[Pharmacological intervention in the medication review of institutionalised elderly patients under polypharmacy]. / Intervención farmacéutica en la revisión del tratamiento en pacientes mayores polimedicados institucionalizados.

OBJECTIVE: To describe the Drug-Related Problems (DRP) and their resolution after pharmacological review in institutionalised elderly patients under polypharmacy. DESIGN: Descriptive, retrospective cohort study from January to October of 2022. LOCATION: Twelve nursing homes at the Community of Madrid. PARTICIPANTS: 295 patients aged 65 or older taking at least 5 chronic medications prescribed prior to the treatment review. INTERVENTIONS: Medication reviews carried out by the pharmacist and agreed upon in face-to-face meetings between the primary care doctor, the nursing home doctor and the pharmacist. MAIN MEASUREMENTS: Detected DRP, types and resolution. A age, sex, and number of medications before and after the intervention. Pharmacological subgroups according to anatomical therapeutic chemical classification system (ATC) and active pharmaceutical ingredients involved in the detected DRPs. RESULTS: 1425 DRP were detected, with a mean of 4.85 (SD 3.33) DRPs/patient. The most frequent DRP was reconciliation error (32.52%), followed by pharmaceutical regimen and dosaje. Among the 1425 improvement proposals, 86.73% of them were accepted.Significant statistically differences were observed between the number of medications per patient prior to the pharmacotherapy review (12.29) and after it (10.20), obtaining an average difference of 2.09 (95%CI: 1.98-2.21; P<.001). CONCLUSIONS: It is found that the intervention of multidisciplinary team in which the pharmacist performs a revision of the medication decreased the number of prescribed medications. Therefore, it reduces polymedication and its associated risks.

Effects of internet-based, psychosocial, and early medical interventions on professional burnout in health care workers: Systematic literature review and meta-analysis.

Background: The prevalence of professional burnout increased among healthcare workers during the coronavirus 2019 (COVID-19) pandemic, with negative effects on their mental health. Consequently, research interest in methods to decrease the prevalence of burnout and reduce the effects of burnout on healthcare workers has increased. Objective: This study was designed to evaluate the effects of Internet-based, psychosocial, and early medical interventions on professional burnout among healthcare workers. Methodology: This systematic review and meta-analysis involved 8004 articles identified from four databases: Cochrane, Web of Science, PubMed/Medline, and clinical trials. Results: Four articles were included in the systematic review, of which two could be meta-analyzed. The pooled effect of the group of interventions compared to control conditions was not statistically significant. Discussion: Evaluating therapeutic effectiveness requires more clinical trials that allow its evaluation. Although we did not find improvements in the three intervention categories, the methodological heterogeneity in each intervention and the need for a standardized intervention guide for managing and decreasing professional burnout, subject to the evaluation of its impact, are highlighted.

Intervención farmacéutica en el manejo de inhaladores con pacientes EPOC citados para una espirometría en un centro de salud / Pharmaceutical intervention in the usage of inhalers with COPD patients that have an appointment in a health center to do an spirometry

Antecedentes: el uso de los inhaladores es algo complejo, con este trabajo en pacientes con EPOC debido a su complejidad, lo que se pretende es que tras la intervención de un farmacéutico se garanti-ce el uso adecuado de dichos medicamentos con el fin de mejorar la calidad de vida.Métodos: se citaba a los pacientes para la realiza-ción de una espirometría por parte de la enfermera y por otro lado la farmacéutica en una consulta valoraba el uso de los inhaladores y realizaba los test de adherencia y calidad de vida. A los tres meses los pacientes acudían a la segunda visita y la farmacéutica repetía el mismo el proceso para detectar los posibles cambios tras la intervención.Resultados: en aquellos pacientes que acudieron a las dos visitas se observó que había cambios estadísticamente significativos entre las puntuacio-nes de adherencia en la primera visita respecto a la segunda. La media de puntuaciones es mayor en la segunda visita (49,09) respecto a la primera (46,45), diferencia significativa con una p<0,05. La calidad de vida era igual en ambas visitas y la media de errores en el uso de inhaladores en la segunda visi-ta (1,773) se reduce de forma significativa respecto a la media de errores en la primera visita (4,727).Conclusiones: la intervención de un farmacéutico en un equipo multidisciplinar para el seguimiento de pacientes EPOC ha resultado beneficiosa para dichos pacientes, sobre todo en cuanto al manejo de los inhaladores y la adherencia al tratamiento. (AU)

Background: the usage of inhalers is something complex. This work with COPD patients pretends that, after the pharmacist intervention, the correct usage of these drugs is guaranteed so as to im-prove the quality of life. Methods: the nurse set a date to do an spirometry to the patients. On the other hand, the pharmacist assessed the usage of the inhalers and carried out the adherence and quality of life tests. Three months after, the patients came back to the con-sultation and the pharmacist repeated the same procedure to detect any possible change after the intervention.Results: on those patients that attended both ap-pointments, it was seen that there were statistically significant changes between the adherence punc-tuation regarding both appointments. The average of punctuation is higher in the second appointment (49.09) in respect to the first one (46.45), this is a significant difference with a p<0.05. The quality of life was the same in both appointments and the errors average in the usage of inhalators in the second appointment decreased (1773) significantly in respect to the errors average in the first appoint-ment (4727).Conclusion: the intervention of a pharmacist in a multidisciplinary team to the following of COPD pa-tients is advantageous to these patients, mainly in relation to the usage of inhalers and the adherence to treatment. (AU)

Psychological suppressive profile and autoantibodies variability in women living with breast cancer: A prospective cross-sectional study.

Breast cancer (BC) is a leading cause of women's morbimortality worldwide. Unfortunately, attempts to predict women's susceptibility to developing BC well before it becomes symptomatic, based on their genetic, family, and reproductive background have proved unsatisfactory. Here we analyze the matching of personality traits and protein serum profiles to predict women's susceptibility to developing cancer. We conducted a prospective study among 150 women (aged 18-70 years), who were distributed into three groups (n = 50): women without breast pathology and women diagnosed with BC or benign breast pathology. Psychological data were obtained through standardized psychological tests and serum protein samples were analyzed through semiquantitative protein immunoblotting. The matching for psychological and immunological profiles was constructed from these data using a mathematical generalized linear model.The model predicted that women who have stronger associations between high-intensity stress responses, emotional containment, and an increased number and reduced variability of serum proteins (detected by IgG autoantibodies) have the greatest susceptibility to develop BC before the disease has manifested clinically. Hence, the present study endorses the possibility of using psychological and biochemical tests in combination to increase the possibility of identifying women at risk of developing BC before the disease shows clinical manifestations. A longitudinal study must be instrumented to test the prediction ability of the instrument in real scenarios. Trial registration: Committee of Ethical Research of the Hospital General de México "Dr. Eduardo Liceaga," Ministry of Health (DI/12/111/03/064).

Cuidado de la salud del adulto mayor en una comunidad semirural desde una metodológica de participación acción investigación centrada en la ocupación / Health care of the elderly in a semi-rural community with a methodology of participatory-action-research focused on the occupational perspective

El objetivo del estudio fue identificar las necesidades del cuidado de la salud de los adultos mayores en una comunidad semi – rural, las redes de apoyo existentes y desarrollar un proyecto de cuidado de salud dirigido a esta población desde un enfoque ocupacional. Se siguió una metodología mixta de tres fases: En la Fase I se utilizó un diseño descriptivo, transversal y correlacional. En la Fase II se utilizó un diseño mixto cuantitativo y cualitativo y en la Fase III una metodología cualitativa. En las Fases II y III se utilizó una metodología de Investigación-Acción Participación y Rehabilitación Basada en la Comunidad. Resultados. Se identificaron los recursos y necesidades ocupacionales y de salud de los adultos mayores residentes en la comunidad. Estos recursos y necesidades sirvieron de base para realizar un programa de sensibilización, capacitación y atención rehabilitatoria a adultos mayores, implementado con la participación de cuidadores primarios. Se identificaron los recursos y necesidades comunitarias en cuanto a sus redes de apoyo, esto generó la creación de un grupo de apoyo para los adultos mayores en situación de vulnerabilidad. Esta experiencia permitió vincular a diferentes actores en el cuidado de la salud del adulto mayor, creando conciencia del valor de su propio conocimiento y su aportación al entretejido social de la comunidad. El involucramiento de los pasantes de licenciatura y maestría de terapia ocupacional a lo largo del proyecto, permitió ampliar el número de beneficiarios, capacitar en rehabilitación basada en la comunidad a cuidadores primarios, además de darle a los estudiantes la oportunidad de involucrarse y colaborar directamente en la comunidad, identificando las necesidades ocupacionales de la población para intervenir en forma más efectiva.

The objective of the study was to identify the health care needs of the elderly in a semi - rural community, their existing support networks and to develop a healthcare project for this population from an occupational perspective. A mixed, three-phase methodology was used. In Phase I, a descriptive, transverse and correlational design was employed, followed by a combined quantitative and qualitative design in Phase II and a qualitative methodology in Phase III. In the latter two phases, a Participatory–Action-Research Methodology and Community Based Rehabilitation was used. Results. The occupational resources and health needs of the elderly in the community were identified. These resources and needs became the basis for the development of an awareness and training program for the caregivers. A rehabilitation support program was also implemented. Social network resources and needs were identified and generated a support group for the elderly in a vulnerable situation. This project allowed to connect different actors involved in the healthcare of the elderly. It also raised awareness among the elderly regarding the value of their own knowledge and their contribution to the social fabric of the community. The involvement of undergraduate and graduate interns in occupational therapy throughout the project facilitated covering different types of health needs as well as to expand the number of beneficiaries. It also gave students the opportunity to get involved and to work directly in the community through the identification of the occupational needs of the population as a means to intervene more effectively.

Developmental Risk Signals as a Screening Tool for Early Identification of Sensory Processing Disorders.

The main purpose of this research was to determine if the indicators of risk included in the Indicators of Developmental Risk Signals (INDIPCD-R) could differentiate between children at risk of sensory processing disorders (SPDs) from those with normal development and if the SPD indicators correlated with a delay or altered development. A retrospective, descriptive, correlational design was used with a sample of 51 children, 36 referred because of clinical sensory processing indicators and 15 with non-clinical indicators. Participants were assessed with a developmental scale Revised Profile of Developmental Behaviors (PCD-R), the Sensory Profile, play and clinical observations. The INDIPCD-R showed a high correlation with developmental areas of PCD-R and a sensitivity and specificity of 100%, when compared with the Sensory Profile. T-test results for independent samples showed significant differences at p ≤ 0.01 level between the children with SPD indicators and those with no clinical signs in the PCD-R. The Mann-Whitney U-test was conducted for unpaired samples, to verify if there were significant differences between children with apparent SPD indicators and children with no apparent difficulties. The Spearman's rho was used to identify the correlations between the INDIPCD-R, with different areas of development. This study supports the use of the INDIPCD-R as a screening instrument that could be used by occupational therapists to discriminate children with and without indicators of SPD. The limitation of this study was that it did not cover all the ages of the INDIPCD-R. Additional studies are required to determine the utility of this instrument for outcome studies and whether it is valid and reliable to identify children at risk of different pathologies. The INDIPCD-R is a low-cost instrument that allows the occupational therapist to make a quick review of the different components that could be involved in SPD and therefore guide the more in-depth evaluation if necessary. Copyright © 2015 John Wiley & Sons, Ltd.