[What do primary care physicians think about deprescription?] / ¿Qué opinan los médicos de atención primaria sobre la deprescripción?

INTRODUCTION: To learn about the perceptions and attitudes of family doctors regarding deprescription. MATERIAL AND METHODS: This is a cross-sectional study conducted at the Organización Sanitaria Integrada Bidasoa, Osakidetza. In November 2018, sessions were held at health centres on deprescribing for family doctors, following which the PACPD-12 questionnaire was handed out, translated into Spanish and adapted. The responses to the questionnaire were collected, together with the socio-demographic variables. RESULTS: Forty-two of the 58 doctors who received the survey responded (72%). One hundred percent considered deprescription beneficial in the current scenario. The drug groups that they most frequently considered deprescribing were the benzodiazepines, bisphosphonates and proton pump inhibitors. The main reasons they gave for deprescribing were to reduce harm from adverse effects and that the medication was of minimal benefit in the patient's circumstances, and they indicated that specific training in deprescribing and pharmacist alerts in the clinical history would facilitate deprescription. Barriers highlighted were lack of time, prescribing by other professionals, or resistance on the part of the patient or their family. CONCLUSIONS: Knowing what doctors think about deprescribing and its barriers and facilitators are necessary to plan a strategy to facilitate the practice. Although all the respondents indicated that they consider deprescription beneficial, they found barriers in their daily practice to their being able to implement it.

Impacto de la pandemia SARS-CoV-2 en el inicio de las prescripciones / Impact of the SARS-CoV-2 pandemic on the start of prescriptions

No disponible

Pharmacokinetic monitoring in ambulatory treatment with teicoplanin for chronic knee prosthetic infection / Monitorización farmacocinética ambulatoria de teicoplanina por infección crónica de prótesis de rodilla

We report a patient with chronic knee prosthetic infection, underwent multiple surgical procedures and previous antibiotic treatments. Traumatologist indicated chronic suppressive antibiotic treatment and no further surgery was indicated due to the patient´s high comorbidity. A microbiology examination revealed the presence of hetero-resistant Staphylococcus epidermidis strains, which meant the possibility of being treated only with linezolid or glycopeptides. It was discarded a chronic use of linezolid due to reasons of hematological toxicity and optical and peripheral neuropathy described in treatments over 28 days. Teicoplanin was proposed for good pharmacokinetic profile, which makes it optimal for outpatient management regimes. Monitoring of treatment was based on the pharmacokinetics monitoring teicoplanin trough levels, and dose adjustment based on them. Monitoring inflammation parameters, hematology and renal function was performed to monitor the effectiveness and toxicity of treatment. During the follow-up period (18 months) patient presented a satisfactory clinical evolution without notable toxicity. In this sense, in selected patients, teicoplanin with outpatient management may be useful in treating chronic infections of joint prosthesis

Presentamos el caso de un paciente con infección crónica de prótesis de rodilla, sometido a múltiples intervenciones quirúrgicas y tratamientos antibióticos previos. La indicación de Traumatología es tratamiento antibiótico de supresión crónico, contraindicando nueva intervención quirúrgica. En esta situación, se constata que la infección está causada por una mezcla de cepas de Staphylococus epidermidis con heterorresistencia con sensibilidad únicamente a linezolid y a glupopéptidos. Se descartó el uso crónico de linezolid por razones de toxicidad hematológica y neuropatía óptica y periférica descritos en tratamientos superiores a 28 días. Se propuso teicoplanina por su buen perfil farmacocinético, que la hace óptima para regímenes de administración ambulatoria. El seguimiento del tratamiento se basó en la monitorización farmacocinética de los niveles valle de teicoplanina, y ajuste de dosis en función de los mismos. Se realizó seguimiento de parámetros de inflamación, hematológicos y de función renal para monitorizar la efectividad y toxicidad del tratamiento. El paciente presentó durante el periodo de seguimiento (18 meses) una evolución clínica satisfactoria sin toxicidad destacable. En este sentido, en pacientes seleccionados, teicoplanina administrada por unidades ambulatorias de administración de antibióticos puede resultar útil en el tratamiento de infecciones crónicas de prótesis articulares

Exploring the influence of consumer characteristics on veal credence and experience guarantee purchasing motivators.

In Europe, in the last decades, public administration has encouraged extensive livestock farming systems, usually related to high quality meat and the preservation of endangered local breeds. Nevertheless, its continuity in the near future should be based on adapting it to the market requirements. This paper investigates consumers' preferences heterogeneity towards veal attributes, as well as the linkage between a wide range of consumer traits and attributes that motivate purchasing of veal with unique characteristics. Main method of analysis included a choice experiment method. Findings showed that regional origin and health information play a stronger role than tenderness degree guarantee at the moment of choice. Moreover, regional origin is more relevant when it is linked to a local breed. Nevertheless, heterogeneous preferences have been detected. In contrast to the general trend, one-person households attach greater importance to the presence of a high degree of tenderness guarantee. Furthermore, younger consumers value more this guarantee, while expert consumers do not.

Conciliación de la medicación en atención primaria tras el alta hospitalaria / Medication reconciliation in primary care after hospital discharge

Objetivos: El objetivo primario de este estudio es comprobar si la información de los cambios propuestos en el tratamiento habitual de los pacientes al alta hospitalaria se traslada a su hoja de tratamiento activo cuando acuden a atención primaria. Se plantean objetivos secundarios como analizar la media de medicamentos por paciente al ingreso y al alta; identificar otros factores que pudieran influir en la modificación del tratamiento durante el ingreso (edad del paciente o número de fármacos previamente indicados, entre otros). También se analiza la relación entre el centro de salud al que pertenece el paciente y la probabilidad de que se concilie su medicación cuando acude a atención primaria. Material y métodos: Se trata de un estudio transversal observacional, desarrollado en la Organización Sanitaria Integrada Bidasoa. Se incluyó a todos los pacientes mayores de 65 años polimedicados (que tomaban 5 o más fármacos) de la organización, dados de alta en el Hospital Bidasoa entre el 15 de octubre y el 11 de noviembre de 2012. Las altas producidas en este periodo se enviaron desde el hospital a cada responsable de seguridad del paciente de los centros de atención primaria, y a través de la revisión de la historia clínica de cada paciente se obtuvo información relativa a si habían acudido a su centro en los 15 días posteriores al alta, así como de si se efectuó alguna modificación en la hoja de tratamiento activo. Resultados: Doscientos sesenta y un pacientes (n = 261) fueron dados de alta en el periodo de estudio, de los cuales 80 cumplían los criterios de inclusión. El informe de alta de 39 de ellos (49%) proponía algún cambio en su hoja de tratamiento activo. De ellos, 35 (90%) se pusieron en contacto con atención primaria, y en 24 pacientes los cambios fueron incluidos en su hoja de tratamiento activo, lo que supone el 68% de los que contactaron con atención primaria y el 61% de los que hubieran requerido cambios. Conclusiones: Los resultados observados en este estudio nos llevan a pensar en la necesidad de establecer un programa de conciliación de la medicación para los pacientes polimedicados al alta hospitalaria. Además, consideramos interesante ahondar en los motivos por los cuales los pacientes que a pesar de haber acudido a atención primaria tras el alta hospitalaria, no vieron trasladados los cambios de la medicación a su hoja de tratamiento activo (AU)

Objectives: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. Material and methods: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. Results: Two hundred sixty-one patients (n = 261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. Conclusions: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital

[Medication reconciliation in primary care after hospital discharge]. / Conciliación de la medicación en atención primaria tras el alta hospitalaria.

OBJECTIVES: The primary objective of this study was to determine if changes prescribed in the usual treatment of patients at discharge from the hospital were updated in their active treatment sheet when they came to the Primary Care clinic. The secondary objectives included, determining whether the drug average varies between the admission and discharge, as well as, identifying other factors related to the modification of treatment during hospital admission including, among others, patient age or the number of drugs previously indicated. Finally, the relationship between the Primary Care Unit to which the patient belonged and the probability that the medication was reconciled was also examined. MATERIAL AND METHODS: This is an observational cross-sectional study conducted in the Bidasoa Integrated Healthcare Organization. The study included every patient over 65 years old with multiple medication (taking 5 or more drugs) belonging to this organization, and discharged from Bidasoa Hospital between 15th October and 11th November 2012. The information on hospital discharges during this period was sent from the hospital to those responsible for patient safety in the Primary Health Care Centers. Each patient clinical history was reviewed in order to confirm if a visit (at least once in the first two weeks after discharge) had been made to their Primary Care Unit, and whether there had been a change in their active treatment sheet. RESULTS: Two hundred sixty-one patients (n=261) were discharged from Bidasoa Hospital in the study period, and 80 met the inclusion criteria. The discharge report proposed a change in the active treatment in 39 of them (49%). Of these, 35 (90%) attended a Primary Care clinic, and the changes were included in their active treatment sheet in 24 patients, representing 68% of those who contacted Primary Care, and 61% of those who would have required changes. CONCLUSIONS: The results demonstrate the need to establish a reconciliation medication program for patients on multiple medications after hospital discharge. Moreover, further studies are needed to investigate what may be the reasons why the changes to active treatment sheets are not taking place for some patients, despite these having visited Primary Care after having been discharged from hospital.

Trajectories of evolution and drivers of change in European mountain cattle farming systems.

In the last few decades, significant changes in livestock farming systems and land use were observed in European mountain areas with large implications for the sustainability of grazing agro-ecosystems. System dynamic studies become essential to understand these changes, identify the drivers involved and trying to anticipate what might happen in the future. The objectives of this study were as follows: (i) to analyse the main recent changes that occurred in mountain cattle farming in the Spanish Pyrenees; (ii) to typify diverse trajectories of evolution of these systems; and (iii) to establish drivers of change that might help understand the evolution of mountain agriculture. A constant sample of mountain cattle farms was analysed for the period 1990 to 2004. In total, 30% of farms have disappeared during this time interval. For the remaining farms, the most important general changes observed were as follows: increment of size; change of productive orientation from mixed beef-dairy to pure beef production; extensification of grazing management; reduction of family labour and increase of pluriactivity; reduction of unitary variable costs; and increase of labour productivity. After the elimination of common temporal effects between dates, multivariate techniques allowed for the identification of three patterns and six specific trajectories of evolution that are profiled in the text. Relationships between the patterns of evolution and other variables referring the farm, the household and the socio-economic environment were identified as drivers of change: (i) the specific location of the farm in relation to the capital village of the municipality and the evolution other sectors of the economy, in particular tourism; (ii) the size of the family labour, presence of successors and degree of dynamism of the farmer; and (iii) the initial orientation of production.

Barriers to bicycle helmet use among Dutch paediatricians.

BACKGROUND: In the Netherlands, bicycle helmet wearing rates are very low and perceived social barriers to helmet use are important. We aimed to determine why Dutch paediatricians do or do not wear helmets while bicycling and whether their personal behaviour is influencing their position about the promotion of helmet use. METHODS: Attendants to the annual meeting of the Dutch Paediatric Society (7-9 November 2006) were surveyed about bicycle riding frequency, helmet use, reasons for not wearing a helmet, helmet use among their own children and personal position about the promotion and legislation of bicycle helmet use. RESULTS: Of the 1110 paediatricians who are active in the Netherlands, 258 answered the survey. Ninety-six per cent of the respondents ride a bicycle (68% more than once a week). Bicycle was used as a mean of transport (32%), as a recreation/sport (11%) or with both purposes (57%). When cycling for transportation, 94% never wear a helmet and 2% always wear it. When cycling for recreation, 70% never wear a helmet and 18% always wear it. The most common reasons given for not wearing a helmet were: 'I never thought about that' (43%), 'Poor appearance' (31%), 'Nobody uses it in the Netherlands' (27%) and 'Uncomfortable' (25%). A majority (91%) of the respondents agreed that bicycle helmets are effective in reducing the rate of head injury to bicyclists and that they should be advised to children (82%) and adolescents (54%). CONCLUSIONS: Our results indicate that among Dutch paediatricians, cycling rate is high and helmet wearing rate is very low and that they experience numerous personal barriers to bicycle helmet use. This might explain why bicycle helmet promotion campaigns are scarcely supported by Dutch paediatricians.

Organ donation in the Basque country: 18 years experience.

PURPOSE: We reviewed of the trends in organ donation within a coordinated transplant program over the last 18 years. METHODS: Two thousand three hundred and fifty five potential donors (PD) were evaluated in 18 years including 1282 who were effective donors (EDs) and the 4081 harvested organs. A retrospective analysis of various parameters was performed comparing four different periods: 1981 to 1986 (P0); 1987 to 1992 (P1); 1993 to 1998 (P2); and 1999 to 2004 (P3). RESULTS: The potential donor detection rate (PD/PMP) increased from 18 in P0 to 47 in P3. The ED rate (ED/PMP) was 10 in P0 and 47 in P3. Organs donated ED evolved from 2.8 in P1 to 3.3 in P3. Mean donor age increased: 32 years in P1 and 53 in P3. ED/PD rate did not vary significantly in the three periods: P1, 54%; P2, 53%; and P3, 55%. There was a change in the main causes of death among our EDs: 54% head trauma, 36% stroke, and 16% other causes in P1 versus 30% head trauma and 64% stroke in P3. Failed donations due to medical contraindications were in P1 17% and in P3; whereas failed donation due to donor management problems and family denials to donation, both dropped: P1 16%; P3 10% and P1 13%; P3 7%, respectively. CONCLUSIONS: The ED rate increased almost fivefold since 1981 to 1986. We think that this was the result of a better detection since the beginning of our program. Failed donation due to medical exclusion criteria along with the mean donor age of our donors increased, but we noticed a significant drop in family denials and exclusions secondary to donor management problems. Our donor profile has changed considerably during 18 years: an increase of more than 20 years in the mean donor age along with an increase of more than 28% among strokes as the cause of death, leading to more failed donations secondary to medical exclusion criteria.

[Telephone triage performed by emergency room physicians]. / Triage telefónico realizado por médicos en urgencias de pediatría.

OBJECTIVE: To determine the applicability and utility of a telephone triage performed by physicians in a pediatric emergency department (PED). PATIENTS AND METHOD: All the telephone consultations registered between 2003-10-1 and 2004-10-3 were reviewed. The variables analyzed were: telephone call record (n = 2,560), compliance with the advice given (randomized sample of patients who were not referred to the PED and all patients who were referred) and parent satisfaction (callers over a 1-month period were contacted). A protocol for answering queries was organized and residents received specific training. RESULTS: There were 59,088 episodes and 2,560 calls were registered (1 call/23 episodes). Forty-eight percent of the calls were received between 5 and 11 pm. All calls were answered by a physician (72% residents, 28% attending physicians). The most frequent reason for calling was to seek advice on symptoms. Eighty-two percent of the calls were resolved through telephone instructions to be carried out in the home. A total of 274 patients were advised to attend the PED, but 29% did not attend, usually because the child's symptoms improved. Twenty patients were admitted to the hospital (6 to wards, 14 to the observation unit). Of the patients not advised to attend, 21% attended the PED and 0.9% were admitted (compared with 7.2% in the referral group, p = 0.0001). More than 90% of the families questioned were satisfied with the advice given. Seventy-five percent would have attended the PED if telephone consultation had not been available. By giving telephone advice, we avoided 115 visits in 1 month. COMMENTS: If special training programs and answering systems are established after a training period, telephone consultation in a PED is a safe and useful method of performing patient triage. Satisfaction among families was high.

Triage telefónico realizado por médicos en urgencias de pediatría / Telephone triage performed by emergency room physicians

Objetivo: Comprobar la aplicabilidad de un triage telefónico realizado por médicos en un servicio de urgencias de pediatría (SUP). Pacientes y método: Se estudian las consultas telefónicas en un SUP entre el 1-10-2003 y el 3-10-2004, analizando: registro de llamadas (n = 2.560); cumplimiento de las recomendaciones (los que recibieron instrucción de acudir y muestra aleatoria de los que no recibieron consejo de acudir), y satisfacción de los padres (encuesta telefónica durante un mes). Se estableció un protocolo de respuesta y los MIR (médicos internos residentes) recibieron formación específica. Resultados: Se registraron 59.088 episodios y 2.560 llamadas (1 llamada/23 episodios). El 48 % se recibieron entre las 17 y las 23 h. Todas las llamadas fueron contestadas por un médico (72 % MIR; 28 % adjunto) El motivo de llamada más frecuente fue la consulta sobre síntomas. El 82 % de las consultas fueron resueltas mediante instrucciones de tratamiento domiciliario. Se recomendó acudir al SUP a 274 pacientes. De éstos, el 29 % no acudió, la mayoría por mejoría de los síntomas. Precisaron ingreso en el hospital 20 pacientes (6 en planta, 14 en observación). Del grupo al que no se recomendó acudir para valoración, el 21 % acude e ingresa el 0,9 % (frente a 7,2 % del grupo derivado; p = 0,0001). De las familias encuestadas, más del 90 % describió como útil el consejo recibido. El 75 % habría acudido a nuestro servicio de no existir la posibilidad de consultar telefónicamente. En un mes se habrían evitado 115 visitas. Discusión: Realizada tras un período formativo y de forma protocolizada la consulta telefónica en un SUP es una herramienta segura y útil para el triage, con un alto grado de satisfacción de las familias

Objective: To determine the applicability and utility of a telephone triage performed by physicians in a pediatric emergency department (PED). Patients and method: All the telephone consultations registered between 2003-10-1 and 2004-10-3 were reviewed. The variables analyzed were: telephone call record (n = 2,560), compliance with the advice given (randomized sample of patients who were not referred to the PED and all patients who were referred) and parent satisfaction (callers over a 1-month period were contacted). A protocol for answering queries was organized and residents received specific training. Results: There were 59,088 episodes and 2,560 calls were registered (1 call/23 episodes). Forty-eight percent of the calls were received between 5 and 11 pm. All calls were answered by a physician (72 % residents, 28 % attending physicians). The most frequent reason for calling was to seek advice on symptoms. Eighty-two percent of the calls were resolved through telephone instructions to be carried out in the home. A total of 274 patients were advised to attend the PED, but 29 % did not attend, usually because the child's symptoms improved. Twenty patients were admitted to the hospital (6 to wards, 14 to the observation unit). Of the patients not advised to attend, 21 % attended the PED and 0.9 % were admitted (compared with 7.2 % in the referral group, p = 0.0001). More than 90 % of the families questioned were satisfied with the advice given. Seventy-five percent would have attended the PED if telephone consultation had not been available. By giving telephone advice, we avoided 115 visits in 1 month. Comments: If special training programs and answering systems are established after a training period, telephone consultation in a PED is a safe and useful method of performing patient triage. Satisfaction among families was high

Actitud ante las caídas de los ancianos. Parte II: “El anciano que se-nos-cae” / Attitudes Concerning Falls in the Elderly. Part II: “The elderly person who falls while under our care”

Nuestra experiencia personal y el análisis delas caídas ocurridas en los ancianos de las ResidenciasGeriátricas y del Hospital de Media-LargaEstancia de Fundación Matía, nos llevan a reflexionarsobre las caídas en los usuarios muydiscapacitados, incapaces de caminar de formaautónoma.Ello, nada tiene que ver con el concepto “Caídas-Síndrome Geriátrico” sino más bien conunos adecuados cuidados gerontológicos, con lanecesidad de clasificar el grado de riesgo y ensu caso con las adecuadas medidas de restricciónfísica

Our personal experience and analysis of thefalls suffered by elderly people in Fundación Matía´s Geriatric Nursing Homes and Medium-Longterm Care Hospital leads us to reflect upon fallsof severely disabled users who are unable towalk autonomously.This has little to do with the concept of “GeriatricSyndrome – Falls”, but rather with adequategerontological care, as well as the need to establishthe level of risk and, adequate, physical restraintmeasures when needed

Effect of solid hold-up on nitrite accumulation in a biofilm reactor--molecular characterization of nitrifying communities.

Biological ammonium oxidation was carried out in two inverse turbulent bed reactors fed with synthetic mineral wastewater containing a high ammonium concentration (100 mg N-NH4+/L). Both reactors were started-up and operated in the same conditions except for the solid carrier concentration: the solid hold-up ratios applied, defined as the ratios of static to expanded bed height, were 0.1 and 0.3 in reactors R10 and R30 respectively. These two solid hold-up ratios generate different particle-to-particle collision frequencies and, therefore, detachment forces. The influence of solid hold-up on biofilm growth and nitrifying performance was studied from a macroscopic (i.e. nitrate and/or nitrite production) and microbiological point of view. After 60 days of operation, both reactors contained the same amount of biomass. However, R10 produced only nitrate while nitrite accumulated in R30. A comparison of microbial populations in the reactors showed that R10 contained both ammonium and nitrite oxidizing populations such as Nitrosomonas and Nitrospira, whereas in R30, ammonium oxidizing populations were much greater than those of nitrite oxidizers. The major ammonium-oxidizing organism was not the same in both reactors.

Labelling information demanded by European consumers and relationships with purchasing motives, quality and safety of meat.

Meat labelling can be an important way of informing the consumer on the quality attributes of meat. However, the type of information consumers demand is not well known and there is a lack of consumer-oriented information. Thus, meat labelling requires special attention. The objectives of this paper were: to identify the type of information that is most demanded by European consumers on beef and lamb labelling; to analyse the relationships between the importance of informational cues and other aspects concerning consumer attitudes towards meat consumption and meat quality, and socio-demographic characteristics; and to identify groups of consumers according to their labelling preferences. The information cues considered most important related to the deadline for meat consumption and the origin of meat. Other important cues were nutritional information, maturation time, name of cut and, especially for beef consumers, information on the system of production and on the traceability and the quality control of the meat. Some groups or segments of consumers were identified that had significant differences in relation to the type of information demanded, purchasing motives, quality preferences, sources of information on quality they trusted most and socio-economic features. They could be briefly profiled as: 'quality/safety orientated'; 'traditional'; 'quality unconcerned/ convenience-driven' and 'origin motivated' consumers.

[Acute abdomen caused by jejunal perforation as a clinical presentation of MEN-1 syndrome]. / Abdomen agudo por perforación yeyunal como presentación clínica de un síndrome MEN-I.

We present a case of acute abdomen due to a jejunal perforation. The final diagnosis was concluded a multiple endocrine neoplasia type I. In the literature reviewed, no similar clinical presentation was found. We review the diagnostic sequence and the management of these patients.