Errores de medicación en quimioterapia antes y después de la implantación de un sistema de prescripción electrónica asistida

Purpose: To identify, quantify and compare  medication errors (ME) of antineoplastic agents produced with manual prescriptions and with electronically assisted prescriptions (EAP).Methods: An observational, descriptive, prospective study in a haematological hospitalisation unit. Antineoplastic agents ME  were determined before and after implementation of EAP. Results: 184 ME and 53 identification errors were detected. A RRR of 92,03% and an AAR of 40,02% were obtained. Non-prescription medication errors, higher dose errors, wrong preparation or  handling errors, administration route errors and rate of administration errors  were significantly lower with EAP.Conclusions: Antineoplastic agents ME have decreased since computerising the prescription process. The decresase of omission errors, dosage-related  errors and  those related to the stability of the mixtures stands out.Objetivos: Identificar, cuantificar y comparar los errores de medicación (EM) de antineoplásicos que se producen con un sistema de prescripción manual y con un sistema de prescripción electrónica asistida (PEA). Método: Estudio observacional, descriptivo, prospectivo, realizado en pacientes ingresados en una unidad de Hematología. Se analizaron los EM producidos antes y después de la implantación de la PEA.  Resultados: Se detectaron 184 EM y 53 de identificación de pacientes. La RRR fue del 92,03% y la RAR del 40,02%. Las  disminuciones de los errores en las categorías de falta de prescripción de un medicamento necesario, dosis mayor, error de preparación/manipulación, vía de administración y velocidad de administración fueron estadísticamente significativas.Conclusiones: La PEA de antineoplásicos disminuye el número de EM. Evita errores derivados de la omisión de información y disminuye los relacionados con la dosis y  la estabilidad de las mezclas

Atezolizumab and Bevacizumab Combination Therapy in the Treatment of Advanced Hepatocellular Cancer

Liver cancer, particularly hepatocellular carcinoma, is a global concern. This study focuses on the evaluation of Atezolizumab and Bevacizumab combination therapy as a promising alternative in the treatment of advanced hepatocellular carcinoma. The objectives of this systematic review include evaluating the efficacy of Atezolizumab and Bevacizumab combination therapy compared to conventional therapies with Sorafenib and other conventional therapies, analyzing the associated adverse effects, and exploring prognostic factors in the setting of advanced hepatocellular carcinoma. A systematic literature review was carried out using the PubMed and Web of Science databases. Fifteen related articles were included and evaluated according to their level of evidence and recommendation. Results: The combination therapy of Atezolizumab and Bevacizumab, along with Sorafenib, showed positive results in the treatment of patients with advanced hepatocellular carcinoma. Significant adverse effects were identified, such as gastrointestinal bleeding, arterial hypertension, and proteinuria, which require careful attention. In addition, prognostic factors, such as transforming growth factor beta (TGF-β), alpha-fetoprotein (AFP), and vascular invasion, were highlighted as key indicators of hepatocellular carcinoma progression. Conclusions: The combination of Atezolizumab and Bevacizumab is shown to be effective in the treatment of advanced hepatocellular carcinoma, although it is essential to take into consideration the associated adverse effects. The prognostic factors identified may provide valuable information for the clinical management of this disease. This study provides a comprehensive overview of a promising emerging therapy for liver cancer.Medicin

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long‐Term Survival

Insuficiència cardíaca; Hipertensió pulmonar; Malaltia valvular cardíacaInsuficiencia cardiaca; Hipertensión pulmonar; Enfermedad valvular cardíacaHeart failure; Pulmonary hypertension; Valvular heart diseaseBackground The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures.This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain, the European Union–European Regional Development Fund (EC07/90772 and PI19/00649), and the Consorcio de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)

Analysis of the Psychosocial Sphere of Older Adults in Extreme Poverty in the Peruvian Amazon

The situation of social exclusion in which older adults live in extreme poverty is a problem that leads to psychological alterations such as depression or cognitive deterioration. Our objective was to analyze the living conditions and the psychosocial sphere of older adult people living in extreme poverty in Requena del Tapiche in Peru. This was an observational, descriptive, cross-sectional study. Sixty participants between 60 and 100 years of age of both sexes were included who gave their informed consent. Sociodemographic variables were analyzed, and the Gijón, family Apgar, Yesavage, and Pfeiffer scales were used. The sample was composed of 55% women and 45% men, with a mean age of 79.2 years (SD 6.67). More than half live alone or with their spouse. Fifty-seven percent sleep on the floor or on wood, and about 82% do not have safe water. Family dysfunction is found in 40%, and 98% are at social risk or with an established social problem and a precarious economic situation. More than 60% suffer from depressive symptoms, which are more frequent in women. We conclude that older adults perceive deficient family support, observing a deteriorated social situation. Most of them are at risk of social exclusion and loneliness, making them more vulnerable. They show sadness, with a high rate of depression. People with more cognitive impairment live alone, and those in social exclusion suffer a higher degree of depression. More cooperative projects and health promotion interventions developed in the peripheral neighborhoods of Requena del Tapiche are needed to improve the impact on the health of older adult people in extreme poverty.The publication costs of this work have been financed by the Catholic University of Valencia under grant 2023-275-001.Medicin

Measuring data‑centre workfows complexity through process mining: the Google cluster case

Data centres have become the backbone of large Cloud services and applica-tions, providing virtually unlimited elastic and scalable computational and storage resources. The search for the efficiency and optimisation of resources is one of the current key aspects for large Cloud Service Providers and is becoming more and more challenging, since new computing paradigms such as Internet of Things, Cyber-Physical Systems and Edge Computing are spreading. One of the key aspects to achieve efficiency in data centres consists of the discovery and proper analysis of the data-centre behaviour. In this paper, we present a model to automatically retrieve execution workflows of existing data-centre logs by employing process mining tech-niques. The discovered processes are characterised and analysed according to the understandability and complexity in terms of execution efficiency of data-centre jobs. We finally validate and demonstrate the usability of the proposal by applying the model in a real scenario, that is, the Google Cluster tracesMinisterio de Ciencia y Tecnología RTI2018–094283-B-C33Ministerio de Ciencia y Tecnología RTI2018-098062-A-I00Universidad de Sevilla 2018/0000052

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions

Identifying stakeholders’ needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers. Methods: Cross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals. Results: A total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies. Discussion: Findings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of al

Disección del septo interventricular como complicación de endocarditis aórtica

oai:ojs.imagenretic.org:article/5We report a case of infective aortic endocarditis complicated with perivalvular pseudoaneurysm diseccting perimembranous ventricular septum. This clinical case is a good example of 3D-echocardiography and cardiac-CT usefulness in anatomic and functional assessment of infective endocarditis complications.Se trata de un caso de endocarditis aórtica infecciosa complicada con un pseudoaneurisma perivalvular que se extiende disecando la porción perimembranosa del septo interventricular. Este caso clínico constituye un claro ejemplo de la utilidad de la ecocardiografía tridimensional y la cardio-TC en la valoración anatómica y funcional de las complicaciones de la endocarditis infecciosa

Investigation to Explain Bioequivalence Failure in Pravastatin Immediate-Release Products

Abstract: The purpose of this work is to explore the predictive ability of the biopharmaceutics classification system (BCS) biowaiver based on the dissolution methods for two pravastatin test products,where one of themshowedbioequivalence (BE)while the other test failed(non-bioequivalence, or NBE), and to explore the reasons for the BE failure. Experimental solubility and permeability data confirmed that pravastatin is a BCS class III compound. The permeability experiments confirmed that the NBE formulation significantly increased pravastatin permeability, and could explain its higher absorption rate and higher Cmax. This finding highlights the relevance of requiring similar excipients for BCS class III drugs. The BCS-based biowaiver dissolution tests at pH 1.2, 4.5, and 6.8, with the paddle apparatus at 50 rpm in 900 mL media, were not able to detect differences in pravastatin products, although the NBE formulation exhibited a more rapid dissolution at earlier sampling times. Dissolution tests conducted in 500 mL did not achieve complete dissolution, and both formulations were dissimilar because the amount dissolved at 15 min was less than 85%. The difference was less than 10% at pH 1.2 and 4.5, while at pH 6.8 f 2, results reflected the Cmax rank order

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions

IntroductionIdentifying stakeholders’ needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers.MethodsCross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals.ResultsA total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies.DiscussionFindings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of all

Buenas prácticas jurídico-procesales para reducir el gasto social (II)

Ministerio de Economía y Competitividad DER 2012-3211