[Potentially inappropriate prescribing in hospitalized patients with comparative study between prescription by internist and geriatricians]. / Prescripción potencialmente inapropiada en pacientes hospitalizados con estudio comparativo entre la prescripción y realizada por internistas y geriatras.

OBJECTIVES: To analyze potentially inappropriate prescribing in hospitalized patients and compare the prescription by internists and geriatricians. METHODS: Cross-sectional study in hospitalized patients older than 65 years. We recorded prevalence of potentially inappropriate prescriptions according to the criteria of "Screening Tool of Older Person's Prescriptions". RESULTS: We included 95 hospitalized patients over 65 years with a median age of 79 years (interquartile range: 73-82 years) and 50.5% female. One hundred eighty-three potentially inappropriate prescriptions were detected in 81 patients (85.2% of patients). The most frequent potentially inappropriate prescription were the prolonged use of inhibitors of proton pump high dose (32.6% of patients), the use of benzodiazepines in patients prone to falling (23.2% of patients), the prolonged use of long-acting benzodiazepines (21.1% of patients) and prolonged use of neuroleptic as hypnotics (21.1% of patients). In comparative study between medical specialties, significant differences were found in mean number of drugs (P = 0.0001) and in prolonged use of neuroleptics as hypnotics (P = 0.015). CONCLUSIONS: A high percentage of hospitalized patients older than 65 years receive potentially inappropriate prescribing. Prolonged use of inhibitors of the proton pump at high doses was the most frequent potentially inappropriate prescribing criterion.

Prescripción potencialmente inapropiada en pacientes hospitalizados con estudio comparativo entre la prescripción realizada por internistas y geriatras / Potentially inappropriate prescribing in hospitalized patients with comparative study between prescription by internist and geriatricians

Objetivos: Analizar la prescripción potencialmente inapropiada en pacientes hospitalizados y comparar la prescripción realizada por internistas y geriatras. Métodos: Estudio transversal en pacientes mayores de 65 años hospitalizados. Se registraron las prevalencias de las prescripciones potencialmente inapropiadas según los criterios de "Screening Tool of Older Person's Prescriptions". Resultados: Se incluyeron 95 pacientes hospitalizados mayores de 65 años con una mediana de edad de 79 años (rango intercuartílico: 73-82 años) y un 50,5% fueron mujeres. En 81 pacientes (85,2% de la muestra) se detectaron un total de 183 prescripciones potencialmente inadecuadas. Los criterios de prescripciones potencialmente inadecuadas más frecuentes fueron el uso prolongado de los inhibidores de la bomba de protones a altas dosis (32,6% de los pacientes), el uso de benzodiacepinas en pacientes propensos a las caídas (23,2% de los pacientes), el uso prolongado de benzodiacepinas de vidamedia larga (21,1% de los pacientes) y el uso prolongado de neurolépticos como hipnóticos (21,1% de los pacientes). En el estudio comparativo entre especialistas, se encontraron diferencias significativas en el número medio de fármacos/paciente (P = 0,0001) y en el uso prolongado de neurolépticos como hipnóticos (P = 0,015). Conclusiones: Un alto porcentaje de los pacientes mayores de 65 años hospitalizados reciben una prescripción potencialmente inapropiada. El uso prolongado de los inhibidores de la bomba de protones a altas dosis fue el criterio de prescripción potencialmente inapropiada más frecuente

Objectives: To analyze potentially inappropriate prescribing in hospitalized patients and compare the prescription by internists and geriatricians. Methods: Cross-sectional study in hospitalized patients older than 65 years. We recorded prevalence of potentially inappropriate prescriptions according to the criteria of "Screening Tool of Older Person's Prescriptions". Results: We included 95 hospitalized patients over 65 years with a median age of 79 years (interquartile range: 73-82 years) and 50.5% female. One hundred eighty-three potentially inappropriate prescriptions were detected in 81 patients (85.2% of patients). The most frequent potentially inappropriate prescription were the prolonged use of inhibitors of proton pump high dose (32.6% of patients), the use of benzodiazepines inpatients prone to falling (23.2% of patients), the prolonged use of long-acting benzodiazepines (21.1% of patients) and prolonged use of neuroleptic as hypnotics (21.1% of patients). Incomparative study between medical specialties, significant differences were found in mean number of drugs (P = 0.0001) and in prolonged use of neuroleptics as hypnotics (P = 0.015). Conclusions: A high percentage of hospitalized patients olderthan 65 years receive potentially inappropriate prescribing. Prolonged use of inhibitors of the proton pump at high doses was the most frequent potentially inappropriate prescribing criterion

Implementación de las guías de práctica clínica sobre ictus isquémico agudo en atención especializada / Implementation of clinical practice guidelines for acute ischaemic stroke in specialist

Introducción: La enfermedad cerebrovascular se asocia a una elevada morbimortalidad. En el año 2008, el Ministerio de Sanidad publicó la «Guía de práctica clínica» sobre prevención del ictus sin que se haya evaluado su implementación. Nos planteamos investigar el seguimiento de dicha guía a través del análisis del control de factores de riesgo vascular y el tratamiento antitrombótico e hipolipemiante en pacientes con ictus isquémico agudo atendidos por neurólogos o internistas. Métodos: Estudio transversal descriptivo basado en los datos obtenidos de informes clínicos factores de riesgo vascular, diagnóstico y tratamientos), cifras tensionales y analíticas de 203 pacientes con diagnóstico principal de ictus isquémico agudo que ingresaron para rehabilitación y cuidados en un hospital de media-larga estancia. Resultados: La edad media ± DE de los pacientes incluidos fue de 75 ± 10 años con un 56% de mujeres. Los factores de riesgo más frecuentes fueron hipertensión arterial (68%) y diabetes mellitus (40%). El 8,9% de los pacientes había recibido fibrinólisis por vía intravenosa. El 91,7% de los pacientes con ictus aterotrombótico recibía antiagregantes; el 59,4% de los pacientes con ictus cardioembólico estaba anticoagulado. Se prescribieron estatinas al 65% de los pacientes con ictus aterotrombótico. En la analítica de ingreso, el 23% de los pacientes presentaba una colesterolemia total mayor de 175 mg/dl y el 26,6% una glucemia plasmática mayor de 126 mg/dl. El 70% de los pacientes tenía tratamiento antihipertensivo, aunque el 47,5% presentaba cifras tensionales mayores de 130/80 mmHg. Conclusiones: Creemos que aún es posible mejorar la prevención secundaria en enfermedad cerebrovascular, principalmente aumentando el porcentaje de pacientes tratados con antiagregantes o anticoagulantes según la etiología, la prescripción de estatinas y mejorando el control tensional (AU)

Introduction: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists. Methods: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care. Results: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg. Conclusions: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control (AU)

Implementation of clinical practice guidelines for acute ischaemic stroke in specialist care centres.

INTRODUCTION: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists. METHODS: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care. RESULTS: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg. CONCLUSIONS: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control.

[Prevalence and factors associated to malnutrition in patients admitted to a medium-long stay hospital]. / Prevalencia y factores asociados a desnutrición entre pacientes ingresados en un hospital de media-larga estancia.

OBJECTIVES: To determine the prevalence of hyponutrition at admission at a mid- to long-term stay hospital. To analyze the possible factors associated to hyponutrition; the possible relationship with mortality at one month, and the treatments for hyponutrition performed. MATERIALS AND METHOD: Descriptive study from the laboratory data obtained in 140 patients. For diagnosing hyponutrition, a tool based on albumin, total cholesterol, and lymphocytes levels was used. Demographical (age and gender) and clinical data (presence of pressure soars, nasogastric tube, dementia, neoplasm, previous admission to the ICU, and main diagnosis) were gathered at admission as well as the mortality at the first month. The treatments used for hyponutrition were reviewed. RESULTS: patients' age was 77.1 years and 63% were females. 17.1% of the patients presented normal nutritional status, 50.7% met the criteria for mild hyponutrition, 26.4% of moderate hyponutrition, and 5.7% of severe hyponutrition. We found no association between hyponutrition and gender, nasogastric tube, soars, dementia or neoplasm, but we did so with age (P = 0.033). We found a relationship between moderate-severe hyponutrition and pressure soars (P = 0.036). We found an association between hyponutrition and mortality at one month (OR = 1.357, 95% CI 1.121 to 1.643; P = 0.02). 35.6% of the patients with moderate-severe hyponutrition received therapy for this condition (28.9% with protein supplements and 6.7% with enteral diet). CONCLUSIONS: hyponutrition affects most of the patients admitted to a mid to long-term stay hospitals and is associated with higher mortality. One third of hyponutrition patients receive nutritional therapy.

Prevalencia y factores asociados a desnutrición entre pacientes ingresados en un hospital de media-larga estancia / Prevalence and factors associated to malnutrition in patients admited to a medium-long stay hospital

Objetivos: Determinar la prevalencia de desnutrición al ingreso en un hospital de media-larga estancia. Analizar posibles factores asociados a la misma; la posible relación con la mortalidad y los tratamientos de desnutrición realizados. Material y métodos: Estudio descriptivo a partir de datos analíticos obtenidos de 140 pacientes. Para el diagnóstico de desnutrición, se aplicó una herramienta basada en niveles de albúmina, colesterol total y linfocitos(CONUT). Se recogieron datos demográficos (edad, sexo) y clínicos (presencia de úlceras por presión, sonda nasogástrica, demencia, neoplasia, estancia previa en UCI y diagnóstico principal) al ingreso así como la mortalidad en el primer mes de ingreso. Se revisaron los tratamientos nutricionales administrados. Resultados: La edad de los pacientes fue de 77,1 años y el 63% eran mujeres. El 17,1% de los pacientes presentaba un estado nutricional normal, el 50,7% criterios de desnutrición leve, el 26,4% de desnutrición moderada y el 5,7% de grave. No se halló asociación entre desnutrición y sexo, sonda nasogástrica, úlcera, demencia o neoplasia aunque sí con la edad (P = 0,033). Se halló asociación entre desnutrición moderada-severa y úlcera por presión (P = 0,036). Se encontró asociación entre desnutrición y mortalidad a un mes (OR = 1,389, IC 95% de 1,142 a1,688; P = 0,001). El 35,6% de los pacientes con desnutrición moderada-severa recibió tratamiento nutricional (28,9% suplementos proteicos y 6,7% dieta enteral). Conclusiones: La desnutrición afecta a la mayor parte de los pacientes que ingresan en un hospital de media larga estancia y se asocia con mayor mortalidad. Un tercio de los pacientes desnutridos reciben tratamiento nutricional (AU)

Objectives: To determine the prevalence of hyponutrition at admission at a mid- to long-term stay hospital. To analyze the possible factors associated to hyponutrition; the possible relationship with mortality at one month, and the treatments for hyponutrition performed. Materials and method: Descriptive study from the laboratory data obtained in 140 patients. For diagnosing hyponutrition, a tool based on albumin, total cholesterol,and lymphocytes levels was used. Demographical (age and gender) and clinical data (presence of pressure soars, nasogastric tube, dementia, neoplasm, previous admission to the ICU, and main diagnosis) were gathered at admission as well as the mortality at the first month. The treatments used for hyponutrition were reviewed. Results: patients’ age was 77.1 years and 63% were females. 17.1% of the patients presented normal nutritional status, 50.7% met the criteria for mild hyponutrition, 26.4% of moderate hyponutrition, and 5.7% of severe hyponutrition. We found no association between hyponutrition and gender, nasogastric tube, soars,dementia or neoplasm, but we did so with age (P = 0.033).We found a relationship between moderate-severe hyponutrition and pressure soars (P = 0.036). We found an association between hyponutrition and mortality a tone month (OR = 1.357, 95% CI 1.121 to 1.643; P = 0.02).35.6% of the patients with moderate-severe hyponutrition received therapy for this condition (28.9% with protein supplements and 6.7% with enteral diet).Conclusions: hyponutrition affects most of the patients admitted to a mid to long-term stay hospitals and is associated with higher mortality. One third of hyponutrition patients receive nutritional therapy (AU)