Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos / Design and validation of the scale to assess the fragility of chronic patients

Objetivo: Crear una escala y herramienta que nos permita medir la fragilidad del paciente crónico. Diseño: Estudio observacional sobre crónicos del área. Emplazamiento: Se ha realizado entre enero de 2011 a diciembre 2015, una población de 2.108 individuos. Los datos se recogieron de la historia clínica y aplicación expresa para el registro de los pacientes frágiles, sobre hoja estructurada de recogida de datos. Participantes: Sujetos frágiles del área Sanitaria Norte de Málaga. Intervención: Diseño y validación de una escala. Mediciones principales: Variable principal de resultado: escala de fragilidad Antequera (EPADI) constituida por seis criterios/factores valorables: edad, Pfeiffer, Barthell, Charlson, sociofamiliar y pluripatológico. Las variables de resultados en accesibilidad se utilizaron como variables de predicción. Las variables cuantitativas se describen mediante la media y desviación estándar. Las variables cualitativas las presentamos en frecuencias junto con sus porcentajes. Para obtener un modelo de predicción de la utilización de recursos la muestra se dividió en dos sub-muestras de igual tamaño. Resultados: A partir de las variables de interés por expertos, se identificaron predictores univariantes en la utilización de recursos en la muestra M_EPADI1, para construir un modelo de regresión logística multivariante que permita predecir la utilización de recursos. Para la validación de la escala se utilizó la muestra M_EPADI2. Conclusiones: Se ha podido comprobar que los criterios utilizados en nuestra escala son adecuados para definir la fragilidad, por lo tanto la escala EPADI valora perfectamente el grado de fragilidad de los usuarios crónicos en base a los recursos consumidos

Objective: To create a scale and tool that allows us to measure the fragility of the chronic patient. Design: Observational study on the area's chronicles. Location: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. Participants: Fragile subjects of the North Sanitary Area of Malaga. Intervention: Design and validation of a scale. Main measurements: Study variables. Main outcome variable: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. Results: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. Conclusions: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. Conclusions: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed

[Design and validation of the scale to assess the fragility of chronic patients]. / Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos.

OBJECTIVE: To create a scale and tool that allows us to measure the fragility of the chronic patient. DESIGN: Observational study on the area's chronicles. LOCATION: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. PARTICIPANTS: Fragile subjects of the North Sanitary Area of Malaga. INTERVENTION: Design and validation of a scale. MAIN MEASUREMENTS: Study variables. MAIN OUTCOME VARIABLE: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. RESULTS: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. CONCLUSIONS: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. CONCLUSIONS: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.

Empleo de adrenalina tópica en hematuria persistente por neoplasia vesical-infiltrante / Use of topical adrenaline in persistent hematuria due to infiltrating bladder cancer

La hematuria es un problema habitual en los tumores vesicales, y en ocasiones origina dolor irruptivo por la formación de coágulos. Las diferentes opciones terapéuticas incluyen quimioterapia, radioterapia o cirugía, así como tratamiento sintomático médico. Sin embargo, el manejo paliativo puede resultar complicado. Presentamos un caso de hematuria persistente tratada ambulatoriamente con adrenalina tópica con buen resultado

Hematuria and urinary obstruction are common problem in bladder tumors, and occasionally causes irruptive or breakthrough pain. Therapeutic options include chemotherapy, radiotherapy, surgery, or symptomatic medical treatment. However, palliative management can be complicated. The case is presented of a patient with persistent hematuria treated with topical adrenaline as an out-patient with positive results

Asociación de opioides mayores y paracetamol en un caso de dolor refractario de origen pancreático / Combination of major opioids and paracetamol in a case refractory pain of pancreatic origin

Introducción: La asociación de opioides potentes a dosis bajas puede producir un efecto sinérgico antinociceptivo. Esto en combinación con analgésicos menores como el paracetamol puede potenciar el efecto antiálgico a la vez que se minimizan los efectos adversos. Caso clínico: Varón de 47 años con cáncer de páncreas y metástasis hepáticas que presenta, como síntoma principal, dolor refractario en hipocondrio derecho, y que encuentra respuesta analgésica con asociación de opioides de tercer escalón. La retirada del paracetamol ocasiona un empeoramiento claro del dolor. Conclusiones: En este caso únicamente se consiguió alivio sintomático con la asociación de opioides (fentanilo/oxicodona) y paracetamol, con escasos-nulos efectos secundarios, utilizando dosis recomendadas en Cuidados Paliativos (AU)

Introduction: The combination of strong low-dose opioids can produce a synergistic antinociceptive effect. In combination with minor analgesics, such as paracetamol it may strengthen the analgesic effect as well as minimising adverse events. Clinical Case: A 47 year-old male diagnosed with pancreatic cancer and hepatic metastases presenting as primary symptom, with refractory pain in right hypochondrium, and an analgesic response found with a combination of third-level opioids. Removal of paracetamol caused a clear worsening of pain. Discussion Symptomatic relief was only achieved with a combination of opioids (fentanyl/oxycodone) and paracetamol, with few/no adverse events by using recommended Palliative Care doses (AU)