Medicine Section Research Articles

Manejo transfusional perioperatorio en craneotomías: encuesta nacional, un punto de partida para valorar la mejora asistencial

ObjectiveTo assess the perioperative management of haemostasis and transfusion practices in adult patients undergoing craniotomies. MethodOnline questionnaire addressed to Spanish anaesthesiologists and promoted by the Neurosciences and Haemostasis, Transfusion Medicine and Fluid Therapy Sections of SEDAR. The questionnaire was sent by email and social media, and was active between June and October 2022. ResultsWe obtained 155 responses from 67 centres; 59.4% perform >100 craniotomies per year. 61.7% were regularly involved in neuroanaesthesiology. Only 21.9% of respondents had pre-anaesthesia assessment performed by a member of that section, and in most of them (83.0%) the assessment was performed ≤3 weeks in advance. Of the respondents with Patient Blood Management programmes, 58.2% had no specific protocols for craniotomies. 90.3% reported that haemoconcentrates are systematically reserved. A lower platelet limit of 100,000/mcL is considered acceptable by 76.8%. 99.4% of respondents discontinued antiplatelet medication based on half-life. Only 23.9% respondents routinely discontinued non-steroidal anti-inflammatory drugs. The transfusion threshold for haemoglobin during surgical bleeding was <10g/dl in 18.7%, <9g/dl in 38.1%, <8g/dl in 38.7% and <7 g/dl in 4.5%. ConclusionsPreoperative anaemia screening and treatment programmes are not implemented and blood product reserves are systematised in patients scheduled for craniotomy. Anti-aggregation therapy is discontinued according to the half-life of the drug without checking platelet functionality.

The standards and tools of the European Union of Medical Specialists Physical and Rehabilitation Medicine Section and Board for rehabilitation management and care: an evidence brief for rehabilitation practitioners.

In line with the World Health Organization's Rehabilitation 2030 initiative that led to its landmark resolution on rehabilitation, the Physical and Rehabilitation Medicine (PRM) Section and Board of the European Union of Medical Specialists have been developing functioning-based standards and tools using the International Classification of Functioning, Disability and Health (ICF) as a reference framework the past few years. This evidence brief aims to enable rehabilitation practitioners to implement these functioning-based standards and tools in rehabilitation care, management, and programming by clarifying functioning as the foundational concept for rehabilitation, introducing the functioning-based standards and tools and presenting concrete applications. This evidence brief also calls for the continuous development of these standards and tools and discusses the implementation challenges and opportunities in the context of the interaction between practice, science and governance.

Extremity War Injury Symposium 2024: Sports Medicine and Medical Readiness Section Summary

Collaboration between military and civilian investigators is necessary to develop strategies for optimizing treatments to diminish the sequelae of non–battle-related musculoskeletal injuries, which are highly prevalent among servicemembers. The 2024 Extremity War Injuries Symposium provided a forum whereby a diverse group of clinicians and researchers could develop strategies for optimizing treatments and diminishing the sequelae of conditions that are highly prevalent among active individuals. Key points were as follows: 1. The value of collaborations between military and civilian investigators cannot be overemphasized. These synergies can leverage the capabilities of established infrastructures in order to answer important questions pertaining to short-term outcomes—for example, warrior readiness of anterior cruciate ligament reconstructions among servicemembers and long-term posttraumatic osteoarthritis (PTOA) outcomes among civilian cohorts. 2. Current and future prospective trials will inform future treatment decisions related to multiligamentous knee injuries and glenohumeral instability. 3. Novel approaches to addressing PTOA in the acute postinjury period will need longitudinal surveillance to measure their impact on improving clinical outcomes and diminishing residual functional deficits.

Improving mental health response in earthquake-prone regions: recommendations following the recent earthquake in Türkiye

We are members of Students’ Education, Empowerment and Development in Mental Health, a group of medical students and psychiatrists from around the globe under the Psychiatry, Medicine and Primary Care Section of the World Psychiatric Association. In this article, we put forward recommendations to help improve the mental health response in disaster-prone regions such as Türkiye. We recommend a three-step multi-tiered mental health response system that could significantly help to address the immediate, short-term and long-term mental health needs of communities directly affected by a disaster. The recommendation draws from the relevant literature and, most importantly, from our lived experiences of living in earthquake-prone countries.

Fatal road traffic accidents and injuries: a preliminary study.

Road traffic accidents (RTAs) are a major public health problem globally and cause deaths, disability, and significant economic costs. In Italy, there was an increased number of road accidents, deaths, and injuries in 2022 compared to 2021, although still below pre-pandemic levels. A retrospective observational study was performed on a case series of 53 consecutive fatal RTAs examined by the Section of Forensic Medicine of Verona. The case series was divided, according to the type of victims involved, into pedestrians, car drivers, car passengers, and motorcyclists. For each, the times and causes of death, the distribution of external and internal injuries, and toxicological data were analysed, and the results were compared with those in the literature. Although this is a preliminary study on a small case series and lacks statistical validation, so more cases are needed, the preliminary results seem to provide a useful tool for assessing injuries in complex fatal road accidents.

Occupational Electronic Health Records: Recommendations for the Design and Implementation of Information Systems in Occupational and Environmental Medicine Practice-ACOEM Guidance Statement.

Occupational and environmental medicine (OEM) clinicians require specialized electronic health records (EHRs) to address the privacy, data governance, interoperability, and medical surveillance concerns that are specific to occupational health. The American College of Occupational and Environmental Medicine (ACOEM) Section of Health Informatics evaluated clinical workflow concerns, assessed health information requirements, and developed informatics recommendations through iterative consultation with ACOEM members. The ACOEM presents 10 recommendations that specialized occupational EHR systems (OEHRs) should meet to serve the information needs and practice requirements of OEM clinicians. Common challenges in OEM practice and potential informatics solutions are used to illustrate each recommendation. The recommendations serve as a framework for occupational health clinicians to consider in their adoption of OEHRs and provide software engineers a set of requirements to facilitate the development and improvement of OEHRs.

КЛИНИЧЕСКИЙ СЛУЧАЙ ДИАГНОСТИКИ ЗЛОКАЧЕСТВЕННОГО ОБРАЗОВАНИЯ ЯИЧКА

All the main processes associated with testicular masses and focal testicular changes in men. The etiology of tumors in the gonads is demonstrated. The diagnostic methods and differential diagnosis of tumors are highlighted. The tumor identified in the presented clinical case is considered from the point of view of diagnostic, morphofunctional, pathological sections of medicine.

Some aspects of tactical medicine in service and combat activities of police officers under the conditions of the legal regime of martial state: problem issues in critical situations and combat conditions

The article highlights the problematic issues of tactical training of law enforcement officers in today’s conditions, considers the actual problems and challenges that law enforcement officers may face during the performance of official duties and the provision of first aid in combat conditions and emergency situations. The issue of the interaction of the National Police of Ukraine with other rescue services at the scene for the effective provision of first aid was considered. It is noted that the interaction of the police and other rescue services at the scene of the event in the conditions of martial law requires a special approach and careful planning. It is necessary to ensure a clear coordination of actions, an appropriate level of protection for the personnel of the rescue services, and to take into account the peculiarities of work in the conditions of hostilities. Effective interaction between different services will minimize the consequences of emergency situations and ensure the safety of the population in the conditions of martial law. The article highlights the algorithm of actions for providing assistance to injured persons by police officers under fire, considers the key issues of training law enforcement officers to provide effective first aid in conditions of martial law or extreme situations in general. The authors of the article emphasize the importance of unified training programs for police officers in tactical medicine, which should include both theoretical knowledge and practical skills. Special attention is paid to ensuring a high level of readiness of police officers for quick and effective response to emergency situations and saving lives in the conditions of an aggravated conflict. Service situations in which police officers may find themselves are often accompanied by conflicts and their escalation, up to “fire contact” with the offender. Therefore, for the training of police officers, the section of tactical medicine is the most relevant, which teaches the basic skills of providing self- and mutual aid in combat conditions, which are primarily aimed at eliminating the preventive causes of death, taking into account the threat from combat operations or an active shooter. Unfortunately, there are infamous cases of the death of police officers while performing law enforcement tasks, which indicates the need for mandatory integration of first aid standards into their training and operations in various tactical situations. In addition, it is important to note that training police officers in tactical medicine will not only help them provide effective care to victims, but will also increase their level of safety while performing their duties. Therefore, unified training programs for police officers in tactical medicine should be an integral part of the training of law enforcement officers.

Challenges in IBD Research 2024: Precision Medicine.

Precision medicine is part of 5 focus areas of the Challenges in IBD Research 2024 research document, which also includes preclinical human IBD mechanisms, environmental triggers, novel technologies, and pragmatic clinical research. Building on Challenges in IBD Research 2019, the current Challenges aims to provide a comprehensive overview of current gaps in inflammatory bowel diseases (IBDs) research and deliver actionable approaches to address them with a focus on how these gaps can lead to advancements in interception, remission, and restoration for these diseases. The document is the result of multidisciplinary input from scientists, clinicians, patients, and funders, and represents a valuable resource for patient-centric research prioritization. In particular, the precision medicine section is focused on the main research gaps in elucidating how to bring the best care to the individual patient in IBD. Research gaps were identified in biomarker discovery and validation for predicting disease progression and choosing the most appropriate treatment for each patient. Other gaps were identified in making the best use of existing patient biosamples and clinical data, developing new technologies to analyze large datasets, and overcoming regulatory and payer hurdles to enable clinical use of biomarkers. To address these gaps, the Workgroup suggests focusing on thoroughly validating existing candidate biomarkers, using best-in-class data generation and analysis tools, and establishing cross-disciplinary teams to tackle regulatory hurdles as early as possible. Altogether, the precision medicine group recognizes the importance of bringing basic scientific biomarker discovery and translating it into the clinic to help improve the lives of IBD patients.

Overview of Death Cases with Asphyxia Examined in the Forensic Medicine and Medikolegal Section of Dr. Moewardi Hospital 2017-2022

Asphyxia is the third most common case in forensics. Death from asphyxia can occur due to murder, accident, or suicide. This study aims to determine the description of death cases with asphyxia. This research is a descriptive research with observational study. The data collection technique used was total sampling with a sample of all cases of death with asphyxia examined at Dr. Moewardi Hospital in the period 2017-2022. From 2017 to 2022, there were 105 cases of death with asphyxia. The most cases were in 2020 (23%). The majority of victims were male (85%) and aged more than 50 years (39%). A total of 21 cases (20%) were strangulation asphyxia, 18 (17%) cases of suffocation asphyxia, 3 cases (3%) chemical asphyxia, 10 cases (10%) asphyxia due to disease, and 53 (50%) cases were other asphyxia. Signs of cyanosis were found in 91% of cases, petechiae in 56% of cases, edema in 2% of cases, and fine foam in 13% of cases. The most victims were found indoors with 48 cases (46%), followed by outdoors with 46 cases (44%), and in transportation with 1 case (1%). The three regions that sent the most victims were Surakarta city (63%), Sukoharjo district (10%), and Karanganyar district (10%). Most cases occurred in 2020. Males are most common in asphyxia cases. Other asphyxia is the most common type of asphyxia. In the majority of cases, signs of cyanosis were found. The place where the victims were found was relatively the same between indoors and outdoors

Inside the April 2024 Issue.

Dear Readers, We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication. POCUS is an ever-changing field as clinicians seek out better and faster solutions for patient care at the bedside. We at POCUS Journal continue to evolve as well. Our editorial board is growing to meet the demands of our high volume and high-quality manuscript submissions. We welcome Dr. Andre Kumar of Stanford University and Dr. Manpreet Malik of Emory University to the Internal Medicine section. We also welcome Dr. Andrea of the University of Southern California to the Pediatrics section. Natalie joins us from Queen’s University as the Social media Editor. If you haven’t seen her high-yield on social media I highly encourage you to visit POCUS Journal on X and Instagram for summaries of research articles and other content published in our journal. A journal our size also needs help with statistics, and we are excited that Nicholas has joined our team from the University of Toronto as Statistical Editor. We also have a new Editorial Director of Artificial Intelligence, Dr. Bredon Crawford. We are the first journal to feature an AI bot on our website, which is thanks to Dr. Crawford. Its name is “PJ” and you can find it on the bottom right of our website: www.pocusjournal.com. And finally, we are excited to have had Kathryn Matsushita join our team as , helping us preserve our standard of high quality publishing as the volume of submitted articles and size of our issues continues to grow. With the addition of these new members, I also share the bittersweet news that our Managing Editor Braeden Hill will be leaving POCUS Journal to pursue MD/PhD studies at The University of Toronto. started at POCUS Journal in 2020 as Social Media Editor and his contributions these past few years have been remarkable. We welcome Laura Guzman of Queen’s University into the role of Managing Editor. Every issue I oversee at POCUS Journal strikes me as better than the last, with fascinating cases and important research that answers key questions related to point of care ultrasound. This issue is no exception. Please find our author guidelines here: https://pocusjournal.com/author-guidelines/ Sincerely, Benjamin T. Galen, MD Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY Editor-In-Chief POCUS Journal

Risk Factors for Early Dental Implant Failure.

To report the prevalence of early implant failure and evaluate factors that contribute to the early failure of dental implants placed at a teaching clinic. The study also aims to identify risk indicators for early implant loss to better predict and prevent early implant loss in the future. This retrospective study included all patients with a dental implant placed by the Section of Oral Surgery and Oral Medicine, Department of Clinical Dentistry, University of Bergen, between January 2011 and December 2018. All information was collected from operation logbooks and from patient records. A failed implant in this study was defined as an implant lost before functional loading. A total of 1,005 dental implants were placed in the studied time period, of which 54 failed early, giving an early failure rate (EFR) of 5.4%, with functional loading obtained for the remaining 94.6%. Analysis showed an increased hazard for early implant failure among smokers, men, and younger patients. With an age increase of 10 years, the risk of implant failure was reduced by 14% (hazard ratio [HRR] = 0.86, P = .037). A higher failure rate was found in anterior maxillary implants than in posterior maxillary implants (7.79% vs 3.29%, respectively; HRR = 0.47; P = .041). The probability for early failure in the posterior mandible was significantly increased compared to the posterior maxilla (HRR = 3.68, P = .005). If the first implant failed, it was more likely that the consecutive implant would also fail (HRR = 1.82). In the study, 53.4% of the placed implants were Straumann (EFR = 5.2%), 30.3% were Nobel Biocare (EFR = 7.2%), and 16.3% were Astra Tech (EFR = 2.5%). This study found that younger, male, and smoker patients were associated with an increase in early failure of dental implants. Significantly increased failure rates were also seen for implants placed in the mandible, and there were differences with respect to implant system. Although differences were found in early failure both for patient- and implant-related factors, the overall early failure rate (5.4%) in this study was low.

Variability in Practice and Implementation of Oxygen Target Saturation Policies in United States' Neonatal Intensive Care Units.

This study aimed to describe target oxygen saturation (SpO2) ranges used for premature infants in United States' neonatal intensive care units (NICUs) and to describe if these target SpO2 ranges have changed in recent years. A 29-question survey focused on target SpO2 practices and policies was distributed via the NICU medical directors listservs for the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine and Pediatrix Medical Group between August and October of 2021. Results were collected via Research Electronic Data Capture (REDCap). We received responses representing 170 unique, levels 2, 3, and 4 NICUs from 36 states. Most NICUs (130, 78%) have recently changed their SpO2 targets in response to target SpO2 clinical trials. Over time, the most commonly reported target SpO2 range has shifted from 88-92% to 90-95. Of NICUs that changed limits, the most common lower SpO2 limits increased from 88 to 90% and the upper SpO2 limits changed from 92 to 95%. The interquartile range for lower SpO2 limit shifted from 85-88% to 88-90% and the IQR for upper SpO2 limit decreased from 92-95 to 94-95%. Most NICUs had designated conditions that would allow for deviations from standard target SpO2 ranges. These most commonly include pulmonary hypertension (152, 95%), severe bronchopulmonary dysplasia (81, 51%), and retinopathy of prematurity (51, 32%). Oxygen saturation limits have changed over time with an overall increase in targeted SpO2. However, there remains considerable interunit variation in SpO2 policies. There is a need to achieve consensus to optimize clinical outcomes. · What are the SpO2 ranges in United States' NICUs?. · There is a shift in SpO2 ranges for preterm infants in NICUs across United States.. · Variability still persists in SpO2 ranges for preterm infants in United States' NICUs..

Gastric Emptying Studies in Pediatrics: A Cincinnati Children's Hospital Experience.

Gastric emptying studies are routinely performed in many nuclear medicine departments; however, there are many different techniques used to perform the procedure across the country. Creating consistency in clinical practice will aid gastroenterologists in diagnosing and treating illnesses associated with abnormalities related to gastric emptying. In 2017, Cincinnati Children's Hospital adopted adult standards for pediatric gastric emptying studies that included a standard meal along with imaging over the course of 4 h. Gastric emptying studies are the second-highest-volume examination performed in the nuclear medicine section at Cincinnati Children's Hospital. Accommodating this volume required changes in the scheduling template, scheduling questionnaire, and epic order sets, as well as identification of specific days and locations for gastric emptying studies. Both protocol standardization and workflow optimization are critically important in creating consistency in patient care. Gastric emptying can be evaluated with solid food, liquid food, or solid and liquid food simultaneously. The methodology of the study is initially determined by the ordering provider but may require special accommodations based on what the patient will tolerate. In coordination with the ordering and interpreting physicians, the nuclear medicine technologists at Cincinnati Children's Hospital have the decision-making ability to deviate from the provider's request as necessary, which helps expedite workflow and eliminates wasted time. Any deviation from the standardized protocol is documented by the nuclear medicine technologist and incorporated into the final report by the interpreting physician, as dietary information is meaningful to the ordering provider. Reference values associated with the standardized or modified protocol are also included in the final report.

MANAGEMENT OF HYPERPROLACTINEMIA CAUSED PITUITARY MICROADENOMA

Hyperprolactinemia is an increase in fasting levels of the hormone prolactin above 20 ng/ml in menand above 25 ng/ml in women. Hyperprolactinemia occurs more often in women of reproductive age,with a percentage of 9 – 17%. The etiology of hyperprolactinemia can occur due to abnormal pituitarysecretions, systemic disease, use of drugs, damage to the hypothalamus-pituitary axis. A 33-year oldfemale patient came to the FER Polyclinic at M. Djamil Hospital with complaints of not menstruatingfor the past 2 months. Irregular menstruation since 15 years ago, menstruation 2-3 times in 6 months,irregular cycle for 7-8 days. The patient also complained of a fluid like breast milk coming out of thebreast for 5 years, initially the fluid came out in a trickle and then gradually reduced and now the fluidcomes out occasionally if the breast is squeezed. From the supporting examinations carried out, it wasfound that the prolactin hormone level in this patient was 134.53, and the results of the MRIexamination showed a mass measuring 1.05x1.12x0.5 mm, which was diagnosed as secondaryamenorrhea, hyperprolactinemia, and suspected pituitary microadenoma. The patient will bemonitored for general condition and vital signs, as well as consultations with colleagues involved, suchas consultations to the Internal Medicine section, Endocrinology, Metabolic and Diabetes Subdivision.

The 2022-2023 Pediatric Respiratory Illness Surge: Survey of Acute and Critical Care Resource Use.

A surge of pediatric respiratory illnesses beset the United States in late 2022 and early 2023. This study evaluated within-surge hospital acute and critical care resource availability and utilization. The study aimed to determine pediatric hospital acute and critical care resource use during a respiratory illness surge. Between January and February 2023, an online survey was sent to the sections of hospital medicine and critical care of the American Academy of Pediatrics, community discussion forums of the Children's Hospital Association, and PedSCCM-a pediatric critical care website. Data were summarized with median values and interquartile range. Across 35 hospitals with pediatric intensive care units (PICU), increase in critical care resource use was significant. In the month preceding the survey, 26 (74%) hospitals diverted patients away from their emergency department (ED) to other hospitals, with 46% diverting 1-5 patients, 23% diverting 6-10 patients, and 31% diverting more than 10 patients. One in 5 hospitals reported moving patients on mechanical ventilation from the PICU to other settings, including the ED (n = 2), intermediate care unit (n = 2), cardiac ICU (n = 1), ward converted to an ICU (n = 1), and a ward (n = 1). Utilization of human critical care resources was high, with PICU faculty, nurses, and respiratory therapists working at 100% capacity. The respiratory illness surge triggered significant hospital resource use and diversion of patients away from hospitals. Pediatric public health emergency-preparedness should innovate around resource capacity.

Proposal for the use of angiotensin II in distributive shock after extracorporeal circulation - position paper of the Section of Intensive Care Medicine and the Section of Cardiothoracic Anaesthesiology of the Polish Society of Anaesthesiology and Intensive Therapy.

Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation.

Improvement in the Outcome of Urolithiasis Medicine Section Patients using Traditional Indian Medicine: A Systematic Review and Meta-analysis

Introduction: Urolithiasis (UL) is a prevalent disorder that significantly burdens the global healthcare system. Except for acute surgical conditions, most kidney stones don’t show any symptoms during presentation. Patients with asymptomatic renal calculi frequently seek alternative treatments. Several Ayurvedic preparations mentioned in Ayurvedic compendia have shown encouraging results in patients after long-term use. However, the results of several Randomised Controlled Trials (RCTs) on the effectiveness of Ayurvedic preparations in UL vary. Aim: To conduct a systematic review and meta-analysis to assess the effectiveness of Ayurvedic preparations in patients with UL. Materials and Methods: The electronic databases Web of Science, PubMed, Cochrane Library, Embase, and ARP were searched upto August 2023 to recognise applicable studies. The modified Jadad Scale was used to assess the quality of the studies. The Cochrane Risk of Bias (RoB) tool was used to determine the RoB for randomised trials. Results: The search retrieved 1459 studies, but only 19 studies were found eligible for inclusion in the study. Statistical analysis revealed a substantial decrease in the number and size of calculi in 178 cases in the intervention group compared to only 101 events in the control group (OR: 3.03, 95% CI; 2.00, 4.61). It also showed a significant reduction in the size of stones, a significant improvement in haematuria with p=0.18, a highly significant improvement in dysuria with p=0.04, and highly significant relief in pain with p&lt;0.0001. Conclusion: This review concludes that Ayurvedic drugs have optimistic results in the treatment of UL. More substantial clinical trials with a larger sample size must be conducted to generate stronger evidence for using Ayurvedic Medicines (AyM) as a treatment choice for UL.

Ayurvedic Medicine: A Traditional Medical System and Its Heavy Metal Poisoning.

Ayurveda is one of the oldest and most widely practiced traditional medical systems in the world. The ancient knowledge in this traditional medical system has yet to be fully explored. The interaction of rich knowledge from various traditional systems of medicine can open new pathways in the herbal drug discovery process. Apart from other hurdles in discovering plant-based medicines, the lack of knowledge of the differences and similarities between the theoretical doctrines of these systems is the greatest impediment to their convergence. Rasashastra is an Ayurvedic medicine section that deals with formulations that include minerals/metals, particularly Parad (mercury). According to the Ayurvedic Formulary of India, the most widely used heavy metals are mercury, arsenic, and lead. However, contemporary scientists are concerned about the use of heavy metals in Ayurvedic preparation. In this review article, we will discuss Ayurvedic medicine and the toxic effects of heavy metals.

Evaluation of a multicomponent integrated intervention to improve the quality of care for anticoagulated frail older adults in a home care system in the city of Buenos Aires

Introduction: Anticoagulation in older adults is a real challenge due to the presence of health conditions that can alter the adequate control of the patient. Older adults confined to home probably could not attend outpatient medical consultations. On many occasions, the monitoring of the patient's health process at home is carried out by a health professional who does not monitor the anticoagulant treatment (e.g. due to lack of experience of the professional).&#x0D; For this reason, the home care section of the Italian Hospital of Buenos Aires (HIBA) created an interdisciplinary team for the telephone follow-up of anticoagulated patients in that area.&#x0D; Objectives: Describe the effect of a multicomponent intervention to improve the quality of anticoagulation therapy in frail elderly patients in the home care system of the HIBA.&#x0D; Methods: Prospective pragmatic evaluation study of a multiple intervention with a before-after design. Variables were analyzed from secondary databases 6 months before and after the intervention. The unit of analysis was the patient acting as his own control. The setting was the home medicine section of HIBA. We included patients aged 65 years or over receiving dicumarinics with home care and follow-up by a doctor with fewer tools in the management of anticoagulants and with communication barriers. Telephone contacts with patients were made by family physicians. A hematologist was consulted whenever necessary. Pharmacists sent pills of vitamin K with educational brochures to the patient's home. Health and social counsellors contacted patients in complex cases to strengthen education. Reasons for withdrawal of the program were: death, hospitalization, termination of the home care service, follow-up of the treatment by a hematologist or anticoagulant suspension.&#x0D; Results: Analysis of the data was performed before the intervention (June 1, 2021 to November 30, 2021) and after the intervention ( December 1, 2021, to June 30, 2022), 41 patients were included, 78% were female, average age was 87 years. The mean of basic activities of daily living was 3.35, the average of the Percentage of International Normalized Ratio Measurements in Range (PINRR) in the pre intervention was 31% and 49% in the post. There weren't thrombotic events and the average of bleeding events was 6% in the pre and 0% in the post, extreme values of INR (&gt;6) in the pre was 3% and in the post 0,5%. Finally the mean of emergency medical consultations was 1,15 in the pre and 0,29 in the post.&#x0D; Conclusions: The present work consists in the analysis of an elderly population highly dependent on activities of daily living. The data shows a possible tendency of reduction in the number of emergency medical consultations, bleeding events and improvement in the PINRR. As next steps we propose evaluate patients' satisfaction with the intervention, analize long-term results as the program works in time and generate institutional tools to deprescribe.&#x0D; &#x0D; &#x0D;