Interacciones farmacológicas relacionadas con el citocromo P-450: Presentación de un caso

ANTECEDENTES Varón de 75 años, diagnosticado de fibrilación auricular, hipertensión y urgencia urinaria, con calidad de vida e independencia óptima hasta hace dos meses.RAZÓN DE CONSULTA Un familiar del paciente hace la siguiente consulta en la farmacia: desde hace dos meses presenta rinitis, boca seca, no puede respirar bien, incluso habla “gangoso”. Se le diagnosticó parálisis del velo del paladar como causante de estos problemas. El paciente está muy angustiado y su familiar pregunta si esta situación pudiera estar provocada o empeorada por la medicación que utiliza

Sistema personalizado de dosificación (SPD), más allá del blíster: presentación de un caso clínico en un paciente con enfermedad de Alzheimer

Los sistemas personalizados de dosificación (SPD) constituyen un recurso primordial para mejorar la adherencia farmacoterapéutica desde la farmacia comunitaria. El farmacéutico comunitario (FC), al ofrecer el SPD como servicio profesional farmacéutico asistencial, debe aprovechar todo su potencial para alcanzar objetivos terapéuticos, además del acondicionamiento de la medicación en el blíster desechable, e incorporar Revisiones del Uso de los Medicamentos (RUM), seguimiento farmacoterapéutico y un contacto frecuente con familia y demás equipo de salud que atienden al paciente. En este caso, conscientes de la importancia de un seguimiento cercano, especialmente durante el confinamiento por la pandemia de COVID-19 y en una paciente con enfermedad de Alzheimer, se consigue mejorar la adherencia terapéutica gracias a un servicio farmacéutico que, más allá del blíster, incluye entrevistas con cuidadora y familia, revisiones del uso de medicación semanales, indicación farmacéutica y contacto directo con el médico de atención primaria (MAP) en situaciones complejas como, por ejemplo: aparición de nuevos problemas de salud y reacciones adversas a los medicamentos (RAM), provocados por medicamentos o dificultad para tragar sólidos. En este caso, debido al aislamiento provocado por el confinamiento, se incluyen además servicios de Atención Farmacéutica Domiciliaria (AFD) y dispensación a domicilio. Protocolizar y realizar una revisión de mediación semanal en el servicio de SPD mejora la adherencia y la consecución de objetivos terapéuticos. La colaboración entre médico, farmacéutico y familia facilita el seguimiento de los pacientes adheridos al servicio para conseguir resultados en salud

Coping strategies in health care providers as second victims: A systematic review

Aim: To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers. Background: The second victim phenomenon involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon. Materials and methods: A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese. Results: Seven hundred and eighty-three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers. Conclusions: The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America

Guia de valoración de las 14 necesidades básicas en un adulto sano

Se presenta una guía de valoración de las 14 necesidades básicas según el Modelo Conceptual de Virginia Henderson en un adulto sano que muestra la definición de la necesidad, así como la valoración inicial y los comportamientos adecuados para la satisfacción de cada necesidad

Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico

El fracaso renal agudo afecta entre un 1 y un 25% de los pacientes ingresados en unidades de cuidados intensivos, cifras que varían según la población y los criterios estudiados. Las complicaciones derivadas del fracaso renal agudo (hipervolemia, acidosis metabólica, hiperpotasemia, hemorragias) se tratan pero la mortalidad sigue siendo elevada a pesar de los avances tecnológicos de los últimos años ya que, habitualmente, el fracaso renal agudo está asociado a sepsis, insuficiencia respiratoria, heridas graves, complicaciones quirúrgicas o coagulopatías de consumo. El rango de mortalidad va desde un 30 a un 90%. Aunque no disponemos de una definición universalmente aceptada, la clasificación RIFLE aporta una herramienta operativa tanto para definir el grado de fracaso renal agudo como para homogeneizar el inicio de las técnicas de depuración extrarrenal y evaluar los resultados obtenidos. En consecuencia, las enfermeras que trabajan en una unidad de cuidados intensivos deben estar familiarizadas con esta afección, con su tratamiento (farmacológico o sustitutivo) y con la prevención de las posibles complicaciones. De igual manera han de ser capaces de detectar las manifestaciones de dependencia de cada una de las necesidades básicas e identificar los problemas de colaboración para conseguir un plan de cuidados individualizado

Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations

Background Health professionals can be 'second victims' of adverse patient events. Second victimhood involves a series of physical and psychological signs and symptoms of varying severity and is most prevalent among nurses and women and in intensive care units (ICUs). Previous research has described personal and organizational coping strategies. Aim The objective of this research is to determine the prevalence of second victimhood, focusing on psychological distress, among Chilean adult intensive care nurses and its relationship with the support provided by their organizations. Study Design A descriptive, correlational and cross-sectional study was conducted in seven intensive care units of Chilean hospitals. Results Of a sample of 326 nurses, 90.18% reported having been involved in an adverse event and 67% reported psychological distress resulting from the adverse event. Embarrassment was the most prevalent psychological symptom (69%). Only 2.8% reported that their organization had an action plan for professionals in the event of a serious adverse event. Participants who had spent longer working in an ICU reported more support from their organization around adverse events. Conclusion Two-thirds of Chilean adult intensive care unit nurses report psychological stress following an adverse event. These results should be assessed internationally because second victims have major implications for the well-being of health professionals and, therefore, for retention and the quality of care. Relevance to Clinical Practice Critical care leaders must actively promote a safe environment for learning from adverse events, and hospitals must establish a culture of quality that includes support programmes for second victims

https://doi.org/10.1016/j.chemosphere.2023.140364

The fate of the antibiotic sulfamethoxazole in amended soils remains unclear, moreover in basic soils. This work aimed to assess the adsorption, leaching, and biodegradation of sulfamethoxazole in unamended and biochar from holm oak pruning (BC)- and green compost from urban pruning (CG)-amended basic soil. Adsorption properties of the organic amendments and soil were determined by adsorption isotherms of sulfamethoxazole. The leachability of this antibiotic from unamended (Soil) and BC- (Soil + BC) and GC- (Soil + GC) amended soil was determined by leaching columns using water as solvent up to 250 mL. Finally, Soil, Soil + BC, and Soil + GC were spiked with sulfamethoxazole and incubated for 42 days. The degradation rate and microbial activity were periodically monitored. Adsorption isotherms showed poor adsorption of sulfamethoxazole in unamended basic soil. BC and CG showed good adsorption capacity. Soil + BC and Soil + GC increased the sulfamethoxazole adsorption capacity of the soil. The low sulfamethoxazole adsorption of Soil produced quick and intense sulfamethoxazole leaching. Soil + BC reduced the sulfamethoxazole leaching, unlike to Soil + GC which enhanced it concerning Soil. The pH of adsorption isotherms and leachates indicate that the anion of sulfamethoxazole was the major specie in unamended and amended soil. CG enhanced the microbial activity of the soil and promoted the degradability of sulfamethoxazole. In contrast, the high adsorption and low biostimulation effect of BC in soil reduced the degradation of sulfamethoxazole. The half-life of sulfamethoxazole was 2.6, 6.9, and 11.9 days for Soil + GC, Soil, and Soil + BC, respectively. This work shows the benefits and risks of two organic amendments, BC and GC, for the environmental fate of sulfamethoxazole. The different nature of the organic carbon of the amendments was responsible for the different effects on the soilPDC 2021-120744-I0

A hybrid classical/quantum approach to cluster fragmentation dynamics: Application to the vibrational predissociation of He2Cl2

A new hybrid classical/quantum method is proposed and applied to investigate the vibrational predissociation (VP) dynamics of the He2Cl2 complex. The full dimensionality of the system (assuming zero total angular momentum) is included in the method. The VP process He2Cl2 is dominated by a sequential mechanism of dissociation of the two van der Waals bonds. The hybrid approach describes the first weak bond fragmentation classically, and the second one quantum mechanically. The rotational distribution of the Cl2 fragment is calculated both with the hybrid method and with a fully classical trajectory simulation, and compared with the experimental distribution. The hybrid distribution is found to agree very well with the experimental one, and to involve a substantial improvement with respect to the classical result. © 1998 American Institute of Physics.This work has been supported by the D.G.I.C.Y.T. Grant No. PB95-0071 ~Spain! and the Spanish-French cooperation program PICASSO No. HF1996-0232.Peer Reviewe

Efficacy and Feasibility of an Osteopathic Intervention for Neurocognitive and Behavioral Symptoms Usually Associated With Fetal Alcohol Spectrum Disorder.

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