Person-Centered Coordinated Care Experience of People With Long-Term Conditions in the Balearic Islands Measured by the P3CEQ.

Objective: This study aimed to use the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) to assess the experience of person-centered coordinated care among people with long-term conditions in the Balearic Islands, Spain. Methods: Over 1300 participants receiving treatment for chronic conditions or HIV pre-exposure prophylaxis were invited to complete the P3CEQ and a socio-demographic questionnaire, both administered electronically via the Naveta app. The P3CEQ assesses the key domains of the P3C through an 11-item questionnaire. Items 1, 2, 3, 4, 5, 8, 9 and 10 assess specifically person-centredness (PC subscale), while items 5, 6, 7, 8 and 9 measure care coordination (CC subscale; question 7 includes 4 sub-questions to specifically assess care plans). Descriptive statistics were used to summarize patient characteristics and P3CEQ items scores. Data analysis included chi-squared test of independence, Student's t-test and analysis of variance test. Pairwise comparisons were adjusted by Bonferroni correction. Results: The P3CEQ and a socio-demographic questionnaire were sent to 1313 individuals (651 men, 657 women, 5 'other gender'). A response rate of 35.34% was achieved, with 464 P3CEQ responders (223 men and 241 women). Significant differences in response rates were observed by age, smoking status, alcohol consumption, membership of patient organizations, and use of alternative medicine. Care planning was rated significantly lower than other measured domains. Women experienced less person-centered care than men (16.64 vs 17.91) and rated care coordination worse than their male counterparts (9.18 vs 10.23). There were also differences in scores between medical condition types, with cancer and inflammatory bowel disease patients rating highest for both person-centered care (21.20 and 19.13, respectively) and care coordination (10.70 vs 10.88, respectively). Patients with skin and rheumatic diseases rated lowest their experience of person-centered care. People with higher education and those employed or studying experienced better person-centeredness. Conclusion: Using the P3CEQ, we detected significant differences in the care experiences of people with chronic conditions, suggesting the need to address potential gender biases, social inequalities, and the poorer ratings observed for certain conditions in the study population.

Patient-reported outcome measures for assessing atopic dermatitis in clinical practice. / Medidas de resultados comunicados por el paciente para evaluar la dermatitis atópica.

Atopic dermatitis is a chronic skin condition that affects up to 20% of children and 10% of adults worldwide. Due to the high burden of dermatological signs and symptoms, atopic dermatitis has a significant impact on the quality of life of patients and their families. In the absence of objective measures to accurately assess severity and symptom burden, patient-reported outcome measures are essential to monitor the impact and progression of the disease, as well as the efficacy of treatments. Although there are currently no standardised guidelines for their use in clinical practice, there are some initiatives, such as the Harmonise Outcome Measures for Eczema and Vivir con Dermatitis Atópica, that can provide guidance. As healthcare systems move towards value-based healthcare models, patient-reported measures are becoming increasingly important for incorporating the patient perspective and improving the quality of healthcare services. The use of these measures can help monitor disease activity and guide treatment decisions. This article discusses the impact of atopic dermatitis and describes the patient-reported outcome measures commonly used in atopic dermatitis and the recommendations of the initiatives that have selected a core set of measures to best assess atopic dermatitis in clinical practice. Considering the recommendations of these initiatives and based on our experience in clinical practice, we propose the use of the Dermatology Life Quality Index to assess the impact of the disease on quality of life, the Patient-Oriented Eczema Measure to assess symptom severity, and the Numerical Rating Scale or the Visual Analogue Scale to measure itch intensity. To systematize the administration of these measures and to integrate them into hospital information systems and medical records, we emphasise the importance of telemedicine platforms that allow the electronic administration of these instruments.

IMPLEMENTING SYSTEMATIC PATIENT-REPORTED MEASURES FOR CHRONIC CONDITIONS THROUGH THE NAVETA VALUE-BASED TELEMEDICINE INITIATIVE: RESULTS OF AN OBSERVATIONAL, RETROSPECTIVE AND MULTICENTER STUDY.

BACKGROUND: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based healthcare to a growing population of chronically ill patients. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into healthcare systems. OBJECTIVE: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative, its correlations with sociodemographic and clinical characteristics, and the evolution of the rates over time. METHODS: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via the chi-square and post-hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. RESULTS: A total of 3,372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12%, with a baseline rate of 53.33%. Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions, with the highest rates for respiratory (71.45%), oncologic (62.70%), digestive (62.40%), and rheumatic diseases (57.82%), and the lowest for HIV+ patients (32.93%). During the first 6 months of follow-up, response rates decreased in all disease types, except for the oncology group, which increased up to 100%. Subsequently, the overall response rate approached baseline levels. CONCLUSIONS: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered healthcare practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations.

HIV-positive women have higher prevalence of comorbidities and anticholinergic burden: assessment of the HIV-positive population from Menorca (Balearic Islands).

Currently, the management of comorbidities and polypharmacy in HIV-infected patients requires a coordinated action, with special focus on gender differences. Observational, cross-sectional study was conducted to study the HIV population from Menorca (Illes Balears). Adult HIV-positive individuals on antiretroviral treatment attending the pharmacy service from Hospital Mateu Orfila (Menorca) were included. In a single visit, demographical and clinical characteristics, comorbidities and cotreatments were collected. Anticholinergic burden (Drug Burden Index, DBI), drug-to-drug interactions (BOT PLUS database) and symptoms associated with HIV treatment (HIV-SI index) were assessed. A total of 223 patients were included, 68.2% men, with a median age of 53.00 (44.50-58.00) years, median BMI of 24.07, 47.73% smokers and 9.90% drug consumers. Women had more advanced stages of the disease and significantly more symptoms (cough and anxiety) versus men (p = .033 and p = .048, respectively). Moreover higher exposures to anticholinergic drugs (DBI 0.51 vs. 0.27) were reported, together with more frequency of drug-to-drug interactions (57.7% vs. 37.5%; p = .005) that increased with age. Red interactions were more frequently reported in PI (2.69%), NNRTIs (1.92%) and booster drugs (1.92%). These results support the need to implement specific measures for the management of HIV-infected women and tools to assess polypharmacy and risk of drug-to-drug interactions.

Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain.

OBJECTIVE: To present the results of a survey about the Telemedicine outpatients experience and satisfaction of a pharmaceutical care  program through Telepharmacy, carried out from hospital pharmacy  departments in Spain during COVID-19 Pandemic (ENOPEX survey), and  identify differences across regions in Spain. METHOD: An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID­19 pandemic, analyzed by autonomous community in Spain. Data was collected in relation to point of delivery; pharmacotherapeutic follow-up; patient's opinion and satisfaction with Telemedicine; confidentiality; future development of pharmaceutical care, through Telepharmacy services;  and coordination with the patient care team. Four multilevel regressions were performed to evaluate the differences between Spanish regions on the most relevant variables of the study, using the R version 4.0.3 software. RESULTS: A total of 8,079 interviews were valid, 52.8% of respondents were  female, age was 41-65 years in 54.3% of participants; 42.7% had been  receiving treatment for more than 5 years; 42.8% lived 10-50 km  from the  hospital; the journey to hospital took more than one hour for 60.2% of  participants. Globally, 85.7% received medicines at home. However, medicines  were delivered at a community pharmacy in some communities, such as  Cantabria (95.8%), or at primary care centers as in Castile La Mancha  (16.5%). In total, 96.7% of participants were satisfied or very satisfied with  Telemedicine pharmaceutical care, through Telepharmacy services, with  differences across communities, with users in Andalusia reporting the highest  satisfaction (OR = 1.58), and users in Castile-León being less satisfied with  Telepharmacy services (OR = 0.66). Users in Catalonia are the ones more  clearly in favor of Telemedicine pharmaceutical care, through Telepharmacy  services as a complementary service, with an OR = 5.85 with respect to other  users. The Telemedicine most frequently mentioned advantage was that  Telepharmacy services avoided visits, especially in Cantabria (92.5%) and  Extremadura (88.4%). Most patients prefer informed delivery of medicines at  home when they do not have an appointment at the hospital: total of 75.6 %,  from 50.1% of users in Cantabria to 96.3% in Catalonia (p < 0.001). The users  less willing to pay for Telepharmacy services were the ones from Castile- León and Galicia, with users in Catalonia and Navarra showing higher  willingness. CONCLUSIONS: In general terms, patients were satisfied with Telemedicine pharmaceutical care, through Telepharmacy services during the COVID­19 pandemic, being mostly in favor of maintaining these services to avoid travels.

OBJETIVO: Describir los resultados de la encuesta sobre experiencia y  atisfacción de la Telemedicina en pacientes externos relativo a un programa de  atención farmacéutica a través de la Telefarmacia, realizado desde los servicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX) e identificar  las diferencias entre las comunidades autónomas de España.Método: Se analizaron los resultados de la encuesta nacional ENOPEX sobre  Telefarmacia en pacientes externos durante el confinamiento debido a la  pandemia COVID-19, realizado en las diferentes comunidades autónomas de  España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la  Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéutica a  través de los servicios de Telefarmacia, y coordinación con el equipo de atención al paciente. Se realizaron cuatro regresiones multinivel para  evaluar las diferencias entre comunidades autónomas sobre las variables más relevantes del estudio por medio del software R versión 4.0.3. RESULTADOS: Un total de 8.079 entrevistas fueron válidas: el 52,8% eran mujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en  tratamiento  prodesde hacía más de 5 años, el 42,8% vivía a 10-50 km del  hospital y el 60,2%  tardaba más de una hora en acudir al hospital.  globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo  comunidades autónomas en las que se optó también por las oficinas de  farmacia, como en Cantabria (95,8%), o los centros de atención primaria,  como en Castilla­La Mancha (16,5%). El 96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con la Telemedicina en la atención farmacéutica  mediante el uso de la Telefarmacia, detectándose variabilidad en cuanto a la  opinión entre comunidades, desde la mejor opinión en Andalucía (odds ratio  =1,58) y la menos favorable en Castilla y León (odds ratio = 0,66). Por su  parte, Cataluña es la comunidad que estaría más claramente a favor de la  Telemedicina en la atención farmacéutica de usar la Telefarmacia como  actividad complementaria, con una odds ratio de 5,85 respecto al resto. Las  ventajas más mencionadas de la Telemedicina fue que los servicios de  Telefarmacia evitaban desplazamientos, especialmente en Cantabria (92,5%) y Extremadura (88,4%). Los pacientes mayoritariamente prefieren el  acercamiento y entrega informada de la medicación a domicilio cuando no  tienen que acudir al hospital, el 75,6% globalmente, desde el 50,1% de  pacientes de Cantabria al 96,3% en Cataluña (p < 0,001). Las comunidades  autónomas menos dispuestas a pagar por el servicio de Telefarmacia fueron  Castilla y León y Galicia, y las que más, Cataluña y Navarra. CONCLUSIONES: En líneas generales, los pacientes están satisfechos con la  Telemedicina aplicada a la atención farmacéutica a través de los servicios de  Telefarmacia durante la pandemia COVID-19, estando mayoritariamente a  favor de mantenerla para evitar desplazamientos.

Humanization Guide of the Spanish Society of Hospital Pharmacy for patients with inflammatory immune-mediated diseases.

OBJECTIVE: This study reports on the results of a project conducted by the Spanish Society of Hospital Pharmacy with patients with immune-mediated inflammatory diseases, with the following objectives: to understand  the experience of patients living with these diseases and the role of healthcare workers in such experience, and to identify opportunities to promote or boost humanization in hospital pharmacy units. METHOD: A user-centered design methodology was used, implementing exploratory and qualitative research tools. Led by a managing  team made up of experts in the methodology, a variety of people participated  in this project. The team comprised representatives of patients with  immunemediated inflammatory diseases, healthcare workers responsible for  their care, members of the immune-mediated inflammatory disease working  group of the Spanish Society of Hospital Pharmacy, and members of two patient advocacy organizations (Spanish Association of Persons with Chronic Immune-Mediated Inflammatory Diseases and the Spanish  association of Patients with Psoriasis). The research tools used included  indepth interviews, patients' diaries, ethnographic studies, and co-creation workshops. RESULTS: Five initiatives were identified as best practices to be implemented: The creation of functional or comprehensive care units; shared  medical records; integration of patient-reported outcomes with patient  experiences; implementation of the "capacity, motivation, opportunity"  pharmaceutical care model; and a closer interaction with patient advocacy  organizations. Six opportunities to improve the current situation were selected  as priority areas for hospital pharmacy departments: spreading knowledge  about immune-mediated inflammatory diseases; promoting a multidisciplinary  approach to these diseases; generating awareness on the  role of hospital pharmacists; revisiting the internal organization of pharmacy  departments; establishing closer relationships with patients; and seeing things  from the patients' point of view. Ten smart humanization initiatives were  proposed and classified in an impact-effort matrix: "Demystifying IMID", "IMID  teen challenge", "Patient­care academy", "Satellite consultation", "IMID  network", "A click away from the pharmacy", Medicines poker", "Patient-to- patient consultation", "Pharma-friendly consultation", and "Patient-centered  IMID sessions". CONCLUSIONS: This Annex to the Spanish Society of Hospital Pharmacy's Guidelines for the Humanization of Hospital Pharmacy Units intends  to promote a humanizing culture, bringing to the fore the unique value  of every single patient suffering from an immune-mediated  inflammatory disease, including their family and friends and their beliefs and  needs, preserving their dignity.

OBJETIVO: Describir el proyecto de humanización para los pacientes con  enfermedades inflamatorias mediadas por la inmunidad de la Sociedad  Española de Farmacia Hospitalaria encaminado a comprender la experiencia de  los pacientes con enfermedades inmunomediadas inflamatorias,  comprender el papel de los profesionales en la experiencia del paciente e  identificar oportunidades para impulsar la humanización desde los servicios de  farmacia hospitalaria.Método: Se empleó la metodología del diseño centrado en las personas, aplicando herramientas de investigación cualitativa y exploratoria. Participaron pacientes con enfermedades inflamatorias mediadas  por la inmunidad, profesionales de todos los perfiles que les atienden, el Grupo de trabajo de Enfermedades Inmunomediadas Inflamatorias de la  Sociedad Española de Farmacia Hospitalaria y representantes de pacientes (Asociación de personas con enfermedades crónicas inflamatorias  inmunomediadas y Asociación de pacientes Acción Psoriasis). Todo ello con la dirección de un equipo experto en diseño centrado en las personas. Entre las  dinámicas empleadas se encuentran: entrevistas en profundidad, diarios de  pacientes, observaciones etnográficas y talleres de cocreación. RESULTADOS: Se identificaron cinco iniciativas consideradas buenas prácticas a  implementar (creación de unidades funcionales o de atención integrada,  historia clínica compartida, integración de los resultados reportados por los  pacientes y de su experiencia, modelo "capacidad, motivación y oportunidad"  de atención farmacéutica y acercamiento a las asociaciones de pacientes). Se  seleccionaron seis oportunidades sobre las que diseñar soluciones en los  servicios de farmacia (favorecer el conocimiento de estas enfermedades,  impulsar su abordaje multidisciplinar, difundir las atribuciones del farmacéutico  de hospital, revisar la organización interna del servicio,  establecer el vínculo con el paciente y adoptar la visión del paciente). Se  propusieron diez grandes ideas para humanizar clasificadas en una matriz de  impacto-esfuerzo ("Remitente IMID", "IMID teen challenge", "Escuela de  familiares", "Consulta satélite", "Redemid", "A un botón de farmacia", "Póquer  de fármacos", "Consulta de paciente a paciente", "Farma friendly", "Sesiones  IMID Patient-Centric"). CONCLUSIONES: Con este anexo a la Guía de Humanización de la Sociedad  Española de Farmacia Hospitalaria se pretende promover una cultura de  humanización, que ponga en valor a la persona que hay detrás de todo  paciente con enfermedades inmunomediadas inflamatorias, teniendo en  consideración su familia, entorno, creencias y necesidades y preservando su  dignidad.

Encuesta de satisfacción en pacientes externosde la atención farmacéutica mediante Telefarmaciadurante la pandemia COVID-19 en España / Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain

Objetivo: Describir los resultados de la encuesta sobre experiencia y satisfacción de la Telemedicina en pacientes externos relativo a un programade atención farmacéutica a través de la Telefarmacia, realizado desde losservicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX)e identificar las diferencias entre las comunidades autónomas de España.Método: Se analizaron los resultados de la encuesta nacional ENOPEXsobre Telefarmacia en pacientes externos durante el confinamiento debidoa la pandemia COVID-19, realizado en las diferentes comunidades autónomas de España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéuticaa través de los servicios de Telefarmacia, y coordinación con el equipo deatención al paciente. Se realizaron cuatro regresiones multinivel para evaluar las diferencias entre comunidades autónomas sobre las variables másrelevantes del estudio por medio del software R versión 4.0.3.Resultados: Un total de 8.079 entrevistas fueron válidas: el 52,8% eranmujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en tratamiento desde hacía más de 5 años, el 42,8% vivía a 10-50 km del hospital y el 60,2%tardaba más de una hora en acudir al hospital. Globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo comunidades autónomas en lasque se optó también por las oficinas de farmacia, como en Cantabria (95,8%),o los centros de atención primaria, como en Castilla-La Mancha (16,5%). El96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con laTelemedicina en la atención farmacéutica mediante el uso de la Telefarmacia,detectándose variabilidad en cuanto a la opinión entre comunidades, desde lamejor opinión en Andalucía (odds ratio =1,58) y la menos favorable en Castillay León (odds ratio = 0,66). (AU)

Objective: To present the results of a survey about the Telemedicineoutpatients experience and satisfaction of a pharmaceutical care programthrough Telepharmacy, carried out from hospital pharmacy departments inSpain during COVID-19 Pandemic (ENOPEX survey), and identify differences across regions in Spain.Method: An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID-19pandemic, analyzed by autonomous community in Spain. Data wascollected in relation to point of delivery; pharmacotherapeutic follow-up;patient’s opinion and satisfaction with Telemedicine; confidentiality; futuredevelopment of pharmaceutical care, through Telepharmacy services; andcoordination with the patient care team. Four multilevel regressions wereperformed to evaluate the differences between Spanish regions on themost relevant variables of the study, using the R version 4.0.3 software.Results: A total of 8,079 interviews were valid, 52.8% of respondentswere female, age was 41-65 years in 54.3% of participants; 42.7% hadbeen receiving treatment for more than 5 years; 42.8% lived 10-50 km from the hospital; the journey to hospital took more than one hour for60.2% of participants. Globally, 85.7% received medicines at home.However, medicines were delivered at a community pharmacy in somecommunities, such as Cantabria (95.8%), or at primary care centers as inCastile La Mancha (16.5%). In total, 96.7% of participants were satisfiedor very satisfied with Telemedicine pharmaceutical care, through Telepharmacy services, with differences across communities, with users in Andalusia reporting the highest satisfaction (OR = 1.58), and users in CastileLeón being less satisfied with Telepharmacy services (OR = 0.66). (AU)

Outpatients' Opinion And Experience Regarding Telepharmacy During The COVID-19 Pandemic: The Enopex Project.

BACKGROUND: Telepharmacy, as a remote pharmaceutical care procedure, is being used worldwide during the COVID-19 pandemic, with the aim of preserving the health of patients and professionals. Its future development should incorporate the assessment of patient perception, but no research study has investigated it. OBJECTIVE: The objective was to poll the opinions and experiences of outpatients with telepharmacy through a purpose-developed questionnaire and to assess it's quality through an internal validity and reliability analysis. METHODS: Cross-sectional observational study of adult patients who used telepharmacy services during the COVID-19 lockdown period in Spain. The subjects answered a 24-item questionnaire, after giving their informed consent. Place of delivery, informed pharmacotherapeutic follow-up, opinion about telepharmacy, future development, ethics/satisfaction, and coordination constituted the six questionnaire categories. After assessing the adequate sample size with the Kaiser-Meyer-Olkin test, the Bartlett sphericity test analyzed the validity of the questionnaire. The intraclass correlation coefficient and Cronbach's α coefficient calculations verified the reliability and internal consistency. RESULTS: A total of 9442 interviews were administered to patients from 81 hospitals, of which 8079 were valid (52.8% female). A 54.1% were aged between 41-65 years; 42.7% had been in treatment for more than 5 years; 42.8% lived between 6-31 miles from the hospital. As many as 96.7% of patients were "satisfied" or "very satisfied" with telepharmacy, 97.5% considering it complementary to their usual follow-up; 55.9% expressed a preference for being followed up face to face when visiting the hospital. 75.6% said they had rather receive their medication at home. The sample size obtained was deemed appropriate [the Kaiser-Meyer-Olkin test (0.789) and Bartlett's sphericity test (p<0.005)]. The reliability analysis resulted in a Cronbach α = 0.7. CONCLUSION: Patients have shown high satisfaction with telepharmacy and the ENOPEX questionnaire is a tool with sufficient validity and reliability to be used in the evaluation of the care that patients receive through telepharmacy.

[Improvement of the nutritional status and quality of life of cancer patients through a protocol of evaluation and nutritional intervention]. / Mejora de la situación nutricional y la calidad de vida de los pacientes oncológicos mediante protocolo de evaluación y de intervención nutricional.

OBJECTIVE: to apply a protocol that facilitates the detection of malnutrition in cancer patients during their treatment of radiotherapy or chemotherapy, selecting those that could benefit from a specific nutritional intervention. METHODOLOGY: malnutrition was assessed with the Malnutrition Screening Tool (MST). Patients at malnutrition risk were evaluated with patient generated subjective-global assessment (PG-SGA) and a subgroup of the sample studied was also assessed with a quality of life (CV) using the EORTC QLQ-C30 questionnaire. RESULTS: from 222 patients, risk of malnutrition was observed in 126 (56.7%). The PG-SGA shows an initial prevalence of malnutrition of 69.2% (61.7% moderately malnourished and 7.5% severe malnutrition) and a mean weight loss of -10.27 kg. In the last evaluation (+12 months), the percentage of malnutrition or risk was significantly reduced to 23.5% and the mean weight loss decreased to -7.1 kg. During follow-up, the scores of the EORTC QLQ-C30 questionnaire improved, especially at three months on the diarrhea scale (p = 0.037), at six months on the pain scale (p = 0.009), and at 12 months on the pain (p = 0.026), nausea and vomiting (p = 0.002), dyspnea (p = 0.016), loss of appetite (p = 0.002) and constipation (p = 0.05) scales. CONCLUSION: the protocol has been effective in improving the nutritional status and quality of life of cancer patients with partial recovery of lost weight.

Mejora de la situación nutricional y la calidad de vida de los pacientes oncológicos mediante protocolo de evaluación y de intervención nutricional / Improvement of the nutritional status and quality of life of cancer patients through a protocol of evaluation and nutritional intervention

Objetivo: aplicar un protocolo que facilite la detección de malnutrición en los pacientes oncológicos durante su tratamiento de radioterapia o quimioterapia, seleccionando los que se podrían beneficiar de una intervención nutricional específica. Metodología: se determinó la presencia de riesgo de desnutrición con el método de cribado Malnutrition Screening Tool (MST). A los sujetos con riesgo se les aplicó el cuestionario Valoración Global Subjetiva Generada por el Paciente (VGS-GP) y en un subgrupo de la muestra estudiada también se midió la calidad de vida (CV) mediante el cuestionario EORTC QLQ-C30.Resultados: de un total de 222 pacientes se observó riesgo de desnutrición en 126 (56,7%). La VGS-GP muestra una prevalencia inicial de desnutrición del 69,2% (61,7% desnutrición moderada y 7,5% desnutrición severa) y una media de pérdida de peso de -10,27 kg. En la última valoración (+12 meses), el porcentaje de desnutrición o riesgo se redujo de forma significativa a un 23,5% y la media de pérdida de peso disminuyó a -7,1kg. Durante el seguimiento, mejoraron las puntuaciones del cuestionario EORTC QLQ-C30, en especial a los tres meses la escala diarrea (p = 0,037), a los seis meses la escala dolor (p = 0,009) y a los 12 meses las escalas dolor (p = 0,026), náusea y vómito (p = 0,002), disnea (p = 0,016), pérdida de apetito (p = 0,002) y estreñimiento (p = 0,05).Conclusión: el protocolo ha resultado eficaz y ha mejorado la situación nutricional y la calidad de vida de los pacientes oncológicos, con recuperación parcial del peso perdido

Objective: to apply a protocol that facilitates the detection of malnutrition in cancer patients during their treatment of radiotherapy or chemotherapy therapy, selecting those that could benefit from a specific nutritional intervention. Methodology: malnutrition was assessed with the Malnutrition Screening Tool (MST). Patients at malnutrition risk were evaluated with patient generated subjective-global assessment (PG-SGA) and a subgroup of the sample studied was also assessed with a quality of life (CV) using the EORTC QLQ-C30 questionnaire. Results: from 222 patients, risk of malnutrition was observed in 126 (56.7%). The PG-SGA shows an initial prevalence of malnutrition of 69.2% (61.7% moderately malnourished and 7.5% severe malnutrition) and a mean weight loss of -10.27 kg. In the last evaluation (+12 months), the percentage of malnutrition or risk was significantly reduced to 23.5% and the mean weight loss decreased to -7.1 kg. During follow-up, the scores of the EORTC QLQ-C30 questionnaire improved, especially at three months on the diarrhea scale (p = 0.037), at six months on the pain scale (p = 0.009), and at 12 months on the pain (p = 0.026), nausea and vomiting (p = 0.002), dyspnea (p = 0.016), loss of appetite (p= 0.002) and constipation (p = 0.05) scales. Conclusion: the protocol has been effective in improving the nutritional status and quality of life of cancer patients with partial recovery of lost weight

[Pre-operative nutrition support in patients waiting for digestive surgery at Hospital Mateu Orfila (Maó-Menorca)]. / Soporte nutricional perioperatorio en los pacientes programados para cirugía digestiva en el Hospital Mateu Orfila (Maó-Menorca).

Malnutrition is associated with high postoperative morbidity and mortality rates. This pilot study evaluated the effectiveness of a peri-operative nutritional support programme for patients who were about to undergo major gastrointestinal surgery. A high-calorie/high-protein enteral formula was administered peri-operatively to the group of patients at nutritional risk/with malnutrition (NR/MN). In order to assess the effectiveness of the preoperative nutritional intervention, the results were compared to a retrospective control group. Statistically-significant differences were found between the two NR/MN groups in incidence of vomiting; wound infection; hyperglycaemia; death in hospital; length of hospital stay; time in ICU; and administration of TPN. Postoperative progress was found to be better in the group of NR/MN patients supplemented preoperatively with an enteral nutrition formula.

La desnutrición se asocia con elevadas tasas de morbimortalidad postoperatoria. En este estudio piloto se ha evaluado la efectividad de un programa de apoyo nutricional perioperatorio a pacientes que iban a someterse a cirugía programada de cirugía mayor digestiva. Se administró de forma perioperatoria la formula enteral hipercalorica/hiperproteica (Fresubin® protein energy drink) al grupo de pacientes con riesgo nutricional/desnutrición (RN/DN). Con el objeto de valorar la efectividad de la intervención nutricional preoperatoria, se ha comparado los resultados respecto a un grupo control retrospectivo. Entre los dos grupos con RN/DN se encontraron diferencias estadísticamente significativas en incidencia de vómitos, infección herida, hiperglucemia, exitus hospitalario, estancia hospitalaria, estancia en UCI y administración de NPT. Se ha demostrado una mejor evolución tras la cirugía en el grupo de pacientes con RN/DS que han sido suplementados de forma preoperatoria con una fórmula de nutrición enteral.

Soporte nutricional perioperatorio en los pacientes programados para cirugía digestiva en el Hospital Mateu Orfila (Maó-Menorca) / Pre-operative nutrition support in patients waiting for digestive surgery at hospital Mateu Orfila (Maó-Menorca)

La desnutrición se asocia con elevadas tasas de morbimortalidad postoperatoria. En este estudio piloto se ha evaluado la efectividad de un programa de apoyo nutricional perioperatorio a pacientes que iban a someterse a cirugía programada de cirugía mayor digestiva. Se administró de forma perioperatoria la formula enteral hipercalorica/hiperproteica (Fresubin® protein energy drink) al grupo de pacientes con riesgo nutricional/desnutrición (RN/DN). Con el objeto de valorar la efectividad de la intervención nutricional preoperatoria, se ha comparado los resultados respecto a un grupo control retrospectivo. Entre los dos grupos con RN/DN se encontraron diferencias estadísticamente significativas en incidencia de vómitos, infección herida, hiperglucemia, exitus hospitalario, estancia hospitalaria, estancia en UCI y administración de NPT. Se ha demostrado una mejor evolución tras la cirugía en el grupo de pacientes con RN/DS que han sido suplementados de forma preoperatoria con una fórmula de nutrición enteral (AU)

Malnutrition is associated with high postoperative morbidity and mortality rates. This pilot study evaluated the effectiveness of a peri-operative nutritional support programme for patients who were about to undergo major gastrointestinal surgery. A high-calorie/high-protein enteral formula was administered peri-operatively to the group of patients at nutritional risk/with malnutrition (NR/MN). In order to assess the effectiveness of the preoperative nutritional intervention, the results were compared to a retrospective control group. Statistically-significant differences were found between the two NR/MN groups in incidence of vomiting; wound infection; hyperglycaemia; death in hospital; length of hospital stay; time in ICU; and administration of TPN. Postoperative progress was found to be better in the group of NR/MN patients supplemented preoperatively with an enteral nutrition formula (AU)

Retrospective assessment of potential interaction between levofloxacin and warfarin.

OBJECTIVE: There is currently a controversy regarding interactions between levofloxacin and warfarin. The aim of this study was to determine the clinical relevance of this interaction in our setting. SETTING: A university hospital in Barcelona, Spain. METHODS: We carried out a retrospective evaluation of all patients hospitalized in our hospital during the period 2000-2005, selecting all those concomitantly treated with levofloxacin and warfarin for the study. The following data were compiled: demographic information, concomitant medication, comorbid conditions, and relevant analytical parameters, particularly the international normalized ratio (INR), including values taken before, during, and after concomitant administration of the two study drugs. Patients for whom INR values during concomitant administration were not available were excluded. Differences in INR before and during the potential interaction, and before and after the interaction were analyzed with the Wilcoxon t test using SPSS (V12.0). In addition, patients were stratified according to presence or not of toxic habits (smoking/alcohol consumption) to investigate the possible impact of these factors on the interaction under study. RESULTS: Among the 30 patients identified, 9 were excluded because INR data during concomitant administration of warfarin and levofloxacin were not available. Statistical analysis demonstrated significant increase in INR (P = 0.001) following addition of levofloxacin to warfarin therapy. CONCLUSIONS: The results of this study reaffirm the hypothesis that concomitant administration of levofloxacin and warfarin leads to INR increase; hence close monitoring of INR is advisable when patients are prescribed this combination of drugs.