Algunos datos para la historia del Palacio de Vista Alegre en Carabanchel Bajo

Amongst the numerous Royal Family possesions in the 19th century, there's one which has been mostly overlooked: Vista Alegre estate, at Carabanchel Bajo. It was a place, similar to those many aristocratic families owned in the surroundings of madrid. María Cristina and her daughters used to go there to rest and to enjoy a bucolic way of life near nature. We ignore how and when they got hold of the estate country, but we contribute some really interesting maps that show its magnitude, the different sorts of contryside buildings, the diverse outside games... and also they let us know better their way of life. From these accounts we may catch a glimpse of Martín López Aguado's authorship, of Pascual and Colomer's participation and of the different repairs in the estate along the years. We've got a better knowledge of the functions of the Royal House, and we can get a close look at the incomes and expenses they got from cropping at this possession. Later on, the country estate was bought by the Marquis of Salamanca who, when he died, left substantial debts that made the building go to public hands (nowadays it belongs to Comunidad of Madrid).Entre las muchas posesiones de la familia real en el siglo XIX ha habido una que ha pasado prácticamente desapercibida: la de Vista Alegre, en Carabanchel Bajo. Fue una finca de recreo, similar a la que muchas familias aristocráticas tenían en las afueras de Madrid. Iban allí María Cristina y sus hijas a descansar, a disfrutar de una vida bucólica, cercana a la naturaleza. Cuándo y cómo llegó a sus manos tal finca lo ignoramos, pero aportamos unos planos ciertamente interesantes, pues por ellos conocemos su magnitud, los distintos tipos de construcciones campestres, los diversos juegos al aire libre... y nos podemos hacer una idea más clara del tipo de vida que llevaban. A través de la documentación aportada, entrevemos la autoría de Martín López Aguado, la intervención de Pascual y Colomer y las distintas reformas que ha debido haber a lo largo de la historia de la finca (sin meternos en la reforma de este siglo para habilitar el nuevo palacio en Centro de Reeducación de Inválidos). Conocemos mejor el funcionamiento de la Real Casa y del Patrimonio, y observamos los gastos e ingresos que obtenían de lo cultivado en esta posesión. Posteriormente, la finca fue comprada por el Marqués de Salamanca quien, al morir, dejó cuantiosas deudas, por lo que el edificio pasó a ser posesión del Estado (actualmente de la Comunidad de Madrid)

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

© 2023Background: The benefit of pharmacogenetic testing before starting drug therapy has been well documented for several single gene–drug combinations. However, the clinical utility of a pre-emptive genotyping strategy using a pharmacogenetic panel has not been rigorously assessed. Methods: We conducted an open-label, multicentre, controlled, cluster-randomised, crossover implementation study of a 12-gene pharmacogenetic panel in 18 hospitals, nine community health centres, and 28 community pharmacies in seven European countries (Austria, Greece, Italy, the Netherlands, Slovenia, Spain, and the UK). Patients aged 18 years or older receiving a first prescription for a drug clinically recommended in the guidelines of the Dutch Pharmacogenetics Working Group (ie, the index drug) as part of routine care were eligible for inclusion. Exclusion criteria included previous genetic testing for a gene relevant to the index drug, a planned duration of treatment of less than 7 consecutive days, and severe renal or liver insufficiency. All patients gave written informed consent before taking part in the study. Participants were genotyped for 50 germline variants in 12 genes, and those with an actionable variant (ie, a drug–gene interaction test result for which the Dutch Pharmacogenetics Working Group [DPWG] recommended a change to standard-of-care drug treatment) were treated according to DPWG recommendations. Patients in the control group received standard treatment. To prepare clinicians for pre-emptive pharmacogenetic testing, local teams were educated during a site-initiation visit and online educational material was made available. The primary outcome was the occurrence of clinically relevant adverse drug reactions within the 12-week follow-up period. Analyses were irrespective of patient adherence to the DPWG guidelines. The primary analysis was done using a gatekeeping analysis, in which outcomes in people with an actionable drug–gene interaction in the study group versus the control group were compared, and only if the difference was statistically significant was an analysis done that included all of the patients in the study. Outcomes were compared between the study and control groups, both for patients with an actionable drug–gene interaction test result (ie, a result for which the DPWG recommended a change to standard-of-care drug treatment) and for all patients who received at least one dose of index drug. The safety analysis included all participants who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03093818 and is closed to new participants. Findings: Between March 7, 2017, and June 30, 2020, 41 696 patients were assessed for eligibility and 6944 (51·4 % female, 48·6% male; 97·7% self-reported European, Mediterranean, or Middle Eastern ethnicity) were enrolled and assigned to receive genotype-guided drug treatment (n=3342) or standard care (n=3602). 99 patients (52 [1·6%] of the study group and 47 [1·3%] of the control group) withdrew consent after group assignment. 652 participants (367 [11·0%] in the study group and 285 [7·9%] in the control group) were lost to follow-up. In patients with an actionable test result for the index drug (n=1558), a clinically relevant adverse drug reaction occurred in 152 (21·0%) of 725 patients in the study group and 231 (27·7%) of 833 patients in the control group (odds ratio [OR] 0·70 [95% CI 0·54–0·91]; p=0·0075), whereas for all patients, the incidence was 628 (21·5%) of 2923 patients in the study group and 934 (28·6%) of 3270 patients in the control group (OR 0·70 [95% CI 0·61–0·79]; p <0·0001). Interpretation: Genotype-guided treatment using a 12-gene pharmacogenetic panel significantly reduced the incidence of clinically relevant adverse drug reactions and was feasible across diverse European health-care system organisations and settings. Large-scale implementation could help to make drug therapy increasingly safe. Funding: European Union Horizon 2020