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Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2227-9032/11/1/79 En este artículo de investigación también participan: Alicia Cana Poyatos, Rafael García Maset y Pilar Royo Maicas. Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.

In Spain, the 2021/22 influenza season overlapped with the sixth wave of the 2019 coronavirus disease pandemic (COVID-19). Influenza is a major public health problem associated with high morbidity and mortality. The objectives of this study were to determine the knowledge, perceptions and practices of influenza vaccination in the Spanish population, coinciding with the COVID-19 pandemic, with special attention paid to people over 65 years of age. A cross-sectional study was carried out by conducting 2211 telephone interviews. It was observed that 81.6% of people ≥ 65 years were vaccinated annually or with some frequency compared to 35.5% of those under 65 years (p < 0.001). Fifty percent of Spaniards showed an intention to be vaccinated in the 2021/22 campaign, during the SARS-CoV2 pandemic. In the case of people ≥ 65 years old, this figure was 83% compared to 42% of those under 65 years old (p < 0.001). Significant predictors of intention to be vaccinated were age of 65 years or older (OR 1.8, 95% CI 1.3–2.5), female sex (OR 1.9, 95% CI 1.5–2.4), belonging to risk groups (OR 2.2, 95% CI 1.6–3.1) and having been previously vaccinated (OR 29.7, 95% CI 22.5–39.2). The main reasons for deciding to be vaccinated were the need to be protected against the virus and to be vaccinated annually. On the other hand, lack of recommendation and considering the influenza vaccine as not necessary were the main reasons for not getting vaccinated. In addition, health personnel stood out as the main source of information (32.9%) compared to traditional media (26.9%) and public administration (12.3%). This study aimed to assess and analyse the factors influencing willingness to receive influenza vaccines in the COVID-19 era among Spanish adults, as well as the main information channels and strategies to encourage vaccination.

BACKGROUND AND AIMS Hemodialysis (HD) induces changes not just to the kidney but in other organs or systems so that patients usually report fatigue, weakness, weight loss, exhaustion, or low levels of physical activity, all present in the frail phenotype criteria. Because its association with negative health-related outcomes, frailty is considered an important issue to mitigate and manage in the hemodialysis population. However, very few studies analyzing the frail phenotype have focused on hemodialysis populations, despite the knowledge that frailty can be reversible after an early detection and treatment. On the other hand, our group has shown that nonimmersive virtual reality exercise during hemodialysis is a safe modality to improve physical function and health-related quality of life. Therefore, the aim of this study was to analyze the impact of an intradialysis nonimmersive virtual reality exercise program on the frail phenotype in a hemodialysis population. METHOD An ongoing randomized trial (ReVID study) enrolls subjects undertaking hemodialysis from June 2021 onward. All participants were assessed using the five Fried frail phenotype criteria as follow; Unintended weight loss in the past year greater than 4.5 kg, self-reported exhaustion was measured using two questions from the Center for Epidemiologic Studies Depression (CES-D) scale, weakness (hand-grip strength) was measured using a hand-grip dynamometer, slow walking speed was measured based on time to needed to cover 4.6 m at usual speed, and low physical activity was measured by using the short version of the Minnesota Leisure Time Activity questionnaire. Each of the five criteria scored as 0 (no frail-related) or 1 (frail-related). Finally, participants were stratified as follows: a score of 0/5 for robust or not frail, a score of 1–2/5 for pre-frail and a score of 3–5/5 for frail. After the frail phenotype assessment, all participants performed an intradialytic exercise program consisting of a nonimmersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min. Adherence to the exercise program was measured as a percentage (number of sessions attended/number of sessions offered). All assessments and interventions were conducted between June and September 2021 at Hospital de Manises (Valencia, Spain). RESULTS 23 subjects were included in the study (median age 70, 5 years; 11 males, 0/23 robust, 8/23 pre-frail and 15/23 frail). A chi-square value of 4329 (P = 0.05) showed a significant change in the frail phenotype of the participants after completing the exercise intervention. 17/23 of the participants ended the exercise program as pre-frail (9 participants changed from frail to pre-frail), and non-worsening in the frail phenotype of the participants was reported. The mean adherence to the exercise program throughout the study was 40%. CONCLUSION This study shows that an intradialytic exercise program consisting of a nonimmersive virtual reality video game adapted to the dialysis session can be useful to mitigate and manage frailty in the hemodialysis population.

BACKGROUND AND AIMS There is controversy over whether intradialysis exercise has an effect on the dialysis dose. Moreover, theoretical models indicate that intradialytic exercise performed at the end of session may have a beneficial effect in postdialysis rebound. Perhaps this effect of exercise at the end of dialysis can improve the dialysis dose. The aim in this study is to determine the effect of intradialysis exercise on dialysis dose, as well as its effect on dialysis dose when performed during the first two or the last two hours of dialysis session. METHOD This study is a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Intradialysis exercise consists of a video game adapted to dialysis: Treasure hunting. It is a non-immersive virtual-reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasts from 20 to 40 min. Intensity was checked through the rate of perceived exertion. Dialysis dose was measured through Kt/V single pool (Kt/V sp), urea reduction percentage (URP), KT and dialisance Kt/V (Kt/Vds) in the short period between dialysis, midweek. These was determined in two different weeks, in one week patients were at rest and in the other week patients did intradialysis exercise. The lean tissue mass (LTM) was determined by multi-frequency stereoscopic bioimpedance. This study is funding from Programa Estatal de I + D + i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017–2020 del Gobierno de España. RESULTS This is an open recruitment study, at the time of this communication 29 patients are active, 14 in Start group and 15 in End group. Age mean (SD) 74 (12) years, males 17, Charlson's Index 8.1 (2.24), time on hemodialysys treatment 55.72 (57.67) months, central venous catheter 8, HDFOL 8. A mixed analysis of repeated measures has been developed with each measure of dialysis dose as the dependent variable (Kt/Vsp, URP, KT and Kt/V ds) and independent variables: group (Start versus End), duration of exercise session and LTM. There were no differences in dialysis dose between Start and End groups. Duration of exercise session significantly increased the dialysis dose (Kt/Vsp + 0.015, P = 0.007, URP + 0.23 P = 0.01 and Kt/V ds + 0.015, P = 0.01). CONCLUSION The time of the dialysis session in which physical exercise is performed does not influence the dialysis dose. Longer duration of the intradialysis exercise session increases the dialysis dose.

BACKGROUND AND AIMS There are few follow-up studies on the composition body by bioimpedance in exercise programs in different population. It is necessary to know if the body composition measured by bioimpedance change during a intradialysis exercise program using virtual reality. The aim is to determine evolution of body composition of patients on intradialysis exercise program using virtual reality. METHOD This is a subanalysis in a clinical trial with intradialysis exercise intervention. Intradialysis exercise consists in a video game adapted to dialysis: Treasure hunting. It is a nonimmersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise lasts from 20 to 40 min. Intensity was checked through the rate of perceived exertion. The body composition is determined by multi-frequency stereoscopic bioimpedance . The study started in September 2019 (Baseline) but due to the COVID-19 pandemic it was paused for 1 year and started again in March 2021 (Restart). Body composition was determined basal, at 3th and 6th month in program. This study is funding from Programa Estatal de I + D + i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017–2020 del Gobierno de España. RESULTS This is an open recruitment study, 49 patients have been recruited as of September 2021, mean (SD) age 72 (13) years, females 18. About 17 patients dropped out (16 of them don’t return after the pandemic start). To date, 32 patients are in exercise program. Paired data analysis showed no difference in normohydrated weight, lean tissue index, or overhydration. The fat tissue index increased significantly (P 0.04) during the pause period in the first year of the pandemic. At the time of this communication, only 12 patients have completed 6 months of the program. We await the evolution of all included patients to report results at 6 months. CONCLUSION The evolution of body composition measured by bioimpedance during an intradialysis exercise program by virtual reality did not show relevant changes. Considering our results and those of previous studies, it’s possible that bioimpedance is not a very sensitive test to evaluate an intradialysis exercise program in the short to medium term. Longer and larger studies are needed.

BACKGROUND AND AIMS Haemodialysis (HD) induces changes in addition to the kidney in other organs or systems so that patients usually present symptoms such as fatigue, generalized muscle weakness and low tolerance to exercise that result in functional impairment, decreased work capacity and dependence for activities of daily living. Intra-dialysis exercise programmes may help to partly reverse this situation. Exercise during the first 2-h of dialysis has proven to be safe. Our group showed that an acute session of virtual reality exercise during the last 30 min of HD was safe too. The aim of this study was to compare the impact of non-immersive virtual reality intra-dialysis during the first 2-h versus the last 2-h of dialysis on lower-limbs muscle strength. METHOD This was a randomized controlled trial. Participants were randomized in two groups: group A performed the exercise during the first and second hour of the HD session and group B performed it during the third and fourth hour. Strength was measured bilaterally with a hand-held Lafayette dynamometer in three movements of the lower limbs (hip flexion, hip abduction and plantar flexion) during the HD session. The intradialytic exercise consisted of a non-immersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min, over a 12-week period. RESULTS A total of 33 subjects were included in the analysis, 17 subjects (median age 71.8 years; 10 men) in group A and 16 subjects (median age 73.3 years, 9 men) in group B. At baseline the period analysed, there were no significant differences between the two groups in any of the movements analysed. The force analysed in the different movements showed that there was a significant increase in all the movements analysed in both groups. There was an increase in force in the movements of the lower right limb of 3.31 N in hip flexion, 2.01 N in hip abduction and 1.10 N in plantar flexion, as well as an increase in the outside in the lower left limb of 3.82 N in hip flexion, 2.47 N in hip abduction and 4.63 N in plantar flexion. There were no significant differences in the increase in strength in the movements analysed between both groups in the movements analysed after the 12-week period analysed. CONCLUSION There are no differences in the application of an intradialytic exercise at the beginning versus at the end of the HD session to improve strength with non-immersive virtual reality. An intradialytic exercise with non-immersive virtual reality improves limb strength in HD patients.

Background: The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives: A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods: Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value < 0.05). Finally, the results were discussed in a deliberative process (phase C). Results: Thirty-one criteria were initially defined (phase A) and grouped into 5 categories: efficacy/effectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value < 0.001), percentage of patients with an improvement of ≥ 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions: From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability.

Multi-criteria decision analysis (MCDA) was proposed to surmount arbitrary clinical decisions in the field of biological therapies for psoriatic patients. At the same time, MCDA may further highlight the potential of bimekizumab for the treatment of moderate-to-severe psoriasis, compared to placebo, adalimumab, ustekinumab, secukinumab, and even ixekizumab and risankizumab. The EVIDEM framework was adapted to reflect relevant criteria for the assessment. Estimated values were obtained by means of an additive linear model combining weights and scores assigned by a multidisciplinary committee of 12 experts. Consistency and replicability were evaluated through an alternative weighting method and a re-test. Bimekizumab was assessed by the committee as an intervention with a positive value contribution for the treatment of moderate-to-severe psoriasis in comparison to any of the alternatives. The drug provides a substantial therapeutical benefits and improves the health results reported by the patients, as it combines a higher level of clearance, rapidity, and persistence with a similar safety and tolerability profile. Under a methodology with increasing use in the health field, bimekizumab was evaluated as a drug with a high added value for the treatment of moderate-to-severe psoriasis when compared to six different alternatives.

Background Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. Materials and methods Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. Results The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests − 330 (95% CI:[− 533, − 126];p = 0.003), outpatient visits − 351 ([− 566, − 135];p = 0.003), and radiology tests − 111 ([− 209, − 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. Conclusion The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Background Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients. Methods A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors. Results By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (−1.7 s), OLST (7.1 s), STS-10 (−5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study. Conclusion An intradialytic non-immersive VR exercise programme improves patient physical function.

Background and Aims It is recommended intradialysis exercise implementation in the first part of the HD session to avoid hemodynamic instability or cramping, but the time restriction to exercise worsens clinical feasibility of exercise as a routine. Exercise using non-immersive virtual reality is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on hemodynamic control. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), episodes of hypotension and episodes of clinical instability are monitored throughout the session. The intervention has already begun and will continue for twelve months. The control analysis is performed during the three months at rest prior to starting the intervention (Rest) and then the intervention begins, every three months. Now we present the results at thirth month with exercise (Exercise) . An mixed ANOVA of repeated measures is used to assess the effect of the intervention. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. The mean baseline (SD) was Body Mass Index 26.2 (5.5) kg/m2, Overhydration 2.1 (1.3) liters, Kt/V was 1.65 (SD 0.21), Serum Albumin 3.84 (0.29) mg/dl and Hemoglobin 11.81(1.27) g/dl . Analysis by time Rest versus Exercise showed as mean (SD): HR 64 (8) vs 64 (7) bpm, SBP 143 (18) vs 141 (18) mmHg and DBP 61 (10) vs 60 (11) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Rest vs Exercise were HR – 1.34 (5.7) vs -0.9 (5.9) bpm, SBP 1.2 (12) vs 2.65 (16) mmHg and DBP 2.65 (5.8) vs 1.09 (7.1) mmHg, no significant differences. Analysis by groups Start versus End showed as means (CI95%): HR 66 (62,69) vs 63 (59,67) bpm, SBP 145 (136,154) vs 136 (126,146) mmHg and DBP 63 (58,68) vs 56 (50,62) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Start group vs End group neither showed significant differences. There were no differences between the groups regarding episodes of hypotension or clinical instability. Conclusion Performing intradialysis with virtual reality is well tolerated at any time during the session. This result improves the opportunities to implement exercise in hemodialysis.

Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group–time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.

Background and Aims Exercise using non-immersive virtual reality (VR) is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. There is controversy about the effect of intradialysis exercise on the dialysis dose. Furthermore, theoretical models also indicate that intradialytic exercise at the end of session may be beneficial in postdialysis rebound. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on postdialysis rebound and dialysis dose. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Dialysis dose was measured through the monocompartimental Kt/V, and the potassium, urea, phosphorus and creatinine rebound was calculated after both baseline and exercise sessions at 17 weeks. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive VR game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. An mixed ANOVA of repeated measures was used to assess the effect of the intervention. Patients exercised for 17 weeks. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. There were no significant differences in rebound urea, creatinine, potassium and phosphorus 30 minutes after finishing dialysis. The mean baseline Kt/V was 1.65 (SD 0.21) and with exercise 1.75 (SD 0.25). The mixed ANOVA analysis showed a significant time effect with an increase in Kt/V (mean 0.10, 95% CI 0.02-0.19, p 0.018) from exercise session vs baseline. No group per time significant interaction was found, so that there was no difference in the dialysis dose between Start and End group. Conclusion Intra-dialysis exercise with virtual reality can improve the dose of dialysis, no matter the timing of the exercise is performed.

Este artículo se encuentra disponible en la siguiente URL: https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0243917 The aim of the present clinical trial is to evaluate the effectiveness of neuromuscular versus classical strength-resistance training as part of a cardiac rehabilitation programme in patients following acute coronary syndrome. The study is designed as a double-blinded, randomised, and controlled clinical trial. Thirty participants suffering from acute coronary syndrome who meet our inclusion criteria will be recruited by a private tertiary hospital. The intervention group will follow 20 sessions of a cardiac rehabilitation programme divided into two parts: aerobic training and neuromuscular strength-resistance training. The control group will complete the same aerobic training as well as a classical strength-resistance training workout programme. The primary outcome of the study will be the mean difference in change from baseline in the Incremental Shuttle Walking Test. The secondary outcomes will be the cardiorespiratory fitness of the patients (assessed by means of the Chester Step Test), lower-limb performance (assessed with the 30-Second Chair Stand Test and Single- Leg Squat Test), lower-limb strength (hip flexor handheld dynamometry), sexual dysfunction assessment (Sex Health Inventory for Men) and quality of life (EQ-5D-5L). This work will provide evidence for the effectiveness of a neuromuscular versus a classic strength-training programme in terms of cardiorespiratory fitness, lower-limb performance capacities and quality of life, in cardiac patients. The data obtained could lead to more effective and functional workouts which, in turn, may enhance the speed at which these patients can return to their everyday activities of life and improve the efficiency of their movement patterns and heart responses. Furthermore, patients may find neuromuscular workout routines more motivating and engaging, thus encouraging them to adopt healthier lifestyle patterns.

Sin financiación 4.531 JCR (2019) Q1, 6/24 Transplantation 1.857 SJR (2019) Q1, 6/70 Nephrology No data IDR 2019 UEV

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients (≥0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.

Fundamento y objetivo Los problemas relacionados con los medicamentos (PRM) son problemas de salud que se producen como consecuencia de fallos de la farmacoterapia del paciente y que interfieren con los resultados esperados de salud. El objetivo de este trabajo es conocer los problemas de salud mas frecuentes que constituyen PRM. Pacientes y metodo La entrevista con el paciente junto con la evaluacion de la historia clinica son las principales fuentes de informacion para evaluar e identificar PRM. Se utilizo un cuestionario validado como instrumento para la entrevista y la CIE-9 para la clasificacion de los problemas de salud encontrados. Resultados Se entrevisto a un total de 2.556 pacientes durante 1 ano en el servicio de urgencies hospitalario, de los que se estudiaron 2.261 tras las exclusiones. Las enfermedades osteoarticulares, los signos y sintomas mal definidos y las lesiones y envenenamientos son los problemas mas relacionados con la aparicion de PRM. Los PRM de necesidad y efectividad mantienen un perfil similar. Los PRM de seguridad se asociaron mas a signos y sintomas mal definidos y lesiones y envenenamientos asi como a alteraciones nerviosas, digestivas y sanguineas. Conclusiones Los PRM mas frecuentes que son causa de consulta en un servicio de urgencies hospitalario son los osteoarticulares, seguidos de los signos y sintomas mal definidos. Se observan diferencias en los diagnosticos entre las distintas dimensiones de PRM y sus tipos.

Background Determining the relative and absolute reliability of outcomes of physical performance tests for people undergoing hemodialysis is necessary to discriminate between the true effects of exercise interventions and the inherent variability of this cohort. Objective The aims of this study were to assess the relative reliability of sit-to-stand-to-sit tests (the STS-10, which measures the time [in seconds] required to complete 10 full stands from a sitting position, and the STS-60, which measures the number of repetitions achieved in 60 seconds), the Six-Minute Walk Test (6MWT), the one-leg heel-rise test, and the handgrip strength test and to calculate minimal detectable change (MDC) scores in people undergoing hemodialysis. Design This study was a prospective, nonexperimental investigation. Methods Thirty-nine people undergoing hemodialysis at 2 clinics in Spain were contacted. Study participants performed the STS-10 (n=37), the STS-60 (n=37), and the 6MWT (n=36). At one of the settings, the participants also performed the one-leg heel-rise test (n=21) and the handgrip strength test (n=12) on both the right and the left sides. Participants attended 2 testing sessions 1 to 2 weeks apart. Results High intraclass correlation coefficients (≥.88) were found for all tests, suggesting good relative reliability. The MDC scores at 90% confidence intervals were as follows: 8.4 seconds for the STS-10, 4 repetitions for the STS-60, 66.3 m for the 6MWT, 3.4 kg for handgrip strength (force-generating capacity), 3.7 repetitions for the one-leg heel-rise test with the right leg, and 5.2 repetitions for the one-leg heel-rise test with the left leg. Limitations A limited sample of patients was used in this study. Conclusions The STS-16, STS-60, 6MWT, one-leg heel rise test, and handgrip strength test are reliable outcome measures. The MDC scores at 90% confidence intervals for these tests will help to determine whether a change is due to error or to an intervention.

To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance.We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result.43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant.Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization.

Medication-related problems (MRPs) are health problems resulting from patient pharmacotherapy failure that interfere with the expected outcome in the patient's health status. The aim of this study was to discover the health problems associated with the appearance of MRPs.Patient interviews, together with the assessment of medical records were the sources of information used in the assessment and identification of MRPs. A validated questionnaire was used for the interviews; in order to classify the health problems found, the ICD-9 was used.2,556 patients were interviewed over a period of one year at a hospital emergency department. 2,261 of these cases were valid. Osteoarticular diseases, poorly defined signs and symptoms of illness, injuries and intoxications were the disorders most commonly associated with the appearance of MRPs. MRPs of necessity and effectiveness had a similar profile. MRPs of safety were more commonly associated with poorly defined signs and symptoms of illness, injuries and intoxications, as well as nervous, digestive and blood problems.Most frequent medication related health problems causing visits to hospital emergency departments were osteoarticular disorders, followed by poorly defined signs and symptoms of illness. Differences were observed in the diagnoses between the different dimensions and types of MRP.

Rapidly occurring changes within the health care systems are creating an opportunity to re-orient the relationships between their different sectors. In order to know the locus of responsibility for various types of preventive activities, we undertook an inquiry on eight areas in six countries from Europe and North America.An inquiry among experts based on a matrix which arrayed the type of preventive health services against the target population. Eight clinical conditions were identified (childhood immunizations; adult influenza vaccination; mammography screening, tuberculosis screening, hypertension screening. PKU screening, HIV screening, and osteoporosis testing) trying to know their target population and the locus of responsibility for setting of policy, level to contact individuals for testing, follow-up of people with abnormal tests and maintenance of their medical records.This pilot study showed very little results coincidence either within the eight surveyed areas or across them. There was no regular pattern for the preventive activities studied among the different countries, neither according to the type of health system, nor to the primary health care orientation of the different systems.There was a limited consensus in the activities studied concerning the best mode of doing public health interventions for personal health services.

ResumenLas páginas siguientes pretenden identificar organización y gestión de la atención primaria necesarios para desarrollar una estrategia de marketing social, consistente y viable. Algunos elementos claves que han de modificarse son: 1. Esquemas administrativos y de gestión centralizados y rigidos. Presupuestos retrospectivos. 2. Estructura de incentivos centralizada y disociada de la cadena de mando. 3. Unidades de dirección y gestión en atención primaria, inmersas en el conflicto político. 4. Carencia de márgenes de elección del usuario. 5. Inexistencia de una estrategia de marketing interno.Se discuten distintas formas de simular mercados como instrumentos para la eficiencia, asi como elementos necesarios del «cambio interno», tales como la modificación del marco jurd ico del In-salud, SAS, etc. en una dirección desreguladora. De todos «los cambios internos» esbozados, tres se consideran esenciales: a) Sistemas de retribución en atención primaria, b) Modificación del marco laboral, c) La reforma del proceso presupuestario. Se proponen estrategias concretas en cada una de estas áreas enfatizando su indispensable interdependencia y congruencia entre si.SummaryThe article desired organizational an managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy.Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less normativist system in the spanish national and regional health services in reviewed too. Three changes are considered essential:a) Payment systems in Primary Health Care, b) Modifications in the personnel contracts, c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence.