ObjectivesTo assess the prescription of benzodiazepines (BZD) in elderly patients, and to explore any gender differences.MethodsSix hundred and fifty-four patients (≥ 65) admitted in an emergency service of a general hospital due to a fall. BZD use information was collected (dose, half-life profile).ResultsBZD are significantly more prescribed to women (47.6%) than men (36.1%) (X2 = 8.097, P = 0.004). We conducted a logistic regression analysis using as dependent variable taking or not BZD and sex as the independent one, covariating the model by age. We noted that sex remains significant despite enter the age variable in the model (OR = 1.5, P = 0.013). A total of 21.6% of patients consumed intermediate or long half-life BZDs, appearing a greater tendency to prescribe such BZD to women (X2 = 3.606, P = 0.058). In the 58.0% of prescriptions, prescribed dose was higher than the recommended for the elderly. The percentage is significantly higher for men (70.0%) than women (53.1%). Furthermore, a total of 54 prescriptions (15.8%) were even higher than the recommended adult dose, with no significant differences between men and women.ConclusionsWe found evidence of a higher prescription of BZD in women independently of age. Despite not being recommended, prescription of intermediate or long half-life BZD continues, in a slightly higher manner in women. BZD are prescribed above the recommended dose for elderly in a large number of patients, especially in men. A considerable proportion of elderly patients (15.8%) consume BZD doses even higher than the recommended for adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Background Pancreatic cancer is one of the most deadly forms of cancer. Standard treatment in metastatic disease is the quemotherapy with gemcitabine, but there is not a standard therapy for gemcitabine-refractory patients. Purpose Assess the off-label efficacy of nab-paclitaxel, in patients who progressed on gemcitabine-based therapy, in our hospital. Materials and Methods Observational retrospective study of pancreatic cancer patients treated with nab-paclitaxel who progressed on gemcitabine-based therapy from June 2011 to April 2012. Data were collected from clinical history, Oncofarm® and Omega3MIL® programmes. We determined: Progression free survival (PFS) and Overall Survival (OS). 12 patients (100% male) were treated with nab-paclitaxel. Eleven of them presented metastatic desease. The patients were treated with two therapies: nab-paclitaxel 100 mg/m2 (1.8,15/28d). 5 patients received this treatment. Median age was 79.4 years (sd = 4.2 years) Gemcitabine 1000 mg/m2 plus nab-paclitaxel 100 mg/m2 (1.8,15/28d): 7 patients received this treatment; Median age was 65.5 years (sd = 6.9 years). Results Median PFS was 2,8 months (95% CI, 1.5 to 4.1 months) with single agent, and 5.3 months (95% CI, 4.0 to 6.5 months) with gemcitabine plus nab-paclitaxel. The PFS in the study was 20% and 83% respectively. The OS couldn’t be determine in the nab-paclitaxel group, because there wasn’t any event during the study period. The OS with gemcitabine plus nab-paclitaxel was 66.7%. Conclusions It showed better clinical outcomes in the gemcitabine plus nab-paclitaxel group in PFS. The nab-paclitaxel can be an effective second-line chemotherapy in gemcitabine resistant patients. No conflict of interest.
Background Vinflunine is a vinca alkaloid indicated as monotherapy for the treatment of patients with advanced or metastatic carcinoma transitional cell urothelial tract after failure of prior treatment that included platinum compounds. Purpose To analyse the use of vinflunine in a 600-bed hospital. Materials and methods Retrospective study of patients treated with vinflunine from February 2010 to April 2011. Data were collected from Oncofarm ® software, medical records of patients and dispensing program to outpatients. Results The authors studied 6 patients: 5 men and 1 woman, mean age: 67 (52-80) years. 4 had distant metastases (M1) at diagnosis and 2 showed no metastasis (M0). As first lines: 2 patients received carboplatin-gemcitabine scheme, with an average of 7 cycles; 2 received carboplatin-gemcitabine with an average of 7 cycles; 1 received 2 cycles of carboplatin-gemcitabine, followed by 4 cycles Gemcitabine; 1 received 5 cycles of cisplatin-gemcitabine, followed by 2 cycles of carboplatin-gemcitabine and 3 cycles of gemcitabine alone. As a second line: 3 patients received Vinflunine an average of 4 cycles; 2 received paclitaxel with an average of 4 cycles, and 1 received 8 cycles of cisplatin-gemcitabine. As a third-line: 2 patients received Vinflunine with an average of 5 cycles and 1 received 3 cycles of paclitaxel, following by a 4th line with 1 cycle of vinflunine. The use of vinflunine regimen in 2 patients was due to progression of liver carcinoma, in 2 to cerebral progression, in 1 to lung and bone progression, and progression in 1 to lung, liver and pelvic node. No patient received other subsequent treatment lines, 3 died of disease progression, 1 is currently being treated with vinflunine and 2 with symptomatic treatment. Conclusions Vinflunine was used in all cases correctly according to its indication, and may be an alternative for patients with advanced transitional cell urothelial tract carcinoma.
Background Glutamine is the most abundant amino acid (AA) in the human body. It is classified as a non-essential AA, however in some situations may become essential and it is needed an exogenous supplementation. Glutamine plasma levels decrease in stress situations which is associated with alterations in protein turnover, intestinal barrier and immune function. Glutamine may be beneficial to critical ill patients due to it is associated with a decrease in infectious complications, decrease in hospital length of stay, and possibly a decrease in mortality. Dose recommended glutamine supplementation in PN is 0.35 g/Kg/d, no longer than nine consecutive days. Purpose Assesment of the use of glutamine-supplemented parenteral nutrition (PN) according to last ESPEN and ASPEN recommendations. Materials and methods Retrospective, observational study of patients with PN support from January to March 2011. Data were collected from the PN software Multicomp 2006®: age, gender, ward, milligrams of glutamine and duration of PN support. Results 192 patients received PN support (117 males, 75 females), 43 were prescribed glutamine-supplemented. The average age was 65 years. The allocation of patients by services was: ICU (34), surgery (7), Oncology (1), Gastroenterology (1). The prescription of the PN in this cases was: 23 postsurgical, 11 intestine diseases, 6 sepsis, 1 head injury, 1 posttraumatic and 1 pneumonia influenza A. Doses of glutamine were on average 13.2 total grams (range: 10-30g). Only 8 of the 43 patients received glutamine supplemented with an appropriate amount to fulfil the guidelines recommendations. Glutamine supplementation was 9.8 days (range 2-42). Conclusions The diagnoses included in our study 97% met the guidelines recommendations. Only 18% of patients received a correct dose of glutamine (0.35g/kg/day). Glutamine supplementation was longer than the recommendation in a 23% of patients. Glutamine supplementation to critically ill patients has been attempted to improve patient outcome, but data remain inconclusive.
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