Rosendo Bugarín González

UTILIZACIÓN DE LOS INHIBIDORES DE LA ACETILCOLINESTERASA Y LA MEMANTINA PARA EL TRATAMIENTO CLÍNICO DE LA DEMENCIA TIPO ALZHEIMER

BACKGROUND: The therapeutic options to treat Alzheimer-type dementia (ATD) in recent years, have made it increasingly necessary to become familiar with the employment pattern of these new medicinal products. METHODS: A cross-sectional observational study of the population with ATD treated with acetylcholinesterase inhibitors and/or memantine in the Gallician Health Service. Databases were compiled with the demographic variables and use data during April 2005 of the medicinal products studied. RESULTS: Of the 5110 patients with ATD, 70.47% were women. The mean age of the women was 80.12 and of the men was 78.61 years old, with standard deviations of 6.66 and 7.03, respectively. The female sex was one of the factors associated with presenting ATD to pharmacological treatment (OR: 1.932 [CI 95%: 1.819-2.052]). The medication used most was donepezyl (44.46% of patients). Significant differences were found in that memantine was used to treat more patients in the group of patients 64 years [p or =95 years (75% in > or =95 years vs. 46.9% in <95 years [p < 0.03]). No significant differences were observed in the use of anti-dementia therapy, expressed in DDD/patient/day between the sexes, age groups, or in the age groups separated according to sex. CONCLUSIONS: The use of memantine (in monotherapy or in combination) is more frequent in patients under 64 years old. Female sex was found to be a factor associated with presenting ATD to pharmacological treatment.Fundamento: En los ultimos anos han aumentado las alternativas terapeuticas en el tratamiento de la demencia tipo Alzheimer (DTA), por lo que se hace necesario conocer el patron de utilizacion de estos nuevos medicamentos. Metodos: Estudio observacional transversal de la poblacion con DTA tratada con inhibidores de la acetilcolinesterasa y/o memantina en el Servicio Gallego de Salud. Se construyeron bases de datos con las variables demograficas y datos de utilizacion durante abril de 2005 de los referidos medicamentos. Resultados: De 5.110 pacientes con DTA, el 70,47% eran mujeres. La edad media de estas fue de 80,12 y de 78,61 en los hombres, con desviaciones tipicas de 6,66 y 7,03 respectivamente. El sexo femenino se mostro como un factor asociado a presentar DTA a tratamiento farmacologico (OR: 1,932 [IC 95%:1,819-2,052]). El medicamento mas utilizado fue donepezilo (44,46% de los pacientes). Se hallaron diferencias significativas en el porcentaje de pacientes con memantina a favor de los pacientes≤ 64 anos (19,7% en ≤64 anos vs. 14% en >64 anos[p<0,05]), y de donepezilo a favor de los pacientes ≥ 95 anos (75% en ≥ 95 anos vs. 46,9% en ≥ 95 anos [p<0,03]). No se observaron diferencias significativas en la utilizacion de la terapeutica antidemencia, expresada en DDD/paciente/dia entre sexos, grupos de edad, ni en la desagregacion de los grupos de edad por sexos. Conclusiones: La utilizacion de memantina (en monoterapia o en combinacion) es mas frecuente en menores de 64 anos. El sexo femenino se mostro como un factor asociado a presentar DTA a tratamiento farmacologico.BACKGROUND: The therapeutic options to treat Alzheimer-type dementia (ATD) in recent years, have made it increasingly necessary to become familiar with the employment pattern of these new medicinal products. METHODS: A cross-sectional observational study of the population with ATD treated with acetylcholinesterase inhibitors and/or memantine in the Gallician Health Service. Databases were compiled with the demographic variables and use data during April 2005 of the medicinal products studied. RESULTS: Of the 5110 patients with ATD, 70.47% were women. The mean age of the women was 80.12 and of the men was 78.61 years old, with standard deviations of 6.66 and 7.03, respectively. The female sex was one of the factors associated with presenting ATD to pharmacological treatment (OR: 1.932 [CI 95%: 1.819-2.052]). The medication used most was donepezyl (44.46% of patients). Significant differences were found in that memantine was used to treat more patients in the group of patients 64 years [p or =95 years (75% in > or =95 years vs. 46.9% in <95 years [p < 0.03]). No significant differences were observed in the use of anti-dementia therapy, expressed in DDD/patient/day between the sexes, age groups, or in the age groups separated according to sex. CONCLUSIONS: The use of memantine (in monotherapy or in combination) is more frequent in patients under 64 years old. Female sex was found to be a factor associated with presenting ATD to pharmacological treatment.

Hipercolesterolemia familiar heterocigota: estudio de utilización de estatinas en condiciones de práctica clínica

Objetivo Comparar el perfil de utilizacion de las estatinas en pacientes con hipercolesterolemia familiar heterocigota (HFH) frente al del resto de la poblacion tratada con estatinas. Diseno Estudio observacional, retrospectivo. Emplazamiento Servicio Gallego de Salud. Participantes Pacientes Mediciones principales Variables en los pacientes HFH: numero de casos, edad, sexo, estatinas utilizadas y dosis diaria definida consumida por paciente y dia (DDD/paciente/dia). Variables en el resto de la poblacion tratada con estatinas: numero de pacientes, estatinas utilizadas y DDD/paciente/dia. Resultados De 331 pacientes Conclusion En la HFH, la DDD/paciente/dia de estatinas duplica la del resto de poblacion tratada con estatinas. El diferente patron de utilizacion de la atorvastatina en la HFH es la principal causa de estos resultados.

A segurança do paciente, qualidade do atendimento e ética dos sistemas de saúde

The “To err is human: building a safer health system” report from the United States Institute of Medicine in 1999 concluded that skilled care activity was not infallible and was likely to cause adverse events. From the early years of the twenty-first century developed countries have focused their interest on citizens in order to reduce the damage of health care systems. All modernization strategies will aim to improve the quality of care. In this context, patient safety is a key component of quality of care. In 2003 the Hastings Center published the report “Promoting patient safety: an ethical basis for policy deliberation”, which provides an ethical reflection on the moral obligations underlying the safety culture developed following the publication of the report To err is human.