Discrepancies in Electronic Medical Prescriptions Found in a Hospital Emergency Department: A Prospective Observational Study.

The medication in an electronic prescribing system (EPS) does not always match the patient's actual medication. This prospective study analyzes the discrepancies (any inconsistency) between medication prescribed using an EPS and the medication revised by the clinical pharmacist upon admission to the observation area of the emergency department (ED). Adult patients with multimorbidity and/or polypharmacy were included. The pharmacist used multiple sources to obtain the revised medication list, including patient/carer interviews. A total of 1654 discrepancies were identified among 1131 patients. Of these patients, 64.5% had ≥1 discrepancy. The most common types of discrepancy were differences in posology (43.6%), commission (34.7%), and omission (20.9%). Analgesics (11.1%), psycholeptics (10.0%), and diuretics (8.9%) were the most affected. Furthermore, 52.5% of discrepancies affected medication that was high-alert for patients with chronic illnesses and 42.0% of medication involved withdrawal syndromes. Discrepancies increased with the number of drugs (ρ = 0.44, p < 0.01) and there was a difference between non-polypharmacy patients, polypharmacy ones and those with extreme polypharmacy (p < 0.01). Those aged over 75 years had a higher number of prescribed medications and discrepancies occurred more frequently compared with younger patients. The number of discrepancies was larger in women than in men. The EPS medication record requires verification from additional sources, including patient and/or carer interviews.

Cancer-Related Fatigue and Circulating Biomarkers in Breast Cancer Survivors.

PURPOSE: Cancer-related fatigue (CRF) is the most common and disruptive symptom experienced by cancer survivors and because of its frequency and severity is especially worrisome in breast cancer survivors (BCS). Despite a great deal of research, the mechanisms underlying CRF have not been determined. The present study aims to describe associations between CRF in BCS and different blood biomarkers. METHODS: A descriptive and cross-sectional study was conducted. A set of biomarkers assessing inflammation were measured in BCS: C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor (TNF); HPA axis dysfunction (cortisol), autonomic dysfunction (noradrenaline); oxidative stress (8-OH deoxyguanosine); insulin resistance markers (insulin, IGF-I, IGFBP3) and sexual hormones (estrogens, progesterone, testosterone). RESULTS: NLR (p = .00) and cortisol (p = .02) were positive and negatively associated with CRF, respectively. The rest of the blood markers were not associated with CRF. CONCLUSION: Our results increase the evidence on pathophysiological mechanisms driving CRF in BCS. However, longitudinal studies are needed to explore the role of these factors as potential causal mechanisms.

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement.

Patients with enteral access usually receive oral drugs via feeding tubes and correct drug administration remains a challenge. The aim of this study was to identify common medication delivery errors (MDEs) in outpatients with percutaneous endoscopic gastrostomy (PEG) and evaluate their association with the need for tube replacement due to deterioration or clogging. A 2-year retrospective study that comprised adult outpatients with a placed/replaced PEG tube and whose electronic medical record included home medication was carried out. Treatment with medication that should not be crushed and administered through an enteral feeding tube was considered an MDE. We included 269 patients and 213 MDEs (20% of oral prescriptions) were detected in 159. Ninety-two percent of the medications associated with MDEs could be substituted by appropriate formulations. Tube replacement due to obstruction was needed in 85 patients. MDEs were associated with increased risk for tube replacement (OR 2.17; 95% CI 1.10-4.27). Omeprazole enteric-coated capsules were associated with the greatest risk (OR 2.24; 95% CI 1.01-4.93). PEG outpatients are highly exposed to MDEs, leading to a significant increase in the odds of tube replacement, mainly when treated with omeprazole. The use of appropriate alternative therapies would prevent unnecessary adverse events.

Biological mechanisms of cancer-related fatigue in breast cancer survivors after treatment: a scoping review.

PURPOSE: Cancer-related fatigue (CRF) is the most common symptom experienced by cancer survivors. It is a multidimensional symptom affecting physical, emotional, and/or cognitive spheres, different from other types of fatigue. Characteristically is not alleviated by sleep or rest. CRF could have specific features in breast cancer survivors (BCS), because of sex, hormones, and distinct treatments. On the other hand, more than 25% of BCS report persistent CRF for 10 years or more after the diagnosis. The present study aims to recapitulate the knowledge about the biological mechanisms that potentially drive CRF in BCS after treatment. METHODS: To answer a broad question, a scoping review methodology was used. Data were collated from three bibliographic databases: PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies were selected if they had included more than 20 BCS, after finishing their treatment, fatigue was measured with a quantitative scale and biomarkers were analyzed. RESULTS: The final database was composed of 1896 records. Sixty-four studies finally met the eligibility criteria. Inflammation (61%), hypothalamic-pituitary-adrenal (HPA) axis dysregulation (14%), autonomic nervous system (ANS) dysfunction (11%), and diet (9%) were the biological pathways most frequently studied. Unfortunately, results from studies about inflammation and HPA axis show many inconsistencies. CONCLUSION: More research about the role of ANS dysfunction and diet on the pathogenesis of CRF would be warranted according to the results of the review. There are some fields such as endocannabinoid systems, mitochondrial dysfunction, gut microbiota, and oxidative stress that have been insufficiently explored. IMPLICATIONS FOR CANCER SURVIVORS: To widen the scope of future research in the physiopathology of CRF, it is necessary to identify mechanisms that would be potentially involved and have been insufficiently explored. Because of the high prevalence of CRF in BCS and the tremendous impact that fatigue has in their quality of life, it is essential to improve the efficacy of the treatments through a good knowledge of the biological basis of CRF.

C-Reactive Protein Is Associated with Physical Fitness in Breast Cancer Survivors.

Background: Physical fitness (PF) is an expression of the physiological functioning of multiple body components. PF is an important prognostic factor in terms of cardiovascular mortality, cancer mortality, and all-cause mortality. PF has been related to some biomarkers in the general population but not in breast cancer survivors (BCS). Purpose: To evaluate the effects of PF on biomarkers potentially related to physical activity (PA) in a sample of BCS. Methods: Cross-sectional study. A total of 84 BCS (mean age 54) who had finished their treatment were recruited. Different components of PF were evaluated, namely body composition (anthropometry), cardiorespiratory fitness (one-mile walk test), muscular (handgrip and sit-to-stand timed test), and motor (gait speed) components. Sexual hormones, inflammation, and insulin resistance biomarkers were measured. Results: C-Reactive Protein (CRP) was associated with every component of physical fitness: cardiorespiratory fitness (p-value = 0.002), muscular (sit-to-stand timed test, p-value = 0.002) and motor (gait speed, p-value = 0.004) components, and body composition (body mass index, p-value = 0.003; waist, p-value < 0.000; and waist-to-hip index, p-value = 0.012). CRP also was associated with "poor physical condition," a constructed variable that encompasses all components of physical fitness (p-value < 0.001). Insulin was associated with cardiorespiratory fitness and gait speed (p-values = 0.002 and 0.024, respectively). Insulin-like Growth Factor-1 was negatively associated with waist perimeter and waist-to-hip ratio. Conclusions: CRP can also be considered an indicator of poor PF in BCS. Implications for cancer survivors: in case of elevation of CRP indicating cardiovascular risk, health professionals should recommend lifestyle changes to improve BCS physical condition.

Effects of an Eight-Week Concurrent Training Program with Different Effort Character over Physical Fitness, Health-Related Quality of Life, and Lipid Profile among Hospital Workers: Preliminary Results.

BACKGROUND: The "effort character" (EC) is a resistance training method without reaching muscle failure. It was defined by González-Badillo and Gorostiaga Ayestarán (2002) as the relationship between the repetitions performed and the repetitions achievable. Then, the EC is at its maximum (i.e., 100%) when the subject realizes all the repetitions possible in a series with any load. Therefore, an EC of 50% indicates execution of 50% of the repetitions achievable in a series. This study aimed to determine the effects of two programs of eight weeks of concurrent training (CT) with different EC over muscle strength (MS), cardiorespiratory fitness (CRF), functional mobility (FM), health-related quality of life (HRQoL), and lipid profile (LP) among hospital workers. METHODS: Fourteen hospital workers (age: 41.1 ± 10.8 years; body mass: 63.0 ± 10.8 kg; height: 165.2 ± 6.5 cm; body mass index (BMI): 23.0 ± 3.4 kg/m2) were randomly assigned to an EC 50% (n = 7) or EC 100% (n = 7) group. RESULTS: The main finding was that both groups significantly improved in MS and FM levels but not HRQoL, with no statistical differences between EC 50% and EC 100% in adherence and any test despite performing half the volume of the strength workout. CONCLUSIONS: An eight-week CT program with different EC (i.e., EC 50% vs. EC 100%) seems to improve the MS and FM levels in hospital workers similarly. These findings could be very useful in health-training practices because of the possibility of planning training loads with half the volume of strength workouts without the loss of any training adaptation.

Psychological impact of the COVID-19 pandemic on patients with allergic diseases.

BACKGROUND: On March 2020, World Health Organization (WHO) declared COVID-19 to be a pandemic disease. Interactions between allergy-related inflammatory and psychiatric disorders including depression, anxiety, and post-traumatic stress disorder (PTSD) have been documented. Therefore, those who have pre-existing allergic conditions may have an increased psychiatric reaction to the stresses of the COVID-19 pandemic. OBJECTIVE: Identify the psychological impact of COVID-19 in patients with allergic diseases and determine if these individuals have a greater risk of presenting with post-traumatic stress disorder (PTSD). METHODS: It is a cross-sectional, survey-based study designed to assess the degree of symptoms of depression and the risk of PTSD using the Patient Health Questionnaire (PHQ-9) and the Impact of Event Scale-Revised (IES-R), respectively, in allergic patients. RESULTS: A total of 4106 surveys were evaluated; 1656 (40.3%) were patients with allergic disease, and 2450 (59.7%) were non-allergic (control) individuals. Of those with allergies, 76.6% had respiratory allergic disease including asthma and allergic rhinitis. Individuals with allergic disease reported higher scores regarding symptoms of PTSD on the IES-R scale (p = 0.052, OR 1.24 CI 0.99-1.55) as well as a higher depression risk score in the PHQ-9 questionnaire (mean 6.82 vs. 5.28) p = 0.000 z = -8.76.The allergy group presented a higher score in the IES-R questionnaire (mean 25.42 vs. 20.59), being more susceptible to presenting PTSD (p = 0.000, z = -7.774).The individuals with allergic conditions were further divided into subgroups of those with respiratory allergies such as allergic rhinitis and asthma vs those with non-respiratory allergies such as drug and food allergy, urticaria and atopic dermatitis. This subgroup analysis compares respiratory versus non-respiratory allergic patients, with similar results on the IES-R (mean 25.87 vs 23.9) p = 0.0124, z = -1.539. There was no significant difference on intrusion (p = 0.061, z = -1.873) and avoidance (p = 0.767, z = -0.297), but in the hyperarousal subscale, patients with respiratory allergy had higher scores (mean 1.15 vs. 0.99) p = 0.013 z = -2.486. CONCLUSIONS: Psychological consequences such as depression and reported PTSD are present during the COVID-19 pandemic causing an impact particularly in individuals with allergic diseases. If we acknowledge the impact and how it is affecting our patients, we are able to implement interventions, follow up, and contribute to their overall well-being.

Tailored exercise as a protective tool in cardio-oncology rehabilitation: a narrative review / Ejercicio individualizado como herramienta protectora en la rehabilitación cardio-oncológica: revisión narrativa

Cardiovascular disease is the leading cause of long-term morbidity and death among cancer survivors, after second malignancies. Preventing cancer treatment-induced cardiotoxicity (CTC) constitutes a crucial endpoint in oncology, from oncology treatment implementation. The American Association of Clinical Oncology has recently highlighted the role of physical exercise as an essential component of co-adjuvant cancer treatment and cancer survivor care programs. Exercise training may protect from cardiotoxicity on a molecular and physiological basis. Two major types of training in this field are: cardiovascular and resistance/strength training. Little is known about the effects of these modalities of exercise on CTC. This narrative review aimed to gather evidence and extract conclusions about the effectiveness of exercise training on CTC. To do so, we reviewed scientific literature under a sophisticated approach in line with the PRISMA project guidelines. Studies on physical training exercise effects and cardiac-related measures throughout the cancer stages (cancer treatment and survivorship) were selected. Data collection comprised extracting information of study features, exercise training characteristics and related effects. As a result, 1087 studies were retrieved from database search and 33 studies were selected, comprising 2778 participants. Most of the studies (n = 29) examined the effects of cardiovascular training on CTC. No studies analysed the effects of resistance-based training. We observed a lack of systematic effect of exercise across studies due to the high heterogeneity (e.g., many studies did not follow the guidelines for training interventions in cancer settings). However, studies combining both cardiovascular and resistance components showed promising results. To sum up, higher adherence to clinical guides should be encouraged to implement physical exercise interventions in medical settings and to ensure intervention effectiveness. Moreover, personalized protocols and routines should be implemented in Cardio-Oncology Rehabilitation Units. Finally, it is mandatory to avoid physical inactivity in patients with cancer

La patología cardiovascular es la primera causa de morbilidad y muerte entre los pacientes supervivientes de cáncer, después de segundas neoplasias. La prevención de cardiotoxicidades inducidas por tratamientos oncológicos constituye una meta en la Oncología. La Asociación Americana de la Oncología Clínica recientemente ha destacado la importancia del ejercicio físico como componente coadyuvante esencial en el tratamiento contra el cáncer. El ejercicio físico puede dar protección en la cardiotoxicidad desde un punto de vista molecular y fisiológico. Dos tipos de entrenamiento destacan: entrenamiento cardiovascular y de fuerza. Esta revisión pretende recoger evidencia y extraer conclusiones sobre la efectividad del ejercicio físico ante la cardiotoxicidad. Para ello revisamos la literatura científica bajo criterios PRISMA. Estudios basados en el efecto del ejercicio físico y mediciones cardiacas a lo largo de procesos oncológicos (tratamiento oncológicos y supervivientes) fueron seleccionados. Como resultado, 1087 estudios fueron recuperados y 33 estudios fueron seleccionados, comprendiendo 2778 sujetos. La mayoría de los estudios (n=29) examinaron el efecto del entrenamiento cardiovascular en la cardiotoxicidad. No hubo estudios que analizaran exclusivamente el entrenamiento de Fuerza. Observamos una escasez de efecto sistémico a lo largo debido a la alta heterogeneidad. De cualquier modo, los estudios combinando entrenamiento cardiovascular y de fuerza parecen demostrar resultados prometedores. En resumen, las guías clínicas deberían animar a implementar programas de ejercicio físico en el entorno médico y garantizar intervenciones efectivas. Asimismo, deberían implementarse protocolos individualizados en unidades de Rehabilitación Cardio-Oncológica. Finalmente, resulta imperativo promover el mensaje de evitar la inactividad física en el paciente oncológico

A New Method for Individualized Digoxin Dosing in Elderly Patients.

BACKGROUND: Digoxin is a frequently prescribed drug in the elderly population. Estimated glomerular filtration rate is widely used to adjust dosages. The HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in elderly patients. We aimed to investigate the usefulness of the HUGE value to predict the initial dose of digoxin in patients aged older than 70 years. METHODS: We reviewed retrospectively the medical records of patients aged older than 70 years with serum digoxin concentrations (SDCs) monitored over a 6-month period (63 patients). A linear regression relating the patient's SDC, maintenance dose of digoxin and the HUGE value was estimated to generate a dosage equation. This equation was validated retrospectively (33 patients) and prospectively (35 patients) in comparison with two existing methods based on creatinine clearance. RESULTS: An equation (HUGE_DIG) was generated to calculate the initial digoxin dose to reach a specific target SDC. Thus, to achieve a SDC of 0.8 ng/mL: Digoxin (mg/day) = 0.091 - 0.006 x HUGE. After retrospective validation, the calculated digoxin doses with this equation were administered in the prospective phase and we did not observe statistical differences between measured and desired SDCs. Moreover, the predictive performance of our equation was better than that obtained with the compared methods. CONCLUSIONS: We offer a new validated digoxin dosing equation for elderly patients. Our results support the need to perform digoxin dosing in elderly people, bearing in mind the changes in renal physiology secondary to ageing and not merely the estimated glomerular filtration rate.