle arm circumference, both criteria being present in 3 residents. In all of them the body mass index mayor was > 27. When analyzing the biochemical parameters, the results were not concordant, since laboratory workups analyzed were not always done at the same time as the interview. After analyzing the data obtained, a nutritional assessment and follow-up protocol was elaborated in collaboration with the physicians in charge of the Center, in which five categories were defined according to the nutritional status. Conclusions: 1) 3/50 malnourished residents were identified, 6/50 at risk for malnourishment, and 22/50 with overweight. 2) We proposed the performance of a whole laboratory work-up in these residents, reviewed their dietary habits in order to correct them or prescribe oral supplements, and recommended adapted physical exercise. 3) A nutritional assessment and follow-up protocol was elaborated (AU)