ABSTRACT
The coronavirus disease 2019 (COVID-19) produces severe respiratory symptoms such as bilateral pneumonia associated to a high morbidity and mortality, especially in patients of advanced age. Vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and dysregulation of the immune system. Vitamin D in modulates immune function too. Vitamin D receptor (VDR) is expressed by most immune cells, including B and T lymphocytes, monocytes, macrophages, and dendritic cells and the signalling of vitamin D and VDR together has an anti-inflammatory effect. Some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19 because vitamin D plays an important role as a modulator of immunocompetence. Over the last few months, some studies have hypothesized the possible beneficial effect of vitamin D supplementation in patients with COVID-19 in order to improve the immune balance and prevent the hyperinflammatory cytokine storm. Some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. Vitamin D should be administered daily until adequate levels are achieved due to vitamin D behaves as a negative acute phase reactant (APR). Despite the lack of evidence on specific doses of vitamin D to treat COVID-19 in older adults, authors consider it is necessary to standardize the use in clinical practice. These recommendations advice supplement vitamin D in a protocoled fashion based on expert opinions, level of evidence 5.
Subject(s)
COVID-19/therapy , Cytokine Release Syndrome , Dietary Supplements , Geriatrics , Vitamin D Deficiency/therapy , Vitamin D/administration & dosage , Vitamins/administration & dosage , Aged , COVID-19/complications , COVID-19/immunology , COVID-19/prevention & control , Cytokine Release Syndrome/prevention & control , Humans , Receptors, Calcitriol/metabolism , Societies, Medical , Spain , Vitamin D/immunology , Vitamin D Deficiency/complications , Vitamins/immunologyABSTRACT
Objective: Acute pain is frequent and underestimated in older persons, especially when they suffer from cognitive impairment. Algoplus is an observational scale for acute pain evaluation, validated in French in older persons with communication disorders. We present the validation by an international expert team of the Algoplus scale in five languages: English, Spanish, Italian, Portuguese, and Turkish. Methods: A total of 181 older consecutive patients were included in five countries (Spain, Australia, Italy, Portugal, and Turkey). Test-retest and inter-rater reliabilities were determined by weighted kappa coefficient for each item and internal consistency by Kuder-Richardson-20 (KD). Results: Regarding test-retest reliability, the kappa coefficient for the five items ranged from 0.68 to 0.84. Inter-rater reliability kappa values ranged from 0.64 to 0.82. Internal consistency was indicated at a KD greater than 0.6. Satisfaction was good to excellent for all teams. Results show that reliability tests are good to excellent for all items of Algoplus. Conclusions: This study shows evidence that Algoplus is an acceptable, reproducible, reliable, and easy-to-use tool. It provides a unique opportunity to include the translated Algoplus scale in daily assessment of older persons with communication disorders in many countries.
Subject(s)
Acute Pain/diagnosis , Communication Disorders , Pain Measurement/methods , Translating , Aged , Aged, 80 and over , Female , Humans , Language , Male , Psychometrics/instrumentation , Reproducibility of ResultsABSTRACT
No disponible
Subject(s)
Humans , Cooperative Behavior , Societies, Medical/legislation & jurisprudence , Societies, Medical/standards , Iatrogenic Disease/prevention & control , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Delivery of Health Care/organization & administration , Iatrogenic Disease/economicsABSTRACT
BACKGROUND AND OBJECTIVE: A number of subjects aged over 65 suffer from some kind of chronic pain. The constant growth of this demographic group makes research of new and efficacious treatment strategies necessary. Transdermal buprenorphine has shown to be a safe and efficacious pharmacotherapy for patients with moderate to severe chronic pain in clinical trials. This paper provides the outcome of this drug in routine clinical practice. PATIENTS AND METHOD: A prospective, uncontrolled observational study that included a 3-month follow-up of patients starting transdermal buprenorphine was performed. Information was collected systematically on pain relief, quality of life (EuroQol-5D questionnaire), comfort of patch use and adverse events. Missing data were imputed by the <
Subject(s)
Analgesics, Opioid/administration & dosage , Buprenorphine/administration & dosage , Pain/drug therapy , Administration, Cutaneous , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Fundamento y objetivo: Una importante proporción de personas mayores de 65 años experimenta algún tipo de dolor crónico. Debido al crecimiento demográfico de este segmento de población, es necesario investigar nuevas estrategias de tratamiento eficaces. Los estudios clínicos han mostrado que la buprenorfina por vía transdérmica es una farmacoterapia eficaz y segura en pacientes con dolor crónico de moderado a intenso. El presente estudio presenta resultados obtenidos en condiciones de práctica clínica habitual. Pacientes y método: Se ha realizado un estudio de postautorización observacional, prospectivo y no controlado, en el que se siguió durante 3 meses a pacientes que comenzaron tratamiento con buprenorfina transdérmica. Se recogió información sistemática sobre el grado de alivio del dolor, la calidad de vida (mediante el cuestionario EuroQol-5D), el manejo del parche y los acontecimientos adversos. Los datos que faltaban se cubrieron empleando la estrategia del «peor caso». Resultados: De los 1.188 pacientes con edad conocida, 564 tenían menos de 65 años, 337 entre 65 y 75 años, y 287 más de 75 años. En estos grupos de edad, un 63,9, un 66,3 y un 67,7%, respectivamente, presentaron alivio del dolor «bueno» o «muy bueno», y un 60,4, un 60,7 y un 65,2%, respectivamente, mejoría de la calidad del sueño. Los aumentos medios de puntuación en la escala analógica visual del EuroQol-5D fueron de 16,0; 15,8, y 16,8 mm, respectivamente. Presentaron acontecimientos adversos relacionados con la buprenorfina el 39,6, el 35,4 y el 31,9%, respectivamente. Conclusiones: Este estudio confirma, en condiciones de práctica clínica habitual, los resultados obtenidos con la buprenorfina transdérmica en los ensayos clínicos aleatorizados y controlados
Background and objective: A number of subjects aged over 65 suffer from some kind of chronic pain. The constant growth of this demographic group makes research of new and efficacious treatment strategies necessary. Transdermal buprenorphine has shown to be a safe and efficacious pharmacotherapy for patients with moderate to severe chronic pain in clinical trials. This paper provides the outcome of this drug in routine clinical practice. Patients and method: A prospective, uncontrolled observational study that included a 3-month follow-up of patients starting transdermal buprenorphine was performed. Information was collected systematically on pain relief, quality of life (EuroQol-5D questionnaire), comfort of patch use and adverse events. Missing data were imputed by the «worst case». Results: Out of 1,188 patients with known age, 564 were under 65, 337 were between 65 and 75, and 287 were over 75 years. Within these respective age groups, 63.9%, 66.3% and 67.7% of patients showed «good» or «very good» pain relief; 60.4%, 60.7% and 65.2% showed improvement of sleep quality; and the mean increases of the score of the EuroQol-5D visual analogue scale were 16.0 mm, 15.8 mm and 16.8 mm. Drug-related adverse events were reported in 39.6%, 35.4% and 31.9% of patients, respectively. Conclusions: This study performed in the routine-care setting supports the findings from previous randomised controlled clinical trials of transdermal buprenorphine
