Percorrer por autor "Afreixo, Vera"
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- Complexity of the therapeutic regimen in older adults with cancer: associated factorsPublication . Oliveira, Rita F.; Oliveira, Ana I.; Cruz. Agostinho; Ribeiro, Oscar; Afreixo, Vera; Pimentel, Francisco; Cruz, Agostinho; Ferraz Oliveira, Rita; Oliveira, Ana IsabelPopulation aging is a worldwide phenomenon and is often associated with multimorbidity and polypharmacy. Complex medication regimens are common among older adults and contribute to the occurrence of harmful health outcomes. Age is one of the main risk factors for cancer. This study aimed to determine and characterize the therapeutic complexity in older patients with cancer, and analyze the factors associated with high complexity and the impact of the oncological context. A cross-sectional study with patients aged ≥65 years with cancer was conducted in three hospitals in northern Portugal. Data collection was obtained using self-reports. The medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI). Descriptive and association statistical analysis were performed. Logistic, linear, simple and multiple regression analysis were conducted, with and without automatic variable selection. A total of 552 patients were included (median age, 71; IQR, 68–76). The mean MRCI before the oncological context was 18.67 (SD 12.60) and 27.39 (SD 16.67) after the oncological context, presenting a statistically significant difference in the values obtained (p < 0.001). An elevated complexity was significantly associated with polypharmacy, chronic diseases and with the administration of high-risk medications (p < 0.05). High MRCI values showed a relationship with the occurrence of potential drug interactions (p < 0.001). There was no relationship with the existence of cardiac risk comorbidity. This study demonstrated the existence of high therapeutic complexity in older patients with cancer, suggesting the need for intervention to prevent medication-related problems in this vulnerable population.
- Drug–drug interaction in elderly patients with cancerPublication . Capitão, Romana; Jesus, Ângelo; Oliveira, Rita; Afreixo, VeraElderly cancer patients have a high risk of exposure to potential drug-drug interactions (pDDIs), given the therapeutic complexity to which they are subjected. The study of pDDIs is very important to enable more effective treatments, with the least possible number of complications.The aim of this study was to identify and characterize pDDIs in elderly cancer patients treated at the Day Hospital of IPO-Porto
- Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysisPublication . Melo, Ana; Moreira, Juliana; Afreixo, Vera; Gonçalves, Daniel Moreira; Donato, Helena; Cruz, Eduardo B.; Vilas-Boas, J. Paulo; Sousa, AndreiaTherapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. From the 8318 records identified, 8 (high to low risk of bias– scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: −0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
- Polypharmacy and drug interactions in older patients with cancer receiving chemotherapy: associated factorsPublication . Ferraz Oliveira, Rita; Oliveira, Ana Isabel; Cruz, Agostinho; Ribeiro, Oscar; Afreixo, Vera; Pimentel, FranciscoPolypharmacy in older adults with cancer receiving chemotherapy leads to increased risks of drug interactions, translating in potential hazardous health outcomes. This study aims to assess the prevalence of polypharmacy, drug–drug interactions (DDIs), and severe-drug interactions (SDIs) in older patients with cancer. Antineoplastic agents (ANAs) involvement and possible risk contexts (comorbidities with cardiac risk, and high-risk medications) were also analysed. ents (ANAs); it was conducted in three hospitals from the north of Portugal. Data collection was obtained using self-reports and medical records. DDIs were identifed and classifed using Micromedex® software. Descriptive and association analyze statistics were performed. Statistical hypothesis tests with p value less than 0.05 were considered signifcant. All statistical procedures and analysis were performed with R version 4.1.3. We enrolled 552 patients. Polypharmacy prevalence was 88.40%; 76.45% and 56.16% of the patients presented with DDIs and SDIs, respectively. SDIs with ANAs were found in 21.20% of the patients. High-risk medications were associated with a higher risk of polypharmacy, DDIs, and SDIs. Polypharmacy and DDIs were higher in patients with hypertension or diabetes. SDIs were higher in patients with diabetes. Polypharmacy, potential DDIs and SDIs were highly prevalent in older adults with cancer. A careful review of the medication administered is necessary to decrease it. These fndings warrant further research to optimize medication in this population and decrease problems related to medication, which may lead to emergency room visits and hospitalisations, compromising patient safety and/or ongoing treatments.
- Polypharmacy in older patients with cancerPublication . Ferraz Oliveira, Rita; Afreixo, Vera; Santos, João; Mota, Priscilla; Cruz, Agostinho; Pimentel, FranciscoPolypharmacy is associated with drug–drug interactions, adverse drug events, hospitalization, increased mortality and rising costs. Older cancer patients are potentially vulnerable to polypharmacy because cancer treatment often involves exposure to chemotherapy and other adjunctive or supportive medication.