Conocimientos, percepciones y actitudes que intervienen en la adherencia al tratamiento en pacientes ancianos polimedicados desde una perspectiva cualitativa / Knowledge, perceptions and attitudes involved in adherence to treatment elderly patients polymedicated from qualitative perspective

Objetivos. Evaluar los conocimientos, percepciones y actitudes de grupos de informantes clave sobre la adherencia al tratamiento de pacientes mayores de 65 años polimedicados que recibieron el alta hospitalaria desde el Servicio de Medicina Interna. Material y métodos. Investigación cualitativa mediante la realización de grupos focales y entrevistas semiestructuradas. La población diana fueron pacientes con prescripción anterior al ingreso de 4 o más fármacos, sin deterioro cognitivo y con autonomía propia. Ejes temáticos valorados: ingreso hospitalario, alta domiciliaria, problemas cognitivos, creencias que disminuyen el cumplimiento y características de los medicamentos. Resultados. Durante la hospitalización se detecta una falta de información sobre la enfermedad que originó el ingreso, los tratamientos suministrados durante la hospitalización y los prescritos tras el alta. En el domicilio la polimedicación, la acumulación de fármacos, la confusión con los genéricos, la complejidad de la pauta, la duplicidad terapéutica y la falta de coordinación entre hospital, primaria y farmacias junto a los problemas cognitivos, las creencias negativas y determinadas características de los medicamentos disminuyen la adherencia al tratamiento. Conclusiones. A la vista de los resultados, sería oportuno aumentar los conocimientos que los pacientes tienen sobre su enfermedad de ingreso, los tratamientos suministrados durante la hospitalización y los prescritos tras el alta. En relación con las actitudes, los profesionales deben mejorar las explicaciones sobre el tratamiento y adaptar los informes del alta hospitalaria. En cuanto a las percepciones, se deben disminuir las creencias negativas y preocupaciones que los pacientes o cuidadores tengan sobre un fármaco ya que pueden dificultar la adherencia al tratamiento(AU)

Aims. To assess the knowledge, perceptions and attitudes of groups of key informants on adherence to treatment by polymedicated patients aged over 65 years following hospital discharge (internal medicine service). Material and methods. Qualitative research study, based on focus groups and semi-structured interviews. The target population were patients prescribed 4 or more drugs prior to admission, self-sufficient and suffering no cognitive impairment. Key areas assessed: hospital admission, hospital discharge, cognitive problems, attitudes that reduce adherence to treatment, and medication characteristics. Results. During their hospitalization, patients lacked information on the condition that caused the admission, the treatment provided during hospitalization, and that prescribed following hospital discharge. At home, polymedication, drug accumulation, confusion about generic drugs, the complexity of the treatment regimen, treatment duplication, and a lack of coordination between hospital, primary healthcare and pharmacies, together with cognitive problems, negative attitudes and certain characteristics of the drugs prescribed, all decrease adherence to treatment. Conclusions. In view of the results obtained, it would be appropriate to increase patient knowledge about their condition on admission to hospital, as well as the treatment provided during hospitalization, and that prescribed after discharge. Regarding attitudes, healthcare staff should better explain the treatment offered and adapt hospital discharge forms for these patients. In terms of perceptions, steps should be taken to reduce negative attitudes and concerns that patients or caregivers may have about a drug, as these views could hinder adherence to treatment(AU)

[Knowledge, perceptions and attitudes involved in adherence to treatment elderly patients polymedicated from qualitative perspective]. / Conocimientos, percepciones y actitudes que intervienen en la adherencia al tratamiento en pacientes ancianos polimedicados desde una perspectiva cualitativa.

AIMS: To assess the knowledge, perceptions and attitudes of groups of key informants on adherence to treatment by polymedicated patients aged over 65 years following hospital discharge (internal medicine service). MATERIAL AND METHODS: Qualitative research study, based on focus groups and semi-structured interviews. The target population were patients prescribed 4 or more drugs prior to admission, self-sufficient and suffering no cognitive impairment. Key areas assessed: hospital admission, hospital discharge, cognitive problems, attitudes that reduce adherence to treatment, and medication characteristics. RESULTS: During their hospitalization, patients lacked information on the condition that caused the admission, the treatment provided during hospitalization, and that prescribed following hospital discharge. At home, polymedication, drug accumulation, confusion about generic drugs, the complexity of the treatment regimen, treatment duplication, and a lack of coordination between hospital, primary healthcare and pharmacies, together with cognitive problems, negative attitudes and certain characteristics of the drugs prescribed, all decrease adherence to treatment. CONCLUSIONS: In view of the results obtained, it would be appropriate to increase patient knowledge about their condition on admission to hospital, as well as the treatment provided during hospitalization, and that prescribed after discharge. Regarding attitudes, healthcare staff should better explain the treatment offered and adapt hospital discharge forms for these patients. In terms of perceptions, steps should be taken to reduce negative attitudes and concerns that patients or caregivers may have about a drug, as these views could hinder adherence to treatment.

Comparison of cefepime versus ceftriaxone-amikacin as empirical regimens for the treatment of febrile neutropenia in acute leukemia patients.

BACKGROUND: High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate. METHODS: We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/microl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started. RESULTS: Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity. CONCLUSIONS: Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides.

Excitatory amino acid receptors coupled to the phosphoinositide pathway in Bergmann glia.

Glutamate (L-glu) receptors coupled to phosphoinositide hydrolysis in primary cultures of Bergmann cells from chick cerebellum were characterized biochemically and pharmacologically. Both ionotropic and metabotropic receptor agonists stimulated [3H] inositol phosphates accumulation in the following order of potency: QA > NMDA > L-glu > KA approximately QA > AMPA > > t-ACPD. QA showed a biphasic dose-response curve (EC50 = 0.07 and 53 microM), suggesting interaction with two populations of receptors; L-glu was the most efficient agonist. Stimulation by NMDA was blocked by CPP, AP5 and MK-801; that by AMPA and KA was inhibited 100% by CNQX and DNQX, whereas the effect of QA was decreased both by CNQX and the metabotropic antagonist 4-CPG. Stimulation of PIP2 hydrolysis induced by metabotropic L-glu receptor agonist t-ACPD was blocked by 4-CPG but was only moderately inhibited by MCPG. EAA-induced [3H]IPs accumulation was dependent on external Ca2+ and was not affected by nifedipine verapamil, or dantrolene; thapsigargin increased the effect. Results suggest that EAA activate the PI pathway in Bergmann glia through ionotropic (NMDA and AMPA/KA) as well as metabotropic receptor subtypes (t-ACPD) which could act jointly influencing neurotransmission at the parallel fiber-Purkinje cell synapses in the cerebellum.

Blood bank leukocyte infusions as remission induction therapy in a case of acute lymphoblastic leukemia.

A 15-year-old female with pre-pre B ALL in third relapse was treated with administration of eight blood bank leukocyte concentrates per day for 5 days. The total number of mononuclear cells per kilogram of weight was 4.89 x 10(8). On the fifth day of infusions the patient was in complete remission (CR), asymptomatic and with a normal CBC. No secondary effects were found. The patient remained in CR without treatment for 10 weeks before relapsing again. The possibility of reaching a short-lived, clinically relevant response, using blood bank leukocyte infusions, is a promising new approach for the treatment of leukemia.