A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot Randomized Controlled Clinical Trial.

BACKGROUND: Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia. METHODS: We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups. RESULTS: Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008). CONCLUSION: A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study.

There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.

A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients.

ABSTRACT: The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention ( n = 24) or control group ( n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17-2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.

Infradiagnóstico de enfermedades neuromusculares en ancianos de 80 y más años / Under-diagnosis of neuromuscular diseases in patients of 80 years and older

La miastenia gravis (MG), la esclerosis lateral amiotrófica y el síndrome de Guillain-Barré (SGB) han sido clásicamente considerados como enfermedades excepcionales o inhabituales en las personas de perfil geriátrico. A lo largo de los últimos 25 años se realizaron diversos estudios de base poblacional en la comarca de Osona (Barcelona), que permitieron describir por primera vez en la literatura incidencias globales altas a expensas de los ancianos, especialmente en aquellos de más de 80 años. Los resultados encontrados indican la posibilidad de infradiagnóstico de estas enfermedades neuromusculares en el anciano, hecho que podría resultar especialmente relevante en el caso de la MG y el SGB, dado que son 2entidades potencialmente reversibles y con alta mortalidad en caso de infradiagnóstico y ausencia de tratamiento

Myasthenia gravis (MG), amyotrophic lateral sclerosis and Guillain-Barre syndrome (GBS) have been classically considered as exceptional or unusual diseases in people with a geriatric profile. Over the past 25 years, several population-based studies have been conducted in the Osona area (Barcelona), which, for the first time, has led to describing the high global incidences in the elderly, especially those over 80 years-old. The results suggest the possibility of underdiagnosis of these neuromuscular diseases in the elderly, a fact that could be especially relevant in the case of MG and GBS, since they are 2potentially reversible entities with high mortality in the event of underdiagnosis and absence of treatment

[Under-diagnosis of neuromuscular diseases in patients of 80 years and older]. / Infradiagnóstico de enfermedades neuromusculares en ancianos de 80 y más años.

Myasthenia gravis (MG), amyotrophic lateral sclerosis and Guillain-Barre syndrome (GBS) have been classically considered as exceptional or unusual diseases in people with a geriatric profile. Over the past 25 years, several population-based studies have been conducted in the Osona area (Barcelona), which, for the first time, has led to describing the high global incidences in the elderly, especially those over 80 years-old. The results suggest the possibility of underdiagnosis of these neuromuscular diseases in the elderly, a fact that could be especially relevant in the case of MG and GBS, since they are 2potentially reversible entities with high mortality in the event of underdiagnosis and absence of treatment.

Prevalencia del síntoma ansiedad en pacientes con demencia en una unidad de psicogeriatría y tratamiento farmacológico asociado / No disponible

La ansiedad es uno de los síntomas que aparece frecuentemente en los pacientes con demencia, si bien su prevalencia varía en función del tipo y fase de la misma, del sexo del individuo e incluso del grado de autonomía funcional. La ansiedad suele tener una repercusión importante sobre la calidad de vida del enfermo y sus cuidadores, lo que justifica la instauración de medidas no farmacológicas y a menudo, también farmacológicas. Ahora bien, la utilización de medicamentos en la población geriátrica y particularmente en los dementes es compleja, por la mayor sensibilidad a los fármacos y mayor susceptibilidad de padecer efectos no deseados. La instauración de tratamientos farmacológicos necesariamente conlleva a una revisión crítica y sistemática de su beneficio/riesgo de acuerdo a los objetivos terapéuticos que han sido predefinidos (AU)

Anxiety is a symptom that occurs frequently in patients with dementia, although their prevalence varies depending on the type and stage of it, the sex of the individual and even the degree of functional autonomy. Anxiety often has a significant impact on the quality of life of patients and their caregivers, which justifies the introduction of non-pharmacological measures and often also drugs. However, the use of drugs in the elderly, particularly in dementia is complex, because has a greater drug sensitivity and susceptibility to unwanted effects. The introduction of drug therapies necessarily leads a systematic critical review of the benefit/risk according therapeutic goals that have been predefined (AU)

Effect of intervention promoting a reduction in antibiotic prescribing by improvement of diagnostic procedures: a prospective, before and after study in general practice.

OBJECTIVE: To investigate if an intervention aimed at improving the quality of the diagnostic procedures in Spanish general practice could lower antibiotic prescribing in patients with respiratory tract infections (RTIs). METHODS: GPs in the intervention group (n=17) registered all patients with RTIs during a 3-week period before and after the intervention. The intervention was aimed at reducing prescribing of inappropriate antibiotics for RTIs by improving the diagnostic procedures and thereby helping the GPs to distinguish between bacterial and viral infections. It consisted of courses in management of RTI according to local clinical guidelines, and included implementation of two rapid diagnostic tests (StrepA and CRP measurement). Diagnoses and prescribing of antibiotics were assessed before and after the intervention, and compared to a control group not exposed to intervention (35 GPs). RESULTS: The intervention led to a significant reduction in antibiotic prescribing. Before the intervention 36% (29%-44%) of consultations were followed by antibiotic prescribing, after the intervention 24% (20%-29%). Antibiotic prescribing in the control group not exposed to intervention was 32% (27%-38%). The reduction was most pronounced in patients with sinusitis and lower RTIs. CONCLUSION: Quality improvement of diagnostic procedures may lead to a reduction of antibiotic prescribing in primary health care in Spain.

Reducción en la prescripción de antibióticos en la sinusitis mediante la realización de una auditoría / Reduction in the prescription of antibiotics in pharyngoamygdalitis and sinusitis by means of an audit

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Indicadores cualitativos en la prescripción de antibióticos: ¿son los más adecuados? / Qualitative indicators in antibiotic prescription: are they the most appropriate ones?

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