ABSTRACT
Este caso clínico relata la complejidad de la atención paliativa domiciliaria en un paciente con disnea. Este paciente está afecto de fibrosis pulmonar idiopática, proceso patológico en el que la disnea puede ser un síntoma de difícil control. La poca tolerancia al tratamiento con sulfato de morfina oral nos obligó a buscar alternativas. Queremos exponer nuestra experiencia con fentanilo inhalado en un paciente con disnea muy importante
This case reflects the complexity of home palliative care in a patient with dyspnea. A case is presented of a patient with idiopathic pulmonary fibrosis, in which the dyspnea was difficult to control. The low tolerance to treatment with oral morphine sulfate, led to looking for alternatives. Experience with inhaled fentanyl in a patient with significant symptomatic dyspnea is reported
Subject(s)
Humans , Male , Aged , Dyspnea/drug therapy , Fentanyl/therapeutic use , Idiopathic Pulmonary Fibrosis/drug therapy , Home Care Services, Hospital-Based/organization & administration , Administration, Inhalation , Palliative Care/methods , Hospice and Palliative Care Nursing/methodsABSTRACT
In the Catalonian Institute of health there are 2 well-established circumstances for indicating lipid-lowering drug treatment with statins in the primary prevention of ischaemic heart disease. These are, severe hypercholesterolaemia, with a low density lipoprotein cholesterol equal to or greater than 240mg/dL, or above 130mg/dL when the coronary risk is equal to or greater than 10% at 10 years. There are data that suggest that these 2 criteria are not the only ones used in routine clinical practice, as such that the majority of patients to whom it is indicated, do not meet either of these 2 conditions. This study aims to determine the characteristics of the patients when statins are indicated outside the aforementioned circumstances. It is concluded that around 40% of patients have clinical characteristics that could justify the treatment. The level of suitability could not be established in about 33% of the patients, due to not being able to determine the coronary risk.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/drug therapy , Myocardial Ischemia/prevention & control , Anticholesteremic Agents/therapeutic use , Cholesterol, LDL/administration & dosage , Cholesterol, LDL/blood , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Primary Prevention , Risk FactorsABSTRACT
Las circunstancias que están bien establecidas, en el ámbito del Institut Català de la Salut, para indicar un tratamiento farmacológico hipolipidemiante con estatinas en la prevención primaria de la cardiopatía isquémica son 2: una hipercolesterolemia severa, con valores de colesterol transportado por las lipoproteínas de baja densidad iguales o superiores a 240 mg/dL, o por encima de 130 mg/dL cuando el riesgo coronario es igual o mayor al 10% a los 10 años. Hay datos que indican que en la práctica habitual estos 2 criterios no son los únicos utilizados, de forma que la mayoría de los pacientes a quienes se indica, de novo, una estatina, no reúnen ninguna de estas 2 condiciones. Este estudio pretende conocer las características que tienen los pacientes cuando estas son indicadas fuera de los supuestos mencionados. Se concluye que cerca del 40% de los pacientes tienen características clínicas que pueden explicar la indicación del tratamiento. En una tercera parte no puede establecerse el grado de adecuación por no poderse determinar el riesgo coronario
In the Catalonian Institute of health there are 2 well-established circumstances for indicating lipid-lowering drug treatment with statins in the primary prevention of ischaemic heart disease. These are, severe hypercholesterolaemia, with a low density lipoprotein cholesterol equal to or greater than 240 mg/dL, or above 130 mg/dL when the coronary risk is equal to or greater than 10% at 10 years. There are data that suggest that these 2 criteria are not the only ones used in routine clinical practice, as such that the majority of patients to whom it is indicated, do not meet either of these 2 conditions. This study aims to determine the characteristics of the patients when statins are indicated outside the aforementioned circumstances. It is concluded that around 40% of patients have clinical characteristics that could justify the treatment. The level of suitability could not be established in about 33% of the patients, due to not being able to determine the coronary risk
