Adecuación del tratamiento farmacológico en pacientes pluripatológicos

ObjectiveTo identify tools for measuring the appropriateness of drug therapy useful in patients with multiple chronic conditions.DesignWe performed a literature review.Data sourcesThe following database were consulted (December 2009): Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME) to detect tools for measuring the appropriateness of treatment in patients with multiple chronic conditions, or otherwise elderly or polypharmacy.Study selectionStudies were identified both qualitative and quantitative methodology, both theoretical and field work, both original and revised work and included work from all areas of the health system. 108 articles were retrieved, of which we selected 59. The consultation of their references include 20 jobs allowed, resulting in a total of 59 articles.Data extractionOf all the tools identified, the researchers performed a selection of those with possible utility for classified PP. The articles were classified into implicit and explicit methods and the characteristics of the field works were tabulated.ResultsWe identified two implicit methods (MAI and Hamdy) and 6 explicit methods (Beers criteria, IPET, STOPP/START, ACOVE, CRIME and NORGEP). None was specific to patients with multiple chronic conditions. The questionnaire MAI, the Beers criteria and its modifications are most often used in literature. The advantages of explicit criteria means that many of them have been developed recently.ConclusionThere are several tools to measure the appropriateness and none of them has been designed for a population of patients with multiple chronic conditions yet, which by its nature requires a specific approach spreads.     

Alimentación y nutrición en atención primaria en Brasil

Objective

To describe food and nutrition actions in primary health care in Brazil.

La financiación de la industria alimentaria y la investigación epidemiológica sobre nutrición y salud

The interests of the food industry to fund nutrition and health research are not limited to promoting scientific advances. Recently, several systematic reviews conducted about the effect of sugar-sweetened beverages and health outcomes have shown some biased conclusions in studies that acknowledge industry sponsorship. In this context, the Nutrition Working Group of the Spanish Epidemiology Society presented a scientific session entitled Food industry and epidemiologic research at its annual meeting. In a round table, four experts in nutrition research presented their points of view about whether the food industry should fund nutrition-related research and the related potential conflicts of interest of the food industry. All the experts agreed not only on defending independence in nutritional epidemiology regarding the design, interpretation and conclusion of their studies but also on the crucial need for guaranteed scientific rigor, scientific quality of the results and measures to protect studies against potential biases related to the conflicts of interest of funding by the food industry. Drs Pérez-Farinós and Romaguera believe that the most effective way to prevent conflicts of interest would be not to allow the food industry to fund nutrition research; Drs Marcos and Martínez-González suggested the need to establish mechanisms and strategies to prevent the potential influences of the food industry in selecting researchers or institutional sponsorship and in the analysis and results of the studies, to ensure maximum independence for researchers, as well as their professional ethics.     

Cómo los equipos de dirección usan los sistemas de información y control en la gestión hospitalaria

ObjectiveTo analyze the relationship between the characteristics of top management teams and the different use of management information and control systems (MICS) to implement policies that encourage cooperation and activity coordination in public hospitals.MethodsData were collected through a questionnaire sent to each member of the top management teams of 231 Spanish public hospitals (chief executive director, medical director, nursing director and director for financial and social issues). A total of 457 valid questionnaires were returned, composing 86 full top management teams (37.23%).ResultsTop management team diversity was positively related to the interactive use of MICS. Management teams composed of younger members and members with longer service used MICS interactively. Top management teams with a predominantly clinical education and experience used MICS interactively, while top teams with a predominantly administrative education and experience used MICS diagnostically. The results also showed that cooperation and coordination in hospitals were positively related to the interactive use of MICS and were negatively related to the diagnostic use of MICS.ConclusionsThe interactive use of MICS is an important mediator in the relationship between top team diversity and policies focused on hospital decentralization. Top management teams with diverse characteristics (e.g. age, length of service, education and experience) use management information interactively to enhance activity coordination and resource allocation in hospitals.     

Metodología de conciliación del tratamiento farmacológico en pacientes pluripatológicos

ObjectiveTo carry out a bibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients.DesignWe performed a literature review.Data sources The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied.Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected.Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation.ResultsMost of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions).ConclusionsThere is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation.     

Radon 222Rn in residential buildings of Swieradów Zdrój and Czerniawa Zdrój

Swieradrów Zdrój and Czerniawa Zdrój are located in Region Izera Block. A total of 789 radon passive dosimeters were distributed in 183 dwellings in these town Swieradów Zdrój and Czerniawa Zdrój to measure the indoor radon concentration in 1999. Three-five measurements were performed in each dwelling, one in the basement, and the others in the main bedroom, in the kitchen, in the bathroom, since these rooms are the most frequently occupied. In addition, the occupants of each dwelling were requested to answer a questionnaire in which a number of questions about the building, ventilation habits and other related aspects were formulated. A charcoal detectors (Pico-Rad system) were used in experiment. It is a passive short-term screening method of radon gas concentration measurements. The indoor radon level was found to range from 14.8 Bq/m3 to 5,723.9 Bq/m3. The arithmetic mean overall indoor concentration was 420.4 Bq/m3 and the geometric mean was 159.7 Bq/m3. The average concentration of indoor radon, which reflects the real risk for inhabitants, is 193.5 Bq/m3. The results hand a log-normal distribution. In Poland, an action level of 400 Bq/m3 was recommended for existing buildings and 200 Bq/m3 for newly built (after 1.01.1998) buildings. In about 23% rooms the level of Rn-222 were above the top limit of 400 Bq/m3. The highest average concentrations were present in a basement (mean 919.9 Bq/m3). A decrease of average activity were observed at the upper levels: at the ground floor (225.2 Bq/m3), at the first floor and at the higher floors (137.6 Bq/m3). The above results indicate that radon emission from the ground provides the main contribution to the radon concentration measured in dwellings indoors in Swieradów Zdrój and Czerniawa Zdrój. The effective dose to the population of the Swieradów Zdrój and Czerniawa Zdrój from indoor radon and its progeny can be derived from this data if we use an equilibrium factor of 0.4 between radon and its progeny and assuming an indoor occupation index of 0.8. Taking into account that a conversion coefficient of 1.1 mSv per mJ h m-3 is recommended in ICRP 65 for members of public, the measured average annual dose is then about 3.3 mSv per year.