S. García Rodicio

Hospital Universitario "Rio Hortega", Valladolid, Castille and León, Spain

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Publications (8)2.21 Total impact


  • No preview · Article · Jan 2010 · Revista Española de Geriatría y Gerontología

  • No preview · Article · Sep 2009 · Revista Española de Geriatría y Gerontología
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    ABSTRACT: To present a protocol based on renal dosage adjustment developed to reduce the risk of adverse events in elderly people institutionalized in a geriatric centre and to determine the degree of adaptation to this protocol. First, we designed a renal adjustment protocol to identify residents with creatinine clearance below 60ml/min, review drug therapy and optimize dosage regimens, if necessary. Then, we evaluated the feasibility of this protocol and adaptation of clinical practice to this protocol through a cross-sectional study of all the residents in the centre. Among the 163 residents assessed by Cockroft-Gault, there were 126 residents with creatinine clearance below 60ml/min (77%; 95% CI, 70-83). Seventeen residents were excluded due to intake of protein supplements or to extreme body mass index. Once the treatments were reviewed, 152/876 (17%; 95% CI, 15-20) prescriptions suitable for renal adjustment were found. In 135/152 prescriptions (89%; 95% CI, 83-93) the dosage was appropriate to creatinine clearance and 17 (11%; 95% CI, 6-17) were considered as potentially optimizable. For these 17 prescriptions, a proposal for dosage adjustment or monitoring was made, which was accepted in 16 cases and rejected in 1 case (metformin in a patient with 44ml/min creatinine clearance and poor glycemic control). A high percentage of the institutionalized elderly have a creatinine clearance below 60ml/min. Given that a not inconsiderable proportion of their prescribed medication is susceptible to renal adjustment, the implementation of a protocol for renal adjustment and renal function follow-up could help to reduce the risk of adverse events.
    No preview · Article · Jan 2009 · Revista Española de Geriatría y Gerontología
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    ABSTRACT: Objective: To find out the degree of pharmacotherapeutic reconciliation between primary and specialized care, analyze the information about medication upon discharge, and evaluate the need for corrective action. Method: Prospective study with a random sample of hospitalized patients. We identified the patient's: 1) Home treatment. 2) Discrepancies with respect to such from emergency reports, pre-anesthesia and discharge reports and the first prescription report. We analyzed these discrepancies and the medication information from discharge reports. Results: 42 of 48 patients were included, with 179 medications. The discrepancies found in emergency, pre-anesthesia and discharge reports were 83%, 39% and 53%, respectively. 36 of 179 drugs were included in the first prescription report (22% with a possible severe repercussion) affecting 57% of patients. The information upon discharge was adequate in 8 of 42 reports and incomplete in 28 of 42 (6 of 42 were not evaluable). Conclusions: The important shortcomings that have been detected stress the urgency of establishing work procedures that avoid possible derived adverse events.
    No preview · Article · Jul 2008 · Atencion Farmaceutica
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    ABSTRACT: Objective: 1) To assess the nutritional status of able elderly, institutionalized at a nursing home; 2) To propose the required nutritional interventions; 3) To establish a consensus protocol for nutritional assessment and follow-up at the Center. Method: Cross-sectional study on all able residents, carrying out: 1) Mini Nutritional Assessment Test; 2) Anthropometrical assessment; 3) Biochemical assessment; and 4) an additional questionnaire (gathering information on dental prostheses, swallowing difficulties, and special diets or oral supplements). Analysis of these data to implement appropriate recommendations and elaborating a nutritional protocol. Results: The mean age of the 50 residents assessed was 84 years [66-97], mean weight 62 kg [35-87], mean height 154 cm [140-175], mean body mass index 26 [15.6-36], mean tricipital fold 18.1 mm [4-36], and mean muscle arm circumference 20.6 cm [14.7-27.1]. By using the Mini Nutritional Assessment Test we identified 3/50 (6% [95% CI: 1-16]) malnourished residents, and 6/50 (12% [95% CI: 4-24]) residents at risk for malnourishment. The body mass index allowed to identify 11/50 (22% [95% CI: 11-35]) overweighed residents-body mass index 27-29-, 10/50 (20% [95% CI: 10-33]) with grade I obesity -body mass index 30-35 and 1/50 (2% [95% CI: 0-10]) with grade II obesity-body mass index > 35-. None of them presented values below the 5th percentile for both the tricipital fold and the muscle arm circumference. Values above the 95th percentile were found in 10/50 (20% [95% CI: 10-33]) residents for the tricipital fold and in 7/50 (14% [95% CI: 5-26]) for the muscle arm circumference, both criteria being present in 3 residents. In all of them the body mass index mayor was > 27. When analyzing the biochemical parameters, the results were not concordant, since laboratory workups analyzed were not always done at the same time as the interview. After analyzing the data obtained, a nutritional assessment and follow-up protocol was elaborated in collaboration with the physicians in charge of the Center, in which five categories were defined according to the nutritional status. Conclusions: 1) 3/50 malnourished residents were identified, 6/50 at risk for malnourishment, and 22/50 with overweight. 2) We proposed the performance of a whole laboratory work-up in these residents, reviewed their dietary habits in order to correct them or prescribe oral supplements, and recommended adapted physical exercise. 3) A nutritional assessment and follow-up protocol was elaborated.
    No preview · Article · Apr 2008 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
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    ABSTRACT: 1) To assess the nutritional status of able elderly, institutionalized at a nursing home; 2) To propose the required nutritional interventions; 3) To establish a consensus protocol for nutritional assessment and follow-up at the Center. Cross-sectional study on all able residents, carrying out: 1) Mini Nutritional Assessment Test; 2) Anthropometrical assessment; 3) Biochemical assessment; and 4) an additional questionnaire (gathering information on dental prostheses, swallowing difficulties, and special diets or oral supplements). Analysis of these data to implement appropriate recommendations and elaborating a nutritional protocol. The mean age of the 50 residents assessed was 84 years [66-97], mean weight 62 kg [35-87], mean height 154 cm [140-175], mean body mass index 26 [15.6-36], mean tricipital fold 18.1 mm [4-36], and mean muscle arm circumference 20.6 cm [14.7-27.1]. By using the Mini Nutritional Assessment Test we identified 3/50 (6% [95% CI: 1-16]) malnourished residents, and 6/50 (12% [95% CI: 4-24]) residents at risk for malnourishment. The body mass index allowed to identify 11/50 (22% [95% CI: 11-35]) overweighed residents-body mass index 27-29-, 10/50 (20% [95% CI: 10-33]) with grade I obesity -body mass index 30-35 and 1/50 (2% [95% CI: 0-10]) with grade II obesity-body mass index > 35-. None of them presented values below the 5th percentile for both the tricipital fold and the muscle arm circumference. Values above the 95th percentile were found in 10/50 (20% [95% CI: 10-33]) residents for the tricipital fold and in 7/50 (14% [95% CI: 5-26]) for the muscle arm circumference, both criteria being present in 3 residents. In all of them the body mass index mayor was > 27. When analyzing the biochemical parameters, the results were not concordant, since laboratory workups analyzed were not always done at the same time as the interview. After analyzing the data obtained, a nutritional assessment and follow-up protocol was elaborated in collaboration with the physicians in charge of the Center, in which five categories were defined according to the nutritional status. 1) 3/50 malnourished residents were identified, 6/50 at risk for malnourishment, and 22/50 with overweight. 2) We proposed the performance of a whole laboratory work-up in these residents, reviewed their dietary habits in order to correct them or prescribe oral supplements, and recommended adapted physical exercise. 3) A nutritional assessment and follow-up protocol was elaborated.
    No preview · Article · Mar 2008 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
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    ABSTRACT: Objective: To evaluate the use of digoxin in a geriatric center. To detect opportunities for improvement and to propose adequate interventions. Method: A prospective study (14 months) of the 210 patients admitted to the center. An identification of those patients under treatment with digoxin, a revision of their clinical records and verification of the adequacy to the previously defined criteria for use took place. The attainment of digoxin plasmatic levels from all patients and control electrocardiogram on those patients whose plasmatic levels were outside of the therapeutic range. A detection of improvement aspects and the establishment of pertinent corrective interventions. Results: During the period of study, 21 out of 210 patients received treatment with digoxin. The indication was considered adequate in 20 of 21 cases and the posology optimizable in all cases given that only 1 had previous digoxinemia, 17 had a creatinine clearance < 50 ml/min, 12 presented potential interactions and in 1 case the digoxin standard was irregular (resting of two consecutive days). After pharmacokinetic monitoring, it was necessary to make a dose adjustment in 7 patients, suspend the treatment in 2 and reinforce the compliance in another 2 patients. Conclusions: The pharmaceutical care intervention described in this study has allowed for the treatment optimization in 11 out of 21 patients treated with digoxin and the creation of a protocol for the pharmacokinetic follow-up of this drug.
    No preview · Article · Nov 2004
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    ABSTRACT: The use of omeprazole at doses higher than the authorized dose (40 mg/24 hours) is common in many Spanish hospitals and unnecessarily increases costs and the risk of adverse effects. The present study quantifies the impact of a radical corrective intervention (substitution by intravenous pantoprazole) which attempted to break this pattern. Aims: To quantify the effects of the substitution on the incidence of the use of doses other than the authorized dose, consumption (number of vials and cost) and treatment duration. Method: Prospective study with a historic control period. The use of intravenous proton pump inhibitors during two periods (one and eight months after the substitution) compared with a control period (one month prior to the substitution). Results: The strategy applied was effective (drastic decrease in doses every 8-12 hours) efficient (38.58% reduction in cost at eight months) and was well accepted by the clinicians.
    No preview · Article · Jan 2000