Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Crystal phase competition by addition of a second metal cation in solid solution metal-organic frameworks

Herein we report a synthetic study focused on the preparation of solid-solution metal-organic frameworks, MOFs, with the use of two kinds of linkers. In particular, we have explored the system composed by zinc, cobalt, 1,2,4-triazole and 4,4′-hexafluoroisopropylidenebisbenzoic acid (Hhfipbb). During this study, four new MOFs have been isolated, denoted TMPF-88 [M(hfipbb)(triazole)(HO)], TMPF-90 [M(triazole)(OCHCH)], TMPF-91 [M(hfipbb)(triazole)(HO)] and TMPF-95 [M(hfipbb)(triazole)(HO)] (TMPF = transition metal polymeric framework, M = Zn, Co, or mixture of them). The study demonstrates that the addition of a second metal element during the MOF synthesis has a major effect in the formation of new phases, even at very high Zn/Co metal ratios. Furthermore, we show that during the MOF formation reaction, there is a competition among different crystal phases, where kinetically favoured phases of various compositions crystallize in short reaction times, precluding the formation of the pure solid-solution phases of other energetically more stable MOFs.This work has been supported by the Spanish Ministry of Economy and Competitiveness, project MAT2013-45460-R. Financial support by Fundación General CSIC (Programa ComFuturo) is acknowledged (F.G.)

Addressed realization of multication complex arrangements in metal-organic frameworks

The preparation of materials with structures composed of multiple metal cations that occupy specific sites is challenging owing to the difficulty of simultaneously addressing the incorporation of different elements at desired precise positions. We report how it is possible to use a metal-organic framework (MOF) built with a rod-shaped inorganic secondary building unit (SBU) to combine multiple metal elements at specific positions in a manner that is controllable at atomic and mesoscopic scales. Through the combination of four different metal elements at judiciously selected molar ratios, 20 MOFs of different compositions and the same topology have been prepared and characterized. The use of diffraction techniques, supported by density functional theory calculations, has led us to determine various possible atomic arrangements of the metal cations within the SBUs. In addition, seven of the compounds combine multiple types of atomic arrangements, which are mesoscopically distributed along the crystals. Given the large diversity and importance of rod-based MOFs, we believe that these findings offer a new general strategy to produce complex materials with required compositions and controllable arrangements of the metal cations for desired applications.Work at Instituto de Ciencia de Materiales de Madrid–Consejo Superior de Investigaciones Científicas (CSIC) has been supported by the Spanish Ministry of Economy and Competitiveness (MINECO) Projects MAT2013-45460-R, CTQ2014-61748-EXP, and MAT2016-78465-R. F.G. acknowledges financial support from Fundación General CSIC (Programa ComFuturo) and MINECO (Ramón y Cajal program). Computational time has been provided by the Centre de Supercomputació de Catalunya. This work, developed under the HyMAP project, has received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant 648319).We acknowledge support by the CSIC Open Access Publication Initiative through its Unit of Information Resources for Research (URICI).Peer reviewe

Highly efficient multi-metal catalysts for carbon dioxide reduction prepared from atomically sequenced metal organic frameworks

The precise control on the combination of multiple metal atoms in the structure of metal-organic frameworks (MOFs) endowed by reticular chemistry, allows the obtaining of materials with compositions that are programmed for achieving enhanced reactivity. The present work illustrates how through the transformation of MOFs with desired arrangements of metal cations, multi-metal spinel oxides with precise compositions can be obtained, and used as catalyst precursor for the reverse water-gas shift reaction. The differences in the spinel initial composition and structure, determined by neutron powder diffraction, influence the overall catalytic activity with changes in the process of in situ formation of active, metal-oxide supported metal nanoparticles, which have been monitored and characterized with in situ X-ray diffraction and photoelectron spectroscopy studies.Work at Instituto de Ciencia de Materiales de Madrid–Consejo Superior de Instigaciones Científicas (CSIC) has been supported by the Spanish Research Agency (Agencia Estatal de Investigación, AEI), Projects MAT2016-78465-R and CTQ2017-87262-R. This work was supported by the EU (ERC CoG HyMAP 648319) and Spanish MINECO (ENE2016-79608-C2-1-R). Authors also wish to thank to “Comunidad de Madrid” and European Structural Funds for their financial support to FotoArt-CM project (S2018/NMT-4367). F. G. acknowledges financial support from MINECO Ramón y Cajal program (RyC-2015-18384).Peer reviewe

Anales de Edafología y Agrobiología Tomo 42 Número 11-12

Suelos. Estudio de la superficie y de la textura de bentonitas homoionicas. JI. Constantes relativas de equilibrio. por E. González Pradas, F. del Rey Bueno, C. Valenzue/a Calahorro y J. D. López González.-- Suelos AC sobre granitos de Galicia (NO de España) con especial referencia al ranker atlántico. III. Fracción orgánica, por M. Carballas, T. Carballas, A. Cabaneiro, M. C. Villar, M. C. Leiros y F. Guitián Ojea.-- Estudio del proceso de intercalación del eter benzo 15-corona-5 en óxido grafítico procedente de un grafito de la Sierra de Huelma (Jaén), por A. J. López Peintido, J. de D. López González, J. Peinado García y J. Rivera Utrilla.-- Estudio de un perfil con caracteres isohúmicos en la comarca de la Bureba (Burgos), Por R· Jiménez Ballesta, . G. Almendros, A.Polo y J. L. Martín de Vidales.-- Uso de algas marinas como fertilizantes de suelos gallegos. I. por P.Rodriguez Seoane, M. L. Andrade Couce, M. l. López López y F. Guitión Ojea. ..-- Uso de algas marinas como fertilizantes de suelos gallegos. II., por M. L. Andrade Couce, P. Rodriguez Seoane, F. Guitián Rivera, M. l. López López y F. Guitián Ojea.-- Transformaciones en la organización durante la alteración y edafogénesis de rocas esquistosas en Galicia, por B. M. Silva hermo y F. Macías Vázquez.-- La influencia conjunta del relieve y la vegetación sobre los suelos forestales de la dehesa del Camarate (Sierra Nevada), por J. Párraga Martínez, R. Delgado Calvo-Flores y J. Aguilar Ruiz.-- Haploxerolis de la sierra de María (Almería), por L. J. Alias y J. Martínez.-- La contaminación por metaIes pesados en la zona de Linares, por M. Serrano Peñuela, l. Saura Vilchez, G. Delgado Calvo-Flores y J. Aguilar Ruiz.-- Contribución al estudio morfológico y evolutivo de los suelos desarrollados sobre dolomías kakiritizadas en clima seco, por l. García Fernández, M. Simón. Torres y J. Aguilar Ruiz.-- Estudio de los suelos sobre jumillitas de la sierra de las Cabras (Albacete), por L. J. Alías Pérez, J, Hemández Bastida y Ma T. Fernández Tapia.-- Contribución al estudio morfológico y evolutivo de los suelos desarrollados sobre coluvios calizos en clima xérico, por l. García Fernández, M. Simón Torres y J. Aguilar Ruiz.-- Los acrisoles gleicos de la zona de Linares (Jaén), por G. Delgado, J. Aguilar y M. Simón.-- Retención de malation y dicofol sobre carbón activo, por E. González Pradas, A. Valverde García, M. Villafranca Sánchez y F. del Rey Bueno.-- Contribución al estudio de los suelos desarrollados sobre sedimentps fluviales recientes de Galicia, por Esther de Bias, F. Gil Sotres y F. Guitián Ojea.-- Estudio edáfico de los suelos del sector Salar-Alhama (Granada), por J. Fernández, E. Ortega, J. Párraga y J. Aguilar.—Fertilidad del Suelo. Respuesta del Rye-grass al fósforo añadido en suelos del Valle del Ebro, por Benigna Eleizalde.-- Number, distribution and characterization of heterotrophic. bact~ria in sorne Argentine soils, by M. A. Sagardoy and C. M. Salerno.-- Naturaleza y propiedades de la materia orgánica en dos tipos de compost de paja de trigo, por G. Almendros, M. C. Lobo, A. Polo y E. Dorado .-- Evolución de algunos compuestos nitrogenados en suelos argiudoles bajo cultivo de maiz, por Marta E. Conti, Ana María Rodríguez Janeiro y Claudia Marre.-- Aplicación del "Sistema de clasificación de las condiciones de fertilidad del suelo" a la cartografía de suelos de la zona de Linares, por G. Delgado y J. Aguilar.-- Acción del humus extraído de una turba sometida a tratamientos ácidos, alcalinos y oxidantes, sobre el desaM rrollo de la planta de lechuga, por C. Ortega y R. García de las Heras.—Nutrición y Fisiología Vegetal. Estudio comparativo de la estructura foliar, intercepción de luz y rendimiento en girasol, por Luis F. Hernández y Gustavo A. Orioli.-- Crecimiento de Chlorella Pyrenoidosa en relación a la presencia del ión bicarbonato en el medio de cultivo, por E. Fernández, E. Sánchez, P. Mateo, l. Bonilla y P. Ortega.-- Efecto del ión sulfato sobre la absorción de azufre, composición foliar y calidad del fruto en limonero Yema, por. F. G. Fernández, M. Caro y A. Cerda.-- Determinación del déficit de saturación hídrica (DSH) en hojas de cítricos y frutales, por A. León, A. Torrecillas, F. del Amor y M. C. Ruiz-Sánchez.-- Fraccionamiento de compuestos de fósforo en flores de Prunus armeniaca durante las etapas de la floración, por Ma Parra y T. Parra.-- Determinación de déficit hídricos nocivos en tejidos foliares de cítricos y frutales, por A. León, A. Torrecillas, F. del Amor y M. J. Sánchez-Blanco.-- Influencia de la aplicación de Edta-Fe y arcilla en judía (Phaseolus vulgaris, L.). Efecto sobre la absorción y distribución de macronutrientes, por I. Agui y M. Gómez-- Estudio del efecto de la presión osmótica del medio nutritivo sobre la composición del fruto de tomate (Lyropersicum eculentum), por Ma P. Sánchez Conde.-- Composición mineral y relaciones fisiológicas de piensos utilizados en la alimentación de vacuno de lidia, por M. Barroso, J. M. Hernández, J. M. Murillo, M. Chaves y A. Troncoso.-- Microbiología. Investigación de la precipitación de carbonato cálcico en la solubilización de fosfatos, por I. Pérez-García, M. A. Rivadeneyra, V. Salmeron y A. Ramos-Cormenzana.—Ecología. Predicción de parametros climáticos de interés ecológico en Galicia: y III. Evapotranspiración potencial y balance hídrico, por R. Retuerto, F. Ucieda y A. Carballeira.—Trabajos recapitulativos. Las clases de fosfatos, su disponibilitlad en suelos agrícolas y otros trabajos relacionados con el elemento fósforo. Parte II. Procesos de adsorción-desorción y estudios sobre fertilidad de suelos y nutrición vegetal, por P. de Arambarri.-- BibliografíaPeer reviewe