BackgroundLowering blood pressure (BP) by antihypertensive (AHT) drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to AHT medications reduces their effectiveness and increases the risk of adverse events.ObjectiveTo evaluate the effectiveness of a multifactorial adherence-based intervention in a primary care setting in lowering BP.Methods/designMulticenter parallel randomized controlled trial. Thirty two nurses in 28 primary care centers of three Spanish regions. Patients aged 18–80 years, taking AHT drugs with uncontrolled BP (n=221) were randomized to a control group (usual care) or a multifactorial adherence-based intervention including nurse-led motivational interviews, pill reminders, family support, BP self-recording, and simplification of the dosing regimen by a pharmacist.Main outcome measuresThe primary outcome was 12-month blinded measure of systolic BP (mean of three measurements). The secondary outcomes were 12-month diastolic BP and proportion of patients with adequately controlled BP.ResultsOne hundred and fourteen patients were allocated to the intervention group and 109 to the control group. At 12 months, 212 (89%) participants completed the study. The systolic BP in the intervention group was 151.3 versus 153.7 in the control group (P=0.294). The diastolic BP did not differ between groups (83.4 versus 83.6). Of the patients in the control group, 9.2% achieved BP control versus a 15.8% in the intervention group. The relative risk for achieving BP control was 1.72 (95% confidence interval: 0.83–3.56).ConclusionA multifactorial intervention based on improving adherence in patients with uncontrolled hypertension failed to find evidence of effectiveness in lowering systolic BP.Trial registrationISRCTN21229328.

According to the value-oriented shade guide, the use of LED/laser light activation was able to increase the degree of whitening of the 20% HP group, but this association was not useful for the 35% HP gel. The spectrophotometer, however, did not detect significant differences among groups.

BackgroundLowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug.Methods/DesignThe proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen.MeasurementThe primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost.DiscussionThe trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).Trial registrationCurrent controlled trials ISRCTN21229328

IntroductionThanks to advances in medicine, more diseases are being cured, but this benefit can become a problem when it causes a worsening of quality of life.ObjectivesThe objective of this paper is to analyze, regarding the following case, the convenience of treating or to limit the therapeutic effort (LTE) in psychiatric patients who are in situations at the end of life.Methods62-year-old woman begins with depressive symptoms from financial problems. In 4 months ago she makes four suicide attempts (drug overdose, cuts, self-stabbing, and precipitation), being hospitalized in ICU after latter because of multiple trauma and shock. During that time, she had a bad evolution with several complications that made LTE be evaluated. A bibliographic search was performed from different database (Pubmed, TripDatabase) about LTE and ethical implications.ResultsTrying to prolong life by disproportionate means in a patient with a poor prognosis or poor quality of life is bad practice. We must assess the severity, quality of life, capacity and preferences of the patient to decide to treat or not, thus guaranteeing the principle of beneficence. It is also important to respect the principle of autonomy, accepting patients can refuse treatment. All this is equally applicable to psychiatric patients, whom we should not stigmatize but rather evaluate their ability to decide, as in any person.ConclusionsIn conclusion, in situations of high suffering and near death, it is necessary a complete evaluation of the patient (psychiatric or not) is carried out in order to act in the most ethical way.

IntroductionWe know the coexistence of traumatic factors (loss of affective relationships, experiences of abuse, extreme risk situations, etc.) is common in psychiatric pathologies in which level of stress experienced exceeds normal capacity of the person, favoring the appearance of dissociative or excision mechanisms. A common mistake is to pathologize them and try to eliminate them.ObjectivesThe objective of this paper is to study trauma and defense mechanisms involved, in order to carry out a better approach.MethodsA bibliographic search was performed from different database (Pubmed, TripDatabase) about trauma, mechanisms involved and the construction of identity.ResultsWe know neural pathways mature asymmetrically in evolutionary development (functions related to attention, concentration and executive function having special importance) and thus, traumas occurred in moments of greatest vulnerability such as early childhood, can damage and interfere with the correct integration of neural processes, producing disproportionate and unnecessarily maintained alert responses (common basis for many pathologies such as borderline personality disorder or traumatic psychosis). In response to this, reactive mechanisms are produced (such as dissociation or cleavage) that are not necessarily pathological and therefore, we should not always intervene by eliminating them because they often function as a protective factor, allowing to preserve functioning and favoring recovery.ConclusionsIn conclusion, we need a better understanding of mechanisms involved in trauma, executive function and the alarm system beyond anxiety reactions, trying to understand the function of symptom without eliminating it, but evaluating whether there are healthier alternatives can be promoted for the complete recovery of the patient.DisclosureNo significant relationships.