Revista Medica Clinica Las Condes最新文献

Frailty is a multidimensional state characterized by a decrease in physiological reserves and resistance to stressors. Its physical dimension is highly recognized and increases vulnerability for developing greater dependency and/or death. Patients with chronic respiratory diseases have a higher risk of developing frailty and among the risk factors are comorbidities, smoking, low levels of physical activity, exacerbations of their underlying pathology, recurrent hospitalizations, poor nutrition and polypharmacy. Frailty is a dynamic and modifiable process. Timely referral to pulmonary rehabilitation programs is one of the different treatments available. The present article describes fragility in chronic respiratory disease patients, and offers tools to evaluate and modify it.

Introduction

Cytostatic drugs are classified as potentially dangerous to health when handled. Methotrexate is a cytostatic and immunosuppressive drug increasingly used in primary care for the treatment of various rheumatological and dermatological problems. Therefore, those workers, such as nurses, who may be exposed to these risks, as a consequence of their professional work must be observed.

Objectives

Describe the management and exposure of methotrexate in the primary care nursing team of Orihuela Health Department, Spain.

Methodology

It corresponds to a descriptive observational study, carried out in the period from April 1 to 25, 2023. An observation guide was applied during a direct visit with nursing and following the recommendations of the current protocols for the management and exposure to cytostatics. Sampling was non-probabilistic for convenience. The sample size was calculated based on the nursing staff by estimating a proportion considering 7 health care areas and 31 auxiliary offices. As an inclusion criterion, a minimum of one year's experience in the administration of medication in the units under study was taken into account.

Results

Of a total of 124 nurses who provide services in primary care at the Orihuela Health Department, a total of 66 nurses participated. The mean age was 37.34 (SD 12.66). Two groups of nurses were created according to basic health zones with inhabitants of more than 25,000 or less than 25,000. It was considered that the Health Planning of the Territory in the autonomous communities of the Information System defined by Royal Decree 137/1984 of 22, on basic health structures for the improvement of Primary Care. In the observation guide, the lowest values were obtained in the evaluation/information of the patient regarding the management and exposure of methotrexate in the nurses. All nurses in both groups successfully applied the 5 rights of medication administration (route, dose, time, patient, and medication) for the safe management of methotrexate.

Conclusion

The results obtained in our research highlight the need to describe the management and exposure of methotrexate in the nursing team and the relevance of seeking methods to improve knowledge and skills. In this sense, this study could, through the observation guide used, improve the management and exposure to methotrexate in the primary care nursing team and avoid unnecessary risks that can have serious consequences for nurses and patients.

Background

A regular circadian rest-activity pattern is essential for optimal health. Any disruption or irregularity can lead to alterations in circadian rhythms, which in turn can trigger cardiometabolic illnesses. This review presents an approach to the literature on the circadian rest-activity pattern and its association with cardiometabolic illnesses.

Method

Narrative review.

Results

Circadian rest-activity pattern alterations, such as lower stability, reduced robustness, and higher fragmentation of circadian rest-activity rhythms, may be detrimental to human health. Furthermore, objective methods such as wrist actigraphy, questionnaires, and sleep diaries, as well as “dim light melatonin onset” (DLMO), have been proposed as feasible methods to assess the circadian rest-activity pattern.

Conclusion

In medical practice, it is crucial to view the circadian rest-activity pattern as a clinical biomarker related to human health. Additionally, alterations in the circadian rest-activity pattern have been linked to cardiometabolic illnesses.

Respiratory illnesses are an important cause of morbidity and mortality. Lung cancer is the leading cause of cancer and the leading cause of cancer mortality. Worldwide, chronic obstructive pulmonary disease (COPD) is the third leading cause of death, after cardiovascular and neoplastic diseases. Fibrosing interstitial lung disease has maintained a progressive increase in incidence, with high mortality. This is how respiratory palliative care has acquired relevance in this area of medicine, improving not only quality of life, but also, as is the case with lung cancer, survival. The aim of this article is to demonstrate the need for respiratory palliative care in cancer and non-cancer lung disease, allowing for an earlier and more timely referral for our patients.

Introduction

The study of communicative cognitive functions in children has been a focus of interest over the decades, aiming to explain the intricate relationships between language and executive functions (EF).

Objective

To historically reconstruct the relationship between developmental language disorder (DLD) and executive functions (EF).

Method

A narrative review was conducted of articles addressing the association between executive functions and developmental language disorder/specific language impairment. The search was performed in the databases of the “American Speech-Language-Hearing Association” and “PubMed” using the following syntax: (((executive function) AND (developmental language disorder)) OR (executive function)) AND (specific language impairment), without considering publication year restrictions.

Conclusions

The convergence of evidence over the decades and the contemporary focus on EF provide a more comprehensive view of the relationship between DLD and executive skills. These conclusions not only enrich the understanding of the underlying processes of DLD but also have crucial implications for clinical practice.

Prostate cancer (PCa) is the most frequent cancer in men in Chile and ranks fourth with regards to mortality according to the latest Globocan 2022 statistics. The aim of this review is to clarify what methods exist for preventing PCa, as well as updating screening recommendations based on the latest available evidence. Numerous risk factors have been described for PCa, including non-modifiable factors such as age, race, and family history. In this context, PCa screening becomes more relevant. Despite certain controversy regarding the usefulness of prostate-specific antigen (PSA), screening has shown that it increases the diagnosis of PCa in early stages, reducing mortality by up to 30%. The object of this review is to comment on the known risk factors for PCa and the usefulness of PCa screening, considering the use of new tools such as magnetic resonance imaging in the diagnosis of the disease.

Gallbladder cancer is a very rare disease in Europe and North America, reason why there is scarce scientific research about it. At the same time, it is very common throughout the Andean region of South America, especially in Chile which once had the highest incidence and mortality rates in the world. Women account for 75% of patients, with cases being strongly related to long standing cholelithiasis, as well as chronic infection. Gallbladder cancer rarely exists without cholelitiasis. It is also closely associated with obesity and a diet high in fat and sugar. It is more common in some native populations, especially the Mapuche population, frequently associated with a low socioeconomic level and less access to the health system. In Chile, the mortality rate decreased by more than 50% in the last 20 years. Prophylactic cholecystectomy in high-risk population, implemented as a national policy in Chile, is reducing incidence and mortality from this disease which, for a long time, was the leading cause of death by cancer in Chilean women. The objective of this article is to outline the epidemiological history of gallbladder cancer in the world and in Chile as well as describe the risk factors and measures for its prevention.

Worldwide, lung cancer is the first cancer in incidence and mortality. The most common histological type is non-small cell lung cancer (NSCLC). At an early stage, resection is the standard curative treatment, but relapse is high, which could be explained by micrometastatic disease. Adjuvant and neoadjuvant chemotherapy have little benefit in disease-free survival and overall survival, which is why new strategies have been studied. Immune checkpoint inhibitors (ICI) act by increasing the surveillance of the immune system. They have been used for years in advanced stage NSCLC, however, new schemes in earlier stages, be it as adjuvant therapy, neoadjuvant therapy or both, have demonstrated an important benefit in the endpoints studied. This review aims to describe the biologic rationale of ICIs in early-stage NSCLC and discuss the selected trials and endpoints.