Open Access
Optipharm: enhancing pharmacological management skills in healthcare students for geriatric care through gamified e-learning
(Elsevier, 2024-07-14) Roncal Belzunce, Victoria; Gutiérrez Valencia, Marta; Echeverría-Beistegui, Icíar; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Background: Complexities in older patient care and frequent polypharmacy requires tailored tools, specific skills and interdisciplinary collaborations. Traditional disease-centered education often overlooks these issues. Despite digital gamification's relevance in health education, limited exploration exists for gamified platforms addressing polypharmacy, especially within comprehensive geriatric assessment (CGA). Objective: This study outlines Optipharm's design, a gamified e-learning tool designed to enhance health students' education in managing polypharmacy among older adults. It also assesses its usability using a validated scale. Methods: Optipharm development utilized gamification techniques guided by pedagogical principles. Learning objectives addressed clinical and educational gaps in older adult care. Hosted on a Moodle system, the platform housed a structured clinical case as a SCORM file, a usability scale, a certificate of achievement, and a literature library. Optipharm was assessed by 304 medical students from the University of Navarre, Spain, using the SUS-G-Sp scale. Results: An immersive gamified e-learning tool simulating clinical practice settings was developed, requiring users to assume the role of healthcare professionals in multidisciplinary outpatient consultations. The interface, with a 2D cartoon-style aesthetic, aligns with learning objectives, integrating engaging storytelling and clear instructions for CGA in Phase 1 and pharmacological optimization in Phase 2. The evaluation of Optipharm's usability revealed very positive perceptions among users, with high agreement rates on usability items. Conclusion: Optipharm represents a pioneering gamified tool designed to simulate clinical scenarios, allowing users to engage as healthcare professionals within multidisciplinary teams and address medication-related challenges in older patients with polypharmacy. It provides a secure, interactive learning environment with clear educational objectives and seamless integration of gamification elements, enhancing users¿ knowledge and skills in managing complex medication regimens. As a platform for experiential learning and knowledge exchange, Optipharm contributes to shaping the future of health education and fostering a culture of patient-centred care among future healthcare professionals.
Open Access
Polypharmacy in older people: time to take action
(Springer International Publishing, 2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Vilches Moraga, A.; Ciencias de la Salud; Osasun Zientziak
The management of polypharmacy in older patients involves a paradigm shift that abandons the disease as the axis of health care towards an integral approach linked to multidisciplinary work, dedication and specifc preparation for medication prescribing in these patients, and a focus on medication reconciliation in transitions of care. Knowing how to face the challenge of polypharmacy and its consequences for patients, healthcare systems and society is everyone’s responsibility and its success will depend on the involvement of all professionals.
Open Access
Efficacy of educational interventions in adolescent population with feeding and eating disorders: a systematic review
(Springer, 2023) Ladrón Arana, Sergio; Orzanco Garralda, María Rosario; Escalada Hernández, Paula; Aguilera-Serrano, Carlos; Gutiérrez Valencia, Marta; Urbiola-Castillo, Jordi; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: Educational interventions are a key element in the care of young patients with feeding and eating disorders, forming part of the majority of therapeutic approaches. The aim of this review is to evaluate the impact of educational interventions in adolescents with feeding and eating disorders. Methods: Following the PRISMA recommendations electronic databases were searched up to 29 June 2023. Studies related to educational interventions in young population diagnosed with feeding and eating disorders (anorexia nervosa, avoidant/ restrictive food intake disorder, bulimia nervosa, pica and ruminative disorders and binge- eating disorder) in Spanish and English language, without temporal limitation, were located in the databases: PubMed, Scopus, CINAHL, Cochrane Library, PsycINFO, CUIDEN, DIALNET, and ENFISPO. A search in the databases of grey literature was performed in OpenGrey and Teseo. The review protocol was registered in PROSPERO (CRD42020167736). Results: A total of 191 articles were selected from the 9744 citations screened. Ten publications were included. The results indicated variability between educational programs, including individual and group interventions, learning techniques and various research methodologies. Variables such as learning, attitudinal and perceptual changes, anthropometric parameters, symptom improvement, normalization of eating patterns, evaluation of the program and cognitive fexibility were identifed. The risk of bias was high due to the low methodological quality of a large number of studies analyzed. Conclusion: The results indicate that educational interventions can infuence the improvement of knowledge level and have a positive efect on health outcomes. Although education is a common practice in the treatment of these pathologies, highquality studies were not identifed. Thus, this review concludes that additional evidence is needed to evaluate the efectiveness of educational programs, with further research studies, especially randomized controlled trials, to confrm these results. Level of evidence: Level I: Systematic review.
Open Access
Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial
(American Medical Association, 2018) Martínez Velilla, Nicolás; Casas Herrero, Álvaro; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Lucía, Alejandro; Galbete Jiménez, Arkaitz; García Baztán, Agurne; Alonso Renedo, Javier; González Glaría, Belén; Gonzalo Lázaro, María; Apezteguía Iráizoz, Itziar; Gutiérrez Valencia, Marta; Rodríguez Mañas, Leocadio; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Importance: Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. Objective: To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. Design, Setting, and Participants: A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. Interventions: The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). Main Outcomes and Measures: The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. Results: Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points (95% CI, -6.8 to -3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, -0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. Conclusions and Relevance: The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. Trial Registration: ClinicalTrials.gov identifier: NCT02300896.
Open Access
Letter: Albumin_Does formulation matter? Authors' reply
(Wiley, 2023) Leache, Leire; Gutiérrez Valencia, Marta; Saiz Fernández, Luis Carlos; Úriz, Juan; Bolado Concejo, Federico; García-Erce, José Antonio; Cantarelli, Lorenzo; Erviti López, Juan; Ciencias de la Salud; Osasun Zientziak
It is well known that retention of sodium and water is a key factor in the pathogenesis of ascites. Based on this, we believe that the reflection seems interesting and the hypothesis about the influence of the sodium content of albumin preparations on the results is theoretically feasible. However, we think that the impact would not be too relevant when compared to other mentioned contributing factors such as different study populations, diuretic management or albumin treatment patterns.
Open Access
Pharmacological treatment optimization in older patients
(2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
El uso de medicamentos en ancianos es un asunto complejo influido por muchos factores tanto relacionados como ajenos al ámbito de la salud. La terapia farmacológica es una de las herramientas más importantes de las que disponemos para conservar o mejorar la salud. Sin embargo, la polifarmacia y el uso inadecuado de medicamentos pueden implicar efectos adversos y situaciones de vulnerabilidad que condicionen resultados negativos en salud. En el siguiente trabajo se pretende estudiar este fenómeno en distintos ámbitos ―a nivel poblacional o comunitario, en pacientes institucionalizados y hospitalizados―, analizando su relación con distintos factores que pueden ser de interés en el paciente mayor, y especialmente con la fragilidad. Finalmente se centra en los ancianos hospitalizados, uno de los sectores más vulnerables a la iatrogenia farmacológica, indagando en el impacto de la hospitalización sobre la terapia farmacológica, revisando las distintas estrategias que se han propuesto para la optimización farmacológica en estos pacientes y explorando la utilidad de una intervención específicamente adaptada a estos pacientes en nuestro medio.
Open Access
Impact of a multidisciplinary approach to polypharmacy management in community-dwelling older adults: insights from a specialized outpatient clinic
(Wiley, 2025-02-18) Roncal Belzunce, Victoria; Gutiérrez Valencia, Marta; Cedeño Veloz, Bernardo Abel; San Miguel Elcano, Ramón; Marín Epelde, Itxaso; Galbete Jiménez, Arkaitz; Preciado Goldaracena, Javier; Ezpeleta, María Irache; Garaioa-Aramburu, Karmele; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Objectives: The increase in polypharmacy among older adults increases the risk of drug-related problems, making multidisci-plinary interventions essential. This study evaluated the impact of a multidisciplinary polypharmacy consultation on medicationmanagement and outcomes in older outpatients.Methods: This prospective observational study at a Spanish teaching hospital involved geriatricians, clinical pharmacists, andnurses. Older adults (≥ 75 years) with polypharmacy underwent medication review at baseline and at 3 and 6 months. Data onmedication use, adherence to Screening Tool of Older Person's Prescriptions (STOOP) criteria, and anticholinergic burden wereanalyzed.Results: The study included 104 older adults (mean age 86.2 years; 66% female). An average of 3.6 recommendations per par-ticipant was made (63.8% acceptance rate). Common drug-related problems were adverse effects (20%), non-adherence (18.1%), and incorrect dose/regimen (14.4%). Interventions led to an average reduction of 1.7 medications per patient, with 1.3 dosage orregimen changes and 1.1 new prescriptions. The mean number of medications decreased from 9.6 at baseline to 8.9 at 3 months(p < 0.001) and remained below baseline at 6 months. STOPP criteria violations per patient dropped from 1.2 to 1.0 (p = 0.036). Of the 126 medications flagged by STOPP criteria, 68.3% were addressed, 24.6% discontinued, mainly psychotropics, and 89.3%of these discontinuations were maintained. The anticholinergic burden decreased from 1.3 to 1.1 at 3 months (p = 0.036) andremained below baseline at 6 months.Conclusions: A multidisciplinary clinic effectively managed polypharmacy in older adults by reducing medication load andimproving appropriateness per STOPP criteria, highlighting the importance of proactive medication management.Trial Registration: ClinicalTrials.gov: NCT05408598 (March 1, 2022).
Open Access
Clinical outcomes of out-of-office versus in-office blood pressure monitoring in adults with hypertension
(Wiley, 2025-05-06) Roncal Belzunce, Victoria; Ramón Espinoza, Fernanda; Gutiérrez Valencia, Marta; Leache, Leire; Saiz Fernández, Luis Carlos; Erviti López, Juan; Ciencias de la Salud; Osasun Zientziak
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: to assess the effects of out-of-office compared to in-office blood pressure (BP) monitoring for improving clinical outcomes in adults with hypertension.
Open Access
Lifestyle habits, problem behaviors and non-suicidal self-injury in adolescents: a systematic review with meta-analysis of longitudinal studies
(Springer, 2025-09-01) Goñi-Sarriés, Adriana; Gutiérrez Valencia, Marta; Morata-Sampaio, Leticia; Saiz Fernández, Luis Carlos; Leache, Leire; Sánchez Villegas, María Almudena; Ciencias de la Salud; Osasun Zientziak; Institute on Innovation and Sustainable Development in Food Chain - ISFOOD; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Some lifestyle habits and problematic behaviors have been associated to non-suicidal self-injury (NSSI) in adolescents in cross-sectional studies but their role as individual risk factors needs to be analyzed through proper longitudinal designs. The objective is to analyze and summarize the evidence on the association of lifestyle habits and problem behaviors with NSSI in adolescents. Longitudinal studies were searched in Medline, Embase and APA PsycInfo without date or language restrictions. Adolescents with and without exposure factors were compared. Out of 5295 identified records, 13 longitudinal studies were included (39,575 participants). Studies included different age ranges (10-20 years, mean 14.3, SD 2.4), and 78% were female. Results showed a statistically significant increased risk of NSSI with regular smoking, alcohol use, early cannabis use, and poor physical activity. Inconsistent results were found for use of technology and sleep habits, and no studies analyzed dietary habits or gambling. Most studies were of moderate or high quality but certainty of the evidence was very low according to GRADE criteria. Longitudinal evidence suggests that some lifestyle habits and problem behaviors are risk factors for NSSI in adolescents. These findings highlight the importance of developing strategies to promote healthy lifestyles in adolescents.
Open Access
Solo 'potencialmente' inadecuados
(Elsevier, 2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Los psicofármacos se asocian con frecuencia a efectos adversos en pacientes mayores, y es lógica su amplia inclusión como PPI en criterios como los STOPP-START, especialmente en algunas circunstancias; sin embargo, la interpretación y aplicación de este tipo de criterios se debe individualizar, para discernir si su uso es adecuado en cada caso concreto, sin que esto reste validez a estas herramientas.