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BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.

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INTRODUCTION AND OBJECTIVES: Poor adherence to oral antidiabetic drugs (Adh-OAD) is a risk factor for poor control of type 2 diabetes mellitus (T2DM). Therefore, it is necessary to quantify the Adh-OAD. This quantification is possible through electronic dispensing records from the community pharmacy. The objective was to evaluate the influence of the Adh-OAD on the control of T2DM and the percentage of glycosylated hemoglobin (%HbA1c) in the patient. MATERIALS AND METHODS: A cross-sectional descriptive observational study was conducted in 8 community pharmacies in Granada (Spain). Patients older than 18 years with T2DM and on oral antidiabetic drugs (OADs) for at least 6 months were included. The main study variables were the control of T2DM, %HbA1c, and the Adh-OAD considering three cut-off points (≥80%, ≥70%, ≥60%). This relationship was studied using multivariate binary logistic regression and multivariate linear regression, respectively. RESULTS: A total of 107 patients were included. The mean age was 70.5 years (SD: 9.7), and 54.2% were men. Eighty-five patients (79.4%) had well-controlled T2DM (mean %HbA1c: 6.5%; SD=0.6). Considering Adh-OAD≥80%, 13.1% (n=14) had a poor adherence and was related to the %HbA1c (ß=0.742; p=0.007) and the control of T2DM (OR: 7.327; 95% CI: 1.302-41.241). Poor adherence was found in 9.3% (n=10) considering Adh-OAD≥70% and in 3.7% (n=4) considering Adh-OAD≥60%. In both cases, a statistically significant relationship was found between Adh-OAD and the %HbA1c and between Adh-OAD and the control of T2DM. CONCLUSIONS: Adh-OAD influenced the %HbA1c in patients with T2DM and the control of their disease.

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Introducción: el hecho de que una persona no puede acceder a un servicio de salud puede favorecer la automedicación, que es la administración de fármacos según la autopercepción del individuo sobre su posible diagnóstico y solución. Aunque es una situación considerada como problema de salud pública, por medio de la educación o futuras investigaciones que generen propuestas, se podrá erradicar las barreras al acceso de la salud oral. Objetivo: determinar la prevalencia de la automedicación en odontología en adultos de Macas, Ecuador, durante el año 2021. Material y métodos: estudio descriptivo, cuantitativo, documental, comunicacional y transversal actual, donde se trabajó sobre la población de edad adulta de Macas, Ecuador; los datos se recolectaron mediante una encuesta online, para luego ser analizados en prevalencia, frecuencia y chi cuadrado. Resultados: 49% de los encuestados respondió que se automedican, los analgésicos fueron el tipo de medicamento más consumido (44.2%); 27% de los individuos respondió que el dolor dental era una causa para tomar medicamentos sin receta, el principal motivo para automedicarse y no acudir al odontólogo fue por indicación del técnico de farmacia (26%). Conclusiones: los datos epidemiológicos obtenidos en esta investigación demuestran la marcada tendencia de las personas a consumir medicinas sin receta médica, por lo que, se deduce que existe una barrera para acceder a los servicios de salud oral; por ello, debería darse la importancia y atención oportuna (AU)

Introduction: the fact that a person cannot access a health service, may favor self-medication, which is the administration of drugs according to the individual's self-perception about their possible diagnosis and solution. Although, it is a situation considered as a public health problem, through education or future research that generates proposals, it will be possible to eradicate the barriers to oral health access. Objective: to determine the prevalence of self-medication in dentistry in adults in Macas, Ecuador, during the year 2021. Material and methods: a descriptive, quantitative, documentary, communicational and current cross-sectional study was carried out on the adult population of Macas, Ecuador; data were collected by means of an online survey and then analyzed in terms of prevalence, frequency and chi-square. Results: 49% of those surveyed responded that they self-medicate, analgesics were the most consumed type of medicine (44.2%), 27% of the individuals responded that dental pain was a cause for taking medicines without prescription, the main reason for self-medicating and not going to the dentist was because of the indication of the pharmacy technician (26%). Conclusions: the epidemiological data obtained in this investigation show us the marked tendency of people to take medicines without a medical prescription; therefore, it can be deduced that there is a barrier to accessing oral health services, and for this reason it should be given importance and timely attention (AU)

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OBJECTIVE: To design a care protocol in Chronic Inflammatory Arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician. METHODS: A multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol. RESULTS: The recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits. CONCLUSIONS: This protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring.

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Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs)...(AU)

Objetivo: Los pacientes con enfermedades terminales son propensos a la polifarmacia innecesaria. Las herramientas de desprescripción pueden contribuir a minimizar los resultados negativos. Por lo tanto, los objetivos del estudio fueron identificar instrumentos validados para la desprescripción de medicamentos inapropiados en pacientes con necesidades de cuidados paliativos y evaluar el impacto en los resultados clínicos, humanísticos y económicos. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PUBMED, EMBASE, COCHRANE y WEB OF SCIENCE (hasta mayo de 2021). Se realizó una búsqueda manual en las referencias de los artículos incluidos. La selección, elegibilidad, extracción y evaluación del riesgo de sesgo se llevaron a cabo por dos investigadores independientes. Se aceptó la inclusión de estudios observacionales y experimentales. Resultados: De los 5791 estudios recuperados, después de excluir duplicados (n = 1050), realizar la selección de títulos/resúmenes (n = 4741) y la lectura completa (n = 41), solo un estudio cumplió con los criterios de inclusión. En este estudio incluido, se realizó un ensayo controlado aleatorizado, que mostró un alto nivel de riesgo de sesgo en general. A los adultos de 75 años o más (n = 130) con esperanza de vida limitada y polifarmacia se les asignaron dos grupos [grupo de intervención (desprescripción) y grupo de control (atención habitual)]. Se realizó la desprescripción con la ayuda de la herramienta STOPPFrail. El número promedio de medicamentos inapropiados y los costos mensuales de los medicamentos fueron significativamente más bajos en el grupo de intervención. No se encontraron diferencias estadísticamente significativas en términos de presentaciones hospitalarias no programadas, caídas, fracturas, mortalidad y calidad de vida. Conclusiones: A pesar de la disponibilidad de varias herramientas para apoyar la deprescripción en pacientes con necesidades de cuidados paliativos...(AU)

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Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs)...(AU)

Objetivo: Los pacientes con enfermedades terminales son propensos a la polifarmacia innecesaria. Las herramientas de desprescripción pueden contribuir a minimizar los resultados negativos. Por lo tanto, los objetivos del estudio fueron identificar instrumentos validados para la desprescripción de medicamentos inapropiados en pacientes con necesidades de cuidados paliativos y evaluar el impacto en los resultados clínicos, humanísticos y económicos. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PUBMED, EMBASE, COCHRANE y WEB OF SCIENCE (hasta mayo de 2021). Se realizó una búsqueda manual en las referencias de los artículos incluidos. La selección, elegibilidad, extracción y evaluación del riesgo de sesgo se llevaron a cabo por dos investigadores independientes. Se aceptó la inclusión de estudios observacionales y experimentales. Resultados: De los 5791 estudios recuperados, después de excluir duplicados (n = 1050), realizar la selección de títulos/resúmenes (n = 4741) y la lectura completa (n = 41), solo un estudio cumplió con los criterios de inclusión. En este estudio incluido, se realizó un ensayo controlado aleatorizado, que mostró un alto nivel de riesgo de sesgo en general. A los adultos de 75 años o más (n = 130) con esperanza de vida limitada y polifarmacia se les asignaron dos grupos [grupo de intervención (desprescripción) y grupo de control (atención habitual)]. Se realizó la desprescripción con la ayuda de la herramienta STOPPFrail. El número promedio de medicamentos inapropiados y los costos mensuales de los medicamentos fueron significativamente más bajos en el grupo de intervención. No se encontraron diferencias estadísticamente significativas en términos de presentaciones hospitalarias no programadas, caídas, fracturas, mortalidad y calidad de vida. Conclusiones: A pesar de la disponibilidad de varias herramientas para apoyar la deprescripción en pacientes con necesidades de cuidados paliativos...(AU)

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Introducción: Durante el acto de la prescripción se deben relacionar los conocimientos de la terapéutica con los principios de la bioética para contribuir al uso racional de medicamentos. En el artículo se analiza el cumplimiento de los principios bioéticos relacionados con las prescripciones de medicamentos por los médicos generales integrales del municipio Santiago de Cuba. Métodos: Se realizó un estudio descriptivo transversal con una muestra de médicos generales integrales en el que se emplearon métodos teóricos, empíricos y matemáticos estadísticos, así como la triangulación metodológica. Se consideró como variable el cumplimiento de los principios bioéticos relacionados con las prescripciones de medicamentos y cinco indicadores que fueron valorados mediante encuesta, entrevista y observación del desempeño. Resultados: Se encontró que los médicos generales integrales alcanzaron un nivel alto de cumplimiento de los principios bioéticos relacionados con las prescripciones de medicamentos con un valor de media ponderada de 2,94. La valoración de la frecuencia de realización de los indicadores evidenció que tres de ellos fueron considerados del nivel alto, dos de nivel medio y ninguno de nivel bajo. Discusión: los resultados fueron confrontados con otros estudios y se confirma que los médicos generales integrales en Cuba por su formación humanista cumplen con la mayoría de los principios bioéticos en su desempeño profesional.

Introduction: During the act of prescription, therapeutic knowledge must be related to the principles of bioethics to contribute to the rational use of medications. The article analyzes compliance with bioethical principles related to medication prescriptions by comprehensive general practitioners of the Santiago de Cuba municipality. Methods: A cross-sectional descriptive study was carried out with a sample of comprehensive general practitioners in which theoretical, empirical and mathematical statistical methods were used, as well as methodological triangulation. Compliance with bioethical principles related to medication prescriptions and five indicators that were assessed through a survey, interview and performance observation were considered as variables. Results: It was found that comprehensive general practitioners reached a high level of compliance with bioethical principles related to medication prescriptions with a weighted mean value of 2.94. The assessment of the frequency of carrying out the indicators showed that three of them were considered high level, two medium level and none low level. Discussion: the results were compared with con studies and it is confirmed that comprehensive general practitioners in Cuba, due to their humanistic training, comply with most of the bioethical principles in their professional performance.

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INTRODUCTION: Electronic prescription is the prescription system that allows healthcare professionals to send medication prescriptions directly to community pharmacies and the outpatient unit of Hospital Pharmacy Services for dispensing. However, there is difficulty in obtaining a reliable pharmacotherapeutic history in chronic patients through electronic prescription upon hospital admission as a critical point for adequate treatment adaptation. Therefore, the pharmacist as a member of the multidisciplinary team must ensure, through medication conciliation, an adequate transition of care through the correct management of the treatment that the chronic patient requires during their hospitalization. OBJECTIVES: To evaluate the quality of electronic prescription records for routine chronic treatment by analyzing the concordance of the electronic prescription. MATERIAL AND METHODS: Observational, cross-sectional and retrospective study at the General University Hospital of Elche. Hospitalized patients in charge of the Orthopedic Surgery and Traumatology, Urology and Neurosurgery Services in which the responsible doctor requested medication reconciliation by the Pharmacy Service between January 2022 - December 2022 were included. RESULTS: 378 patients, 209 (55.3%) women and 169 (44.7%) men, with a mean age±standard deviation of 71.0±11.6 years and 69.0±11.8 years, respectively. The total percentage of patients with discrepancies in the electronic prescription with respect to the usual chronic treatment was 60.6%, reflecting that only 39.4% of the patients had non-discordant electronic prescriptions. CONCLUSIONS: More than half of hospitalized surgical patients present discrepancies in the medications prescribed in the home electronic prescription, which justifies the importance of treatment reconciliation upon admission carried out by hospital pharmacists.

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Los medicamentos son una herramienta fundamental en el tratamiento de la enfermedad y la terapéutica moderna, los que al utilizarse sobre la base de criterios científico-técnicos, permiten la obtención de importantes beneficios sanitarios representados por la prevención, diagnóstico, curación, atenuación y tratamiento de las enfermedades. Sin embargo, cuando los medicamentos se utilizan de manera inapropiada se convierten en una amenaza para la salud individual y colectiva. El presente documento aborda la prescripción y dispensación desde su esencia como un proceso racional y metódico que, basándose en los antecedentes diagnósticos pertinentes, permite la mejor elección posible de los medicamentos requeridos por el usuario

Medicines are a fundamental tool in the treatment of disease and modern therapeutics, which, when used on the basis of scientific-technical criteria, allow the achievement of important health benefits represented by prevention, diagnosis, cure, attenuation and treatment of diseases. However, when drugs are used inappropriately they become a threat to individual and collective health. The present document addresses prescription and dispensing from its essence as a rational and methodical process that, based on the relevant diagnostic background, allows the best possible choice of drugs required by the user

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OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

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OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

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El Grupo de Trabajo Avilés surgió en 2009 con el impulso del Consejo Superior de Deportes (CSD) y está formado, entre otros, por representantes de los Centros de Medicina dela Educación Física y el Deporte de todas las comunidades autónomas que cuentan con estas infraestructuras. Como objetivos de este grupo de trabajo figuran la coordinación entre estas estructuras autonómicas de la medicina del deporte, el planteamiento de soluciones comunes a las diferentes problemáticas que sufren cada uno de los centros y el ser un grupo de asesoramiento, en los diferentes ámbitos de la medicina de la educación física y el deporte, para el CSD. Este grupo de trabajo se reúne periódicamente y en su última reunión, celebrada en Miranda de Ebro (Burgos) el 2 y 3 de octubre de 2023, se acordaron una serie de conclusiones, en relación a los beneficios de la actividad física en patologías como la diabetes, el cáncer o las enfermedades neurodegenerativas, la defensa de la Prescripción de Ejercicio Físico como una actuación sanitaria de máxima prioridad, la digitalización de los centros de medicina del deporte y el uso de la inteligencia artificial y la necesidad de crear plazas de formación para especialistas. (AU)

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Resumen Desde la primera publicación de la declaración de consenso sobre pautas de ejercicio para personas con cáncer, de la asociación Ejercicio y Ciencias del Deporte - Australia (ESSA, Exercise and Sports Science Australia), ha ocurrido un crecimiento exponencial en las investigaciones que evalúan el papel del ejercicio antes, durante y después del tratamiento del cáncer. El propósito de este reporte es utilizar la evidencia científica actual, junto a la experiencia clínica y los principios de las ciencias del ejercicio, para poner al día la declaración de consenso de ESSA sobre la prescripción de ejercicio específica para el cáncer. En esta declaración de consenso se reporta un resumen de los beneficios alcanzados mediante el ejercicio luego de un diagnóstico de cáncer, así como las fortalezas y limitaciones de la evidencia acumulada. Se propone, entonces, un marco de prescripción del ejercicio para permitir la aplicación de consideraciones específicas para el cáncer en la individualización, especificidad, seguridad, factibilidad y progresión del ejercicio para toda clase de pacientes. Se ofrecen consideraciones adicionales específicas para la prescripción del ejercicio cuando hay presencia de enfermedades hematológicas, osteomusculares, sistémicas, cardiovasculares, linfáticas, gastrointestinales, genitourinarias y neurológicas y preocupaciones relacionadas con su tratamiento, así como la presencia crónica de comorbilidades. Además, se identifican y comentan temas prácticos específicos y barreras que deben tomarse en cuenta para la prescripción del ejercicio. Si bien es cierto que el ejercicio multimodal de intensidad moderada a intensa será apropiado para la mayoría, no hay una prescripción establecida ni una dosificación semanal, que se puedan considerar basadas en la evidencia, para todos los pacientes de cáncer. Es necesaria una prescripción del ejercicio dirigida específicamente a esta población, que asegure el mayor beneficio (conforme lo defina cada paciente) a corto y largo plazo, con un bajo riesgo de perjuicio.

Abstract Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment. Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA's position statement on cancer-specific exercise prescription. Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is then proposed to enable the application of cancer-specific considerations for individualisation, specificity, safety, feasibility and progression of exercise for all patients. Additional specific exercise prescription considerations are provided for the presence of haematological, musculoskeletal, systemic, cardiovascular, lymphatic, gastrointestinal, genitourinary and neurological disease- and treatment-related concerns, as well as presence of co-morbid chronic disease. Further, we also identify and discuss cancer-specific pragmatic issues and barriers requiring consideration for exercise prescription. Conclusions: While for the majority, multimodal, moderate to high intensity exercise will be appropriate, there is no set prescription and total weekly dosage that would be considered evidence-based for all cancer patients. Targeted exercise prescription, which includes the provision of behaviour change advice and support, is needed to ensure greatest benefit (as defined by the patient) in the short and longer term, with low risk of harm.

Resumo Desde a primeira publicação da declaração de consenso da Organização de Ciências do Exercício e do Esporte - Austrália ((ESSA, Exercise and Sports Science Australia) sobre diretrizes de exercícios para pessoas com câncer, tem ocorrido um crescimento exponencial nas pesquisas que avaliam o papel dos exercícios antes, durante e depois do tratamento do câncer. O objetivo deste relatório é usar as evidências científicas atuais com a experiência clínica e os princípios da ciência do exercício, para atualizar a declaração de consenso da ESSA sobre a prescrição de exercícios específica para o câncer. Esta declaração de consenso relata um resumo dos benefícios obtidos por meio de exercícios após o diagnóstico de câncer, bem como os pontos fortes e as limitações da evidência acumulada. Assim, propõe-se uma estrutura de prescrição de exercícios para permitir a aplicação de considerações específicas para o câncer na individualização, especificidade, segurança, viabilidade e progressão do exercício para todas as classes de pacientes. Considerações adicionais específicas para a prescrição de exercícios são fornecidas quando há doenças hematológicas, osteomusculares, sistêmicas, cardiovasculares, linfáticas, gastrointestinais, geniturinárias, neurológicas e preocupações relacionadas ao seu tratamento, bem como a presença crônica de comorbidades. Além disso, questões práticas específicas e barreiras à prescrição de exercícios são identificadas e discutidas. Embora seja verdade que o exercício multimodal de intensidade moderada a vigorosa seja apropriado para a maioria, não há uma prescrição definida ou dosagem semanal que possa ser considerada baseada em evidências para todos os pacientes com câncer. Há uma necessidade de prescrição de exercícios especificamente direcionada a essa população, garantindo o maior benefício (conforme definido pelo paciente individual) em curto e longo prazos, com baixo risco de danos.

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RESUMEN Las enfermedades cardiovasculares y el cáncer corresponden a la primera y segunda causa de muerte a nivel mundial, respectivamente. Comparten factores de riesgo comunes: envejecimiento, estilos de vida no saludables, entre otros; con la atenuante que los pacientes con cáncer o sobrevivientes a este, por sus tratamientos, pueden desarrollar cardiotoxici- dad. Por lo tanto, las estrategias de prevención y tratamiento en algunos de sus abordajes también son similares. Pueden considerarse enfermedades simultáneas o consecutivas, pueden coexistir en un mismo paciente, corresponde entonces un abordaje multidisciplinario, basado en evaluación del riesgo, entrenamiento físico, optimización de terapia farmacoló- gica, consejería de estilos de vida saludable, control de factores de riesgo cardiovascular, apoyo psicológico, adherencia a un estilo de vida más activo con la consecuente mejora en la capacidad cardiopulmonar y por lo tanto funcional. Este documento tiene la intención de plantear una propuesta de protocolo para la prescripción de ejercicio en paciente on- cológico o sobreviviente de cáncer para la prevención de enfermedad cardiovascular, basado en recomendaciones de los consensos internacionales.

ABSTRACT Protocol proposal for exercise prescription in cancer patients or cancer survivors for the prevention of cardiovascular disease Cardiovascular diseases and cancer correspond to the first and second causes of death worldwide. They share common risk factors: aging, unhealthy lifestyles, among others; with the attenuating circumstance that cancer patients or survivors may develop cardiotoxicity due to their treatment. Therefore, the prevention and treatment strategies in some of its approaches are also similar. Diseases can be considered simultaneous or consecutive, they can coexist in the same patient, so a multidisciplinary approach is appropriate, based on risk assessment, physical training, optimization of drug therapy, healthy lifestyle counseling, control of cardiovascular risk factors, psychological support, adherence to a more active lifestyle with the consequent improvement in cardiopulmonary and therefore functional capacity. This document intends to propose a protocol proposal for the prescription of exercise in cancer patients or cancer survivors for the prevention of cardiovascular disease, based on international consensus recommendations.

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INTRODUCCIÓN: El uso de tigeciclina ha ido en aumento en los últimos años, debido al incremento de la resistencia bacteriana y la escasez de alternativas terapéuticas. OBJETIVO: Caracterizar y evaluar las prescripciones de tigeciclina en pacientes internados en un hospital universitario, durante los años 2017 y 2018. METODOLOGÍA: Estudio observacional retrospectivo, donde se caracterizaron los pacientes, las terapias, la microbiología asociada, los desenlaces clínicos y las reacciones adversas asociadas a los tratamientos con tigeciclina. Se determinó la proporción de prescripciones apropiadas por un comité de expertos y el consumo de tigeciclina medido en DDD/100 camas-día. RESULTADOS: Se caracterizaron 89 pacientes, de los cuales 67 (75,3%) cumplieron los criterios de selección. El 53,7% de los pacientes eran hombres, con una edad promedio de 60 ± 15 años. El principal motivo de hospitalización fue quirúrgico (65,7%). El 67,1% de los tratamientos con tigeciclina se inició en una Unidad de Paciente Critico y el foco de infección predominante fue abdominal (64,3%). El 50% de las terapias con tigeciclina fueron dirigidas según la microbiología identificada. En 65,7% de los casos se usó tigeciclina como monoterapia en la dosis habitual (62,9%). Náuseas (8,6%), diarrea (7,1%) y vómitos (4,3%) fueron los efectos adversos más reportados. El 84,3% de los tratamientos se consideraron apropiados. El año 2017 se consumió 0,4 DDD/100 camas-día y 0,6 DDD/100 camas/día el 2018, siendo la UCI el servicio que presentó el mayor uso en ambos años. DISCUSIÓN: Tigeciclina fue utilizada principalmente en monoterapia para el tratamiento de infecciones intraabdominales en pacientes hospitalizados, por motivos quirúrgicos, en una unidad de paciente crítico, en las dosis habituales recomendadas de 100 mg como dosis de carga seguida de 50 mg cada 12 hs IV. En 50% de los casos, la terapia fue dirigida según microbiología. Los eventos adversos más habituales fueron los gastrointestinales. CONCLUSIÓN: La mayoría de las terapias prescritas fueron consideradas apropiadas por el comité de expertos.

BACKGROUND: The use of tigecycline has been increasing in recent years, due to increase in bacterial resistance and the scarcity of therapeutics alternatives. AIM: To characterize and evaluate the tigecycline prescriptions of patients hospitalized in a university hospital, during the years 2017 and 2018. METHODS: A retrospective observational study was carried out, where the patients, the therapies, the associated microbiology, the clinical outcomes and the adverse reactions associated with tigecycline were characterized. The proportion of appropriate prescriptions was determined by committee of experts and the consumption of tigecycline measure in DDD/100 bed-days. RESULTS: 89 patients who used tigecycline were characterized, of which 67 (75.3%) met the selection criteria. 53.7% of the patients were male, with a mean age of 60 +/- 15 years The main reason for hospitalization was surgical (65.7%). 67.1% of the treatments with tigecycline were started in a critical patient unit and the predominant focus of the infection was the abdomen (64.3%). 50% of the therapies with tigecycline were ordered according to the identified microbiology. In 65.7% of the cases, tigecyclin was used as monotherapy at the usual dose (62.9%). Nausea (8.6%), diarrhea (7.1%) and vomiting (4.3%) were the most reported adverse events. 84.3% of the treatments were considered appropriate. In 2017, 0.4 DDD/100 bed/days were consumed and 0.6 DDD/100 bed/days in 2018, with de ICU being the service that presented the highest use in both years. DISCUSSION: Tigecycline was mainly used as monotherapy for the treatment of intra-abdominal infections in patients hospitalized for surgical reasons in a critical patient unit at the usual doses of 100 mg loading followed by 50 mg every 12 hours IV. In 50% of the case the therapy was directed according to microbiology. The most common adverse events were gastrointestinal. CONCLUSION: Most of the prescribed therapies were considered appropriate by the expert committee.

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Resumo A Prescrição Social (PS) foi desenvolvida sobretudo no Reino Unido e foi reconhecida pelo Serviço Nacional de Saúde britânico como uma abordagem inovadora para apoiar a sustentabilidade do sistema de saúde. A PS tem o potencial de promover parcerias entre estruturas comunitárias, ajudando assim a ligar os sectores social e da saúde para formar um sistema local de PS. O nosso objetivo foi avaliar o desempenho de um programa de PS, examinando o impacto no desempenho cognitivo e no bem-estar emocional. Foi aplicado um questionário a uma amostra de 60 idosos não institucionalizados, com idades compreendidas entre os 66 e os 96 anos. Foram definidos dois grupos de 30 participantes: Grupo PS (que foram incluídos no programa de prescrição social) e Grupo Controlo (que não beneficiam de qualquer programa). Todos os instrumentos foram validados para a população portuguesa. O bem-estar emocional foi avaliado através da Rosenberg Self-Esteem Scale e o desempenho cognitivo foi avaliado através do Mini-Mental State Examination. Os resultados mostraram que o grupo PS tem níveis mais baixos de comprometimento cognitivo e uma pontuação média de autoestima mais elevada, mas não foram detetadas diferenças estatisticamente significativas na escala de desempenho cognitivo. Estes resultados sugerem que os programas de PS têm um impacto especial e positivo na autoestima dos idosos. Esta evidência realça a importância de considerar estes programas como um eixo estratégico de intervenção para o envelhecimento ativo. Constatou-se a mais-valia da PS como mecanismo potenciador de benefícios associados à saúde e ao bem-estar. Futuras investigações deverão ser realizadas com acesso a uma amostra mais alargada e explorar outras variáveis dependentes.

Abstract Social Prescription (SP) has been developed mostly in the United Kingdom (UK) and has been recognised by the UK National Health Service as an innovative approach to support the sustainability of the health system. It also has the potential to promote partnerships between community structures, thereby helping to link the health and social sectors to form a local SP system. Our objective was evaluate the performance of a SP programme, examining the impact on cognitive performance and emotional well-being. A questionnaire was applied to a sample of 60 non-institutionalized older adults, aged 66-96 years. Two groups of 30 participants were defined: SP Group (that were included in the social prescription program) and Control Group (that do not benefit from any program). All the instruments were validated for the Portuguese population. Emotional well-being was assessed using the Rosenberg Self-Esteem Scale and cognitive performance was assessed using the Mini-Mental State Examination. Results showed that the SP group has lower levels of cognitive impairment and a higher average self-esteem score, but no statistically significant differences were detected in the cognitive performance scale. These results suggest that the SP programs have a special and positive impact on the self-esteem of the elderly. This evidence highlights the importance of considering these programs as a strategic intervention axis for active aging. The added value of SP as a mechanism that fosters benefits associated with health and well-being was noted. Future investigations should be conducted with access to a larger sample and explore other dependent variables.

Resumen La prescripción social (PS) se desarrolló principalmente en el Reino Unido y ha sido reconocida por el Servicio Nacional de Salud británico como un enfoque innovador para apoyar la sostenibilidad del sistema sanitario. También tiene el potencial de promover asociaciones entre estructuras comunitarias, ayudando así a vincular los sectores social y sanitario para formar un sistema local de PS. Nuestro objetivo era evaluar el rendimiento de un programa de SP examinando el impacto sobre el rendimiento cognitivo y el bienestar emocional. Se administró un cuestionario a una muestra de 60 ancianos no institucionalizados de edades comprendidas entre los 66 y los 96 años. Se definieron dos grupos de 30 participantes: Grupo PS (que fueron incluidos en el programa de prescripción social) y Grupo Control (que no se beneficiaron de ningún programa). Todos los instrumentos fueron validados para la población portuguesa. El bienestar emocional se evaluó mediante la Rosenberg Self-Esteem Scale y el rendimiento cognitivo mediante el Mini-Mental State Examination. Los resultados mostraron que el grupo PS tenía niveles más bajos de deterioro cognitivo y una puntuación media de autoestima más alta, pero no se detectaron diferencias estadísticamente significativas en la escala de rendimiento cognitivo. Estos resultados sugieren que los programas de PS tienen un impacto especial y positivo en la autoestima de las personas mayores. Esta evidencia pone de manifiesto la importancia de considerar estos programas como un eje estratégico de intervención para el envejecimiento activo. Se constató el valor añadido de la PS como mecanismo para potenciar los beneficios para la salud y el bienestar. Futuras investigaciones deberían realizarse con acceso a una muestra más amplia y explorar otras variables dependientes.

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Introducción El gradiente de sodio durante las sesiones es uno de los factores clave en el balance de este ion en los pacientes en hemodiálisis; sin embargo, hasta la aparición de los nuevos monitores con módulos de sodio, las diferencias entre el sodio prescrito y el medido han sido poco estudiadas. El objetivo del presente estudio fue comparar el impacto del cambio del monitor 5008 Cordiax al nuevo monitor 6008 Cordiax sobre los resultados de la conductividad real medida, del sodio plasmático inicial y final. Material y métodos Se incluyeron 106 pacientes en hemodiálisis. Cada paciente recibió dos sesiones de diálisis en las que solo se varió el monitor. Las variables recogidas fueron: el concentrado, sodio y bicarbonato prescritos, conductividad real, sodio plasmático inicial y final medidos por dialisancia iónica y se calculó el cambio de la concentración de sodio plasmático durante el tratamiento o delta de sodio (ΔPNa). Resultados El cambio de monitor de diálisis mostró pequeñas diferencias, aunque significativas, en el sodio plasmático inicial (138,14 mmol/L con 5008 vs. 138,81 mmol/L con 6008) y final (139,58 mmol/L vs. 140,97 mmol/L), así como en la conductividad real obtenida (13,97 vs. 14,10 mS/cm). El ΔPNa también aumento significativamente. Conclusión El cambio de monitor 5008 a 6008 se asocia a un aumento en la conductividad, un sodio plasmático más elevado y un incremento en el ΔPNa. El conocer y confirmar este cambio permitirá individualizar la prescripción de sodio, evitar posibles efectos indeseables y podría ser el estudio preliminar para explorar el nuevo biosensor de control de sodio incorporado en la nueva generación de monitores (AU)

Introduction The sodium gradient during hemodialysis sessions is one of the key factors in sodium balance in patients with dialysis-dependent chronic kidney disease; however, until the appearance of the new monitors with sodium modules, the differences between prescribed and measured sodium have been understudied. The present study aimed to compare the impact on the measured conductivity and the initial and final plasma sodium after changing the 5008 Cordiax to the new 6008 Cordiax monitor. Material and methods 106 patients on hemodialysis were included. Each patient underwent 2 dialysis sessions in which only the monitor was varied. The variables collected were dialysate, sodium and bicarbonate prescribed, real conductivity, initial and final plasma sodium measured, and the calculated sodium gradient (ΔPNa). Results The change of dialysis monitor showed small but statistically significant differences in the initial (138.14 mmol/L with 5008 vs. 138.81 mmol/L with 6008) and final plasma sodium (139.58 mmol/L vs. 140.97 mmol/L), as well as in the actual conductivity obtained (13.97 vs. 14.1 mS/cm). The ΔPNa also increased significantly. Conclusión The change from 5008 to 6008 monitor is associated with increased conductivity, leading the patient to end the sessions with higher plasma sodium and ΔPNa. Knowing and confirming this change will allow us to individualize the sodium prescription and avoid possible undesirable effects. It could be the preliminary study to explore the new sodium biosensor incorporated into the new generation of monitors (AU)

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Introducción. La prescripción social es el proceso de recomendación de activos beneficiosos para la salud y bienestar. Para ello es necesario conocer los activos de la comunidad de trabajo. El fotovoz es una técnica de investigación participativa que permite conocer una comunidad con la fotografía.Objetivos. Elaborar un fotovoz con los activos de salud de la comunidad.Métodos. Se formó a profesionales y se hizo un paseo comunitario para identificar y fotografiar activos de la comunidad. Se hizo una puesta en común de las fotografías recogidas y una selección. Se creó un fotovoz que se expuso en el centro.Resultados. Un total de 17 profesionales sanitarios hicieron 91 fotografías a activos. Se hizo una selección y se llevó a cabo una discusión, y como resultado, se creó un fotovoz con 16 activos.Conclusión. El fotovoz es un proceso participativo basado en la comunidad que permite mejorar el conocimiento que los profesionales sanitarios tienen sobre los recursos de salud disponibles en su entorno y hacer una prescripción social. (AU)

Introduction. Social prescribing is the process of recommending assets beneficial to health and well-being. To do this, it is necessary to get to know the assets of the working community. Photovoice is a participatory research technique that enables getting to know a community with photography.Objectives. Prepare a Photovoice with community health assets.Methods. Professionals were trained and a community walk was held to identify and photograph community assets. A sharing the photographs collected and made a selection. A Photovoice was created and exhibited in the centre.Results. A total of 17 healthcare professionals took 91 asset photographs. A selection was made and a discussion held. As a result a photovoice was created with 16 assets.Conclusion. PhotoVoice is a community-based participatory process that enables improving health professionals' knowledge of the health resources available in their setting and enables social prescribing. (AU)

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Objetivo: Analizar si informar la frecuencia de administración (FA) en el módulo de prescripción de la estación clínica de atención primaria (ECAP) del Institut Català de la Salut (ICS) mejora la adecuación de la FA de las prescripciones. Diseño: Estudio de adecuación antes-después con control no equivalente de prescripciones sin cambios en la FA. El periodo de estudio incluye desde el 1 de septiembre de 2019 hasta el 29 de febrero de 2020.Emplazamiento: Ámbito de atención primaria. Participantes: Se incluyen las prescripciones de los medicamentos con una única FA adecuada o mayoritariamente adecuada realizadas por los médicos de familia del ICS durante el periodo de estudio.IntervenciónRecomendar la FA adecuada en el módulo de prescripción. Mediciones principales: Adecuación definida como la coincidencia entre la FA prescrita y la FA adecuada. Resultados: Tras la intervención se produjo un aumento del 22,75% de prescripciones con FA adecuada. El mayor aumento se dio en los medicamentos del sistema genitourinario y hormonas sexuales. En términos absolutos, el grupo de antiinfecciosos es el que obtuvo más prescripciones con FA adecuada entre los dos periodos. Conclusiones: La intervención aumentó la adecuación en la FA de las prescripciones, lo que supone una mejora en la seguridad y en la eficacia de los tratamientos. Se evidencia que el diseño y la implantación de mejoras en los sistemas de prescripción electrónica contribuye a aumentar la calidad de la prescripción.(AU)

Objective: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. Design: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020.Location: Primary care setting. Participants: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included.Intervention: Recommendation of the appropriate dosing frequency in the prescription module. Main measurements: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. Results: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. Conclusions: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.(AU)

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El objetivo de este trabajo es recopilar, evaluar e interpretar las evidencias disponibles sobre la relación existente entre el grado de longitudinalidad en atención primaria (AP) y la prevalencia de polifarmacia y sus problemas asociados. Siguiendo la declaración PRISMA realizamos una revisión sistemática de la literatura en las bases de datos PubMed y Scopus. El cribado por títulos y resúmenes, y la revisión de referencias realizados de forma independiente por 2 autores detectó 16 trabajos de potencial interés. Tras la revisión independiente de todos los originales, 4 fueron descartados por no satisfacer los criterios de inclusión. Los 12 trabajos seleccionados, 9 estudios de cohortes retrospectivos y 3 estudios transversales, estudiaban la relación de la longitudinalidad en AP, medida con diversos índices cuantitativos, con la prevalencia de polifarmacia y otros problemas terapéuticos asociados, como las prescripciones inadecuadas, las duplicidades o las interacciones medicamentosas. Todos mostraban una relación significativa, frecuentemente fuerte (RR>2 o<0,5), entre los indicadores de longitudinalidad y las diversas variables dependientes. Aunque nuestro conocimiento podría mejorar mediante estudios prospectivos que evaluaran directamente la longitudinalidad y su repercusión en los problemas por exceso de medicación, con las evidencias existentes, se puede afirmar que la protección y la promoción de la longitudinalidad en la AP es un elemento clave para el control de la polifarmacia y los problemas asociados (AU)

The aim of this work was to collect, evaluate and interpret the available evidence on the relationship between continuity in primary care (i.e., longitudinality), and the prevalence of polypharmacy and its associated problems. Following the PRISMA reporting statement, we carried out a systematic review of the literature searching PubMed and Scopus databases. The screening of titles and summaries and the review of references carried out independently by two authors detected 16 works of potential interest, of which 4 were discarded after the independent review of all the originals because they did not meet inclusion criteria. The 12 papers selected studied the relationship between Longitudinality, measured with various quantitative indices, and the rate of polypharmacy or various associated problems, such as duplicate drugs, inadequate prescriptions or drug interactions. They all showed a significant relationship, often strong (RR>2 or<0.5), between longitudinality indicators and the various dependent variables. Although our knowledge could be improved by prospective studies that more directly evaluate longitudinality and its impact on problems due to excess medication, with the existing evidence, we can affirm that the protection and promotion of continuity in primary care can be a key element for the control of polypharmacy and associated problems (AU)

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