4CPS-383 Drug prescription in the elderly. Are we doing well? Rodríguez Fernández, Z; González González, MA; Gutiérrez Gutiérrez, E ...
European journal of hospital pharmacy. Science and practice,
03/2021, Letnik:
28, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Background and importanceInappropriate use of drugs in elderly patients has health consequences for the patient and for the health system.Aim and objectivesThe main objective was to review medication ...in older adults, especially potentially inappropriate medications (PIMs) using the screening tool of older persons’ prescriptions (STOPP). The secondary objective was to assess the possibility of detecting prescription errors by the pharmacist in community pharmacies and in primary care, through the use of the electronic prescription.Material and methodsA descriptive cross sectional study was conducted at a tertiary hospital. We included patients aged over 75 years who have been admitted as inpatients to an internal medicine department for 60 days. Study variables were: age, sex, prescription drugs to hospital discharge, electronic prescriptions and PIMs according to the STOPP criteria (2014).Results55 patients were selected, with an average age of 84.47±4 96 years and a male/female ratio of 0.89. 437 prescriptions were analysed. Regarding the number of prescribed drugs per patient: 27.27% (n=15) patients were prescribed 0–4 drugs; 41.82% (n=23) 5–9 drugs; and 30.91% (n=17) ≥10 drugs. Analysing PIMs according to the STOPP criteria (2014): 187 PIMs (42.79%) were detected. 163 PIMs (87.17%) could be detected by electronic prescriptions. In the group of patients with 0–4 prescribed drugs, 19.25% (n=36) of PIMs were detected; 42.78% (n=80) in the group of 5–9 drugs; and 37.97%(n=71) in patients with ≥10 drugs. The most common PIMs were: concomitant administration of two drugs of the same class 14, 97% (n=28); and any medication prescribed longer than that indicated 12.29% (n=23).Conclusion and relevanceThe results of the study showed a significant number of PPIs and a profile of polymedicated patients (≥5 prescribed drugs), associating polypharmacy with an increase in the number of PIMs. Therefore, there is a need to analyse and correct inappropriate medications and discrepancies in medical prescriptions to hospital discharge in our elderly patients. For this, the hospital pharmacist is a key element. In addition, the intervention of pharmacists from pharmacies and health centres who can verify the electronic prescription is possible and can make an important contribution.References and/or acknowledgementsConflict of interestNo conflict of interest
Tourette Syndrome (TS) is a complex neurodevelopmental disorder which is normally associated to psychiatric comorbidity such as attention deficit hyperactivity disorder, obsessive compulsive ...disorder, anxiety or depression. Quality of life (QoL) in these patients can be affected by tic severity and associated comorbidities.
The aim of the study was to describe and analyze QoL and psychiatric comorbidities in a sample of pediatric patients, as well as to develop a Spanish version of the questionnaire CandA-GTS-QoL to measure quality of life in this population.
Single-center, observational, prospective study. Patients aged 6 to 16 years old with TS were included. Demographic, clinical, diagnostic and treatment data were gathered. Questionnaires regarding tic severity, psychiatric comorbidity and quality of life were used.
Twenty-two patients with DSM-5 diagnosis of TS were included (86.4% male, median age 11 years). Of those, 86.4% had been previously diagnosed of psychiatric comorbidities and 72.7% received psychopharmacologic treatment. The prevalence of an ICD-10 current diagnosis of anxiety was 72.7%, depression 50%, ADHD 40.9% and OCD 7.3%. Median QoL score was 59.5 (RIC: 34.8-71.3) for PedsQL, and 55.5 (RIC: 45-65) for CandA-GTS-QoL, with a correlation between scores of R2 = 0.83 (p < 0.01). Higher tic severity was associated with poorer QoL (PedsQL R2: -0.732, p <0.01, CandA-GTS-QoL R2: -0.501, p = 0.021). A higher EDAH score for ADHD was associated with poorer QoL (PedsQL R2: -0.463, p = 0.03, CandA-GTS-QoL R2-0.534, p < 0.01).
Prevalence of psychiatric comorbidities in pediatric TS is high and frequently underdiagnosed. Tics and psychiatric comorbidities affect quality of life. Further studies are needed to validate the Spanish version of CandA-GTS-QoL scale.
To describe patients diagnosed with hematoma of the rectus abdominis (HRA) muscle.
A retrospective analysis of patients diagnosed with HRA over the past 8 years in our center.
A total of 17 patients ...(9 women) with mean age of 73 years were included in the study. In 52% of the cases the HRA was the cause of hospitalization. Anticoagulant therapy was documented in 70%. More than half of patients treated with low molecular weight heparin had renal insufficiency. In the group receiving oral anticoagulants (OA), 86% had INR greater than 4. Paroxysmal cough appeared in 13. The most common presentation was abdominal pain and palpable mass. CT scan sensitivity was superior to that of the ultrasound. The most common location was the lower right. Treatment was conservative in all but one. Two patients died. Mean decrease in hemoglobin was 4.7 g/dl. Average stay was 19 days.
In our center, HRA almost equally affects both genders and appears in older people with excessive anticoagulation and cough. The clinical presentation, increased diagnostic sensitivity of CT scan and predominance in the right abdominal involvement are similar to other series. Mortality and hospital stay are higher than described.
We report a case of human anaplasmosis (HA) fulfilling the confirmation criteria: epidemiologic data and clinical picture compatible with HA; presence of a morulae within polymorphonuclear leukocyte; ...and positive PCR assay for Anaplasma phagocytophilum: This case report shows the presence of HA in Spain.
Derived neutrophils/(leukocytes-neutrophils) ratio (dNLR) and lactate dehydrogenase (LDH) level have been correlated with immune checkpoint inhibitors (ICI) outcomes. A lung immune prognostic index ...(LIPI) that showed association with ICI outcomes was developed by Mezquita L et al. based on these 2 systemic inflammation indicators (dNLR <3 and LDH > upper limit of normal (ULN)), characterizing 3 prognostic groups: good, 0 factors; intermediate, 1 factor; poor, 2 factors. This index hasn’t been specifically studied in first-line setting of NSCLC with pembrolizumab monotherapy.
This is a multicenter retrospective study to explore the prognostic value of LIPI score in treatment-naïve advanced NSCLC with high PD-L1 expression (>=50%) treated with pembrolizumab. Consecutive patients treated in 19 Spanish hospitals between March 2015 and April 2019 were included. Pretreatment LIPI score was calculated for all subjects and primary endpoint was OS.
223 patients were included. Mean age 67 years (SD 9.8). 77.6% were male and 75% PS<=1. Predominant histologies: adenocarcinoma (65%), squamous-cell carcinoma (26%). Median number of cycles: 7 (IQR:1-33). 30.3% were LIPI 0 (good prognosis), 42.4% LIPI 1 (intermediate prognosis), and 27.3% LIPI 2 (poor prognosis). Disease control rate (DCR) was 65,6%. In Kaplan-Meier analysis, median OS for good, intermediate, and poor groups was 15,1m (95% CI, 13-17,1), 21,7m (95% CI, 18,8-24,5) and 9,3m (95% CI, 7-11,7) (p<0.001). Worse PFS was observed in LIPI2 but was not statistically significant (p=0.064). There were not OS or PFS differences between LIPI 0 and 1, but a LIPI score of 2 was independently associated with poorer OS (unadjusted HR: 3.7; 95% CI:1.89-7.5 , p<0.001); and HR adjusted by gender, sex, number of metastatic locations, basal haemoglobin, corticoids use and PS score: 2.3;95% CI: 1.3-3.9, p=0,002). LIPI 2 group patients had also worse DCR (45% vs 64% in LIPI0 and 74% in LIPI1, p=0.012).
LIPI score was able to define a group of patients with poor benefit from pembrolizumab monotherapy in such a selected population (advanced NSCLC with high PD-L1 expression) with high probability to get benefit from it according to KN-024.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
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