Influencia de los servicios de atención farmacéutica sobre los factores de riesgo cardiovascular, fidelización y satisfacción de los pacientes en la farmacia comunitaria (Proyecto FISFTES)

Objetivo: Analizar los efectos de los servicios de educación sanitaria (ES) y seguimiento farmacoterapéutico (SFT) sobre los factores de riesgo cardiovascular (FRCV) modificables y RCV (SCORE) de pacientes que acuden a una farmacia comunitaria, así como el grado de fidelización y satisfacción de los pacientes hacia los servicios ofrecidos.Material y métodos: Estudio experimental, longitudinal, aleatorio, por grupos: grupo educación sanitaria (GES)/ grupo seguimiento farmacoterapéutico (GSFT) llevado a cabo en 11 farmacias comunitarias españolas, entre abril y diciembre de 2011, en pacientes entre 18-85 años, con 1 o más FRCV.Variables estudiadas: RCV (SCORE), FRCV modificables, fidelización, satisfacción.Resultados: De los 79 pacientes que aceptaron participar, 72 finalizaron el estudio (36 GES, 36 GSFT). Los  pacientes con RCV leve se mantuvieron en el GES en un 36,0 % y aumentaron en el GSFT de un 47,0 % a un 53,0 %. Los pacientes con RCV alto se redujeron un 11,0 % en el GES y un 6,0 % en el GSFT. El grado de fidelización bueno se mantuvo en un 92,3 % y el grado de fidelización malo se redujo de 7,7 % a 3,8 %. El 65,5 % de los pacientes pagaría por el servicio de ES y el 86,4 % por el de SFT.Conclusiones: Ambos servicios mejoraron el RCV de los pacientes, aunque el SFT consiguió un 6 % más de pacientes con RCV leve, fidelizando al paciente a la farmacia comunitaria.  Después de 6 meses, siete de cada diez pacientes pagaría por el servicio de ES y nueve de cada diez por el de SFT

The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study

Background: Potential adverse drug events (PADEs) are defined as being potentially harmful unintentional medication discrepancies. Discrepancies regarding medication history (MH) often occur when a patient is being admitted to a hospital’s emergency department (ED); they are clinically important and represent a significant source of data regarding adverse drug events occurring during emergency admission to hospital. This study sought to measure the impact of pharmacist-acquired MH during admission to an ED; it focused on whether a patient’s current home medication regimen being available for a doctor when consulting a patient in an ED would have reduced potential adverse drug events.Method: A multicentre, double-blind, randomised, controlled parallel-group study was carried out at 3 large teaching hospitals in Bogota, Colombia. Two hundred and seventy patients who had been admitted to an ED were enrolled; each had a standardised, comprehensive MH interview, focusing on a patient’s current home medication regimen prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The main outcome dealt with comparing the intervention and control groups regarding the percentage of patients having at least 1 potential adverse drug event.Results: There were 811 PADE (3.35 per patient), 528 (65 %) on the standard care arm and 283 (35 %) on an intervention arm. Most PADEs were judged to have had the potential to cause moderate discomfort (42.6 %), 33.4 % were deemed unlikely to have caused harm and 23.9 % were judged to have had the potential to cause clinical deterioration.Conclusion: Many patients suffer potentially adverse drugs events during the transition of care from home to a hospital. Patient safety-focused medication reconciliation during admission to an ED involving a pharmacist and drawing up a history of complete medication could contribute towards reducing the risk of PADES occurring and improve follow-up of patients’ medication-based therapy

Reducción de la infección de localización quirúrgica en pacientes sometidos a una craneotomía

[spa] INTRODUCCIÓN: La infección de localización quirúrgica (ILQ) es la complicación postoperatoria más común entre los pacientes quirúrgicos. Una infección de localización quirúrgica después de una craneotomía (ILQ-CRAN) es una complicación con unas consecuencias devastadoras para el paciente. Se asocia a una alta morbilidad y requiere tratamiento antibiótico de larga duración, además de reintervención con recambio del colgajo óseo en muchas ocasiones. Su incidencia varía entre el 2,2 – 19,8%. Las ILQ-CRAN de órgano o espacio pueden comportar osteomielitis del hueso del cráneo y en algunas ocasiones meningitis o ventriculitis además de cerebritis. Aunque los bundles, o paquetes de medidas, están ampliamente demostrados en diferentes tipos de cirugía como la intervención más eficiente para la reducción de tasas de ILQ, no hay evidencia sólida respecto craneotomías. Los estudios hasta ahora publicados se centran en el momento intraquirúrgico, obviando las intervenciones pre y post cirugía. Tampoco hay consenso respecto la profilaxis antibiótica tópica, probados con éxito en otros tipos de cirugía, como la espinal o la traumatológica. Por todo lo anteriormente expuesto, parece evidente la necesidad de generar evidencia sólida sobre los factores de riesgo de desarrollar una ILQ-CRAN así como evaluar la utilidad de medidas específicas para su prevención

Small scale fracture behaviour of multilayer TiN/CrN systems: Assessment of bilayer thickness effects by means of ex-situ tests on FIB-milled micro-cantilevers

TiN/CrN multilayered PVD coatings are known to exhibit outstanding micromechanical properties and wear resistance. On the other hand, information on their small scale fracture behaviour is rather scarce. The present work aims to address it by testing to failure FIB-milled microbeams of multilayer TiN/CrN systems with different bilayer periods (8, 19 and 25 nm). In doing so, these micrometric specimens are first FIB notched, and thus deflected by means of a nanoindentation system. It is found that multilayer architecture translates into a beneficial synergic effect regarding critical load for reaching unstable failure; and thus, on energy absorption at fracture. Such behaviour is associated with small scale crack deflection as main toughening mechanism.Peer ReviewedPostprint (author's final draft

Influence of mechanical design on the evolution of the environmental impact of an induction hob

Purpose: This paper studies the influence of the mechanical design of five different induction hob generations (G1 to G5), which are currently installed in several million homes, on the evolution of their environmental impact. Methods: Life cycle assessment (LCA) has been applied using SimaPro 8.0.3.14 and EcoInvent v2.2 database. Samples of each design were obtained to generate a life cycle inventory. These induction hobs have been developed and produced in Zaragoza (Spain). The functional unit has been defined as all of the components influenced by the mechanical design of a cooktop with four induction hobs and a width of 60 cm, including every component except the electronic boards and the use phase, as they are not affected by the mechanical design. The limits of the LCA model include the production of the raw materials and energy, the manufacture and production processes, the distribution, and the end of life. Results and discussion: This study has revealed that the differences in mechanical design highly affect the environmental impact, especially in the environmental categories of abiotic depletion and human toxicity due to the consumption of copper, steel, and plastics. The manufacturing phase highly affects human toxicity, mainly due to the variation in PPS use. There is a decreasing tendency in the environmental impact from the first (G1) to the last generation (G5), as G5 causes the lowest burden in 8 out of 11 analysed categories. The different generations analysed in this paper show that the compact designs of induction hobs help to decrease the environmental impact, especially thanks to the reduction in wiring lengths. It is also important to enhance the wiring separation at the end-of-life phase, avoiding designs that hinder recycling processes. Conclusions: Compact designs and reduced wiring lengths help to reduce the environmental impact. The consumption of copper, steel, aluminium, and polymers creates considerable impact, although the end-of-life phase reduces the burden created by metals, thanks to recycling. Manufacturing processes such as injection moulding also produce a noteworthy impact, especially in ozone layer depletion due to the inclusion of solvents in EcoInvent’s injection moulding dataset. The impact caused by the distribution phase for this product is almost negligible in most categories

Disintegrability under composting conditions of plasticized PLA-PHB blends

The disintegration under composting conditions of films based on poly(lactic acid) poly(hydroxybutyrate) (PLA-PHB) blends and intended for food packaging was studied. Two different plasticizers, poly(ethylene glycol) (PEG) and acetyl-tri-n-butyl citrate (ATBC), were used to limit the inherent brittleness of both biopolymers. Neat PLA, plasticized PLA and PLA-PHB films were processed by melt-blending and compression molding and they were further treated under composting conditions in a laboratory-scale test at 58 +/- 2 degrees C. Disintegration levels were evaluated by monitoring their weight loss at different times: 0, 7, 14, 21 and 28 days. Morphological changes in all formulations were followed by optical and scanning electron microscopy (SEM). The influence of plasticizers on the disintegration of PLA and PLA-PHB blends was studied by evaluating their thermal and nanomechanical properties by thermogravimetric analysis (TGA) and the nanoindentation technique, respectively. Meanwhile, structural changes were followed by Fourier transformed infrared spectroscopy (FTIR). The ability of PHB to act as nucleating agent in PLA-PHB blends slowed down the PLA disintegration, while plasticizers speeded it up. The relationship between the mesolactide to lactide forms of PLA was calculated with a Pyrolysis-Gas Chromatography-Mass Spectrometry device (Py-GC/MS), revealing that the mesolactide form increased during composting. (C) 2014 Elsevier Ltd. All rights reserved.Authors thank Spanish Ministry of Economy and Competitiveness by financial support (MAT2011-28468-C02-01 and MAT2011-28468-C02-02). M.P. Arrieta thanks Generalitat Valenciana for Santiago Grisolia Fellowship (2011/007). Authors gratefully acknowledge Prof. Ma Dolores Salvador (Polytechnic University of Valencia) for her assistance with nanomechanical and optical microscope analysis.Arrieta, MP.; López Martínez, J.; Rayón Encinas, E.; Jiménez, A. (2014). Disintegrability under composting conditions of plasticized PLA-PHB blends. Polymer Degradation and Stability. 108:307-318. https://doi.org/10.1016/j.polymdegradstab.2014.01.034S30731810

Gas-phase formation of glycolonitrile in the interstellar medium

Our automated reaction discovery program, AutoMeKin, has been utilized to investigate the formation of glycolonitrile (HOCH2CN) in the gas phase under the low temperatures of the interstellar medium (ISM). The feasibility of a proposed pathway depends on the absence of barriers above the energy of reactants and the availability of the suggested precursors in the ISM. Based on these criteria, several radical–radical reactions and a radical–molecule reaction have been identified as viable formation routes in the ISM. Among the radical–radical reactions, OH + CH2CN appears to be the most relevant, considering the energy of the radicals and its ability to produce glycolonitrile in a single step. However, our analysis reveals that this reaction produces hydrogen isocyanide (HNC) and formaldehyde (CH2O), with rate coefficients ranging from (7.3–11.5) × 10−10 cm3 molecule−1 s−1 across the temperature range of 10–150 K. Furthermore, the identification of this remarkably efficient pathway for HNC elimination from glycolonitrile significantly broadens the possibilities for any radical–radical mechanism proposed in our research to be considered as a feasible pathway for the formation of HNC in the ISM. This finding is particularly interesing given the persistently unexplained overabundance of hydrogen isocyanide in the ISM. Among the radical–molecule reactions investigated, the most promising one is OH + CH2CHNH, which forms glycolonitrile and atomic hydrogen with rate coefficients in the range (0.3–6.6) × 10−10 cm3 molecule−1 s−1 within the 10–150 K temperature range. Our calculations indicate that the formation of both hydrogen isocyanide and glycolonitrile is efficient under the harsh conditions of the ISMThis work was supported by the Spanish Ministry of Science and Innovation (MICINN) through the CHEMLIFE project (Ref. PID2020-113936GB-I00). It was also partially supported by the Consellería de Cultura, Educación e Ordenación Universitaria (Centro singular de investigación de Galicia acreditación 2019–2022, ED431G 2019/03 and Grupo de referencia competitiva ED431C 2021/40) and the European Regional Development Fund (ERDF), and MICINN through Grant #PID2019-107307RB-I00. ALS thanks Xunta de Galicia for financial support through a predoctoral grantS

Análisis del efecto y grado de fidelización de los pacientes mediante los servicios de educación sanitaria y de seguimiento farmacoterapéutico ofertados desde la farmacia comunitaria (Proyecto Fisftes)

El estudio pretende analizar y comparar el grado de fidelización entre pacientes con uno o más factores de riesgo cardiovascular a los que se les realizarán únicamente educación sanitaria y pacientes con uno o más factores de riesgo cardiovascular a los que se les realizará seguimiento farmacoterapéutico. Cada farmacia participante en el proyecto instaurará un "servicio de control de los factores de riesgo cardiovascular" en el que se determinará de forma gratuita a cada paciente los niveles de presión arterial, colesterol total, triglicéridos, glucosa basal, peso, índice de masa corporal y riesgo cardiovascular. Todos estos parámetros se medirán a los cero, tres y seis meses. A los pacientes del grupo control se les realizará educación sanitaria y a los pacientes del grupo intervención se les realizará seguimiento farmacoterapéutico. Además, el estudio incluirá una "campaña antitabaco" para pacientes fumadores. En cada paciente se medirán y tratarán de forma individualizada todos los factores de riesgo cardiovascular con el objetivo de disminuir el riesgo cardiovascular de cada paciente. Para medir el grado de fidelización de los pacientes se realizará un registro mensual de todos los medicamentos y productos sanitarios que el paciente adquiera cada vez que visite la farmacia. En la visita cero y en la visita de los seis meses, se pasará a los pacientes un cuestionario anónimo para poder analizar el grado de satisfacción de los pacientes con la farmacia y con el servicio de seguimiento farmacoterapéutico, tras seis meses de educación sanitaria o seguimiento fármaco terapéutico

Calidad de vida y estrés laboral: la incidencia del Burnout en el deporte de alto rendimiento madrileño. Quality of life and job stress: Burnout among high performance sport professionals from Madrid.

<b>Resumen</b><p align="justify">En la literatura sobre la psicología de la salud en las organizaciones es generalmente aceptado que el Burnout (Síndrome de quemarse por el trabajo) aparece como consecuencia de un estrés laboral crónico excesivo que provoca una disminución de la habilidad en el desempeño de la actividad profesional y la aparición de diferentes problemas de salud en quien lo padece. El Burnout (Síndrome de quemarse por el trabajo) ha sido conceptualizado como un síndrome psicológico tridimensional de agotamiento emocional, despersonalización y baja realización personal en el trabajo. El propósito de este estudio es evaluar la presencia del Burnout en el colectivo de los profesionales del Alto Rendimiento Deportivo. Para ello se utilizó una muestra de 102 profesionales en activo empleados en 20 organizaciones representativas del fenómeno del Alto Rendimiento Deportivo de la ciudad de Madrid, España. Para medir la incidencia del Burnout (Síndrome de quemarse por el trabajo) se utilizó el Inventario de Burnout de Maslach. Los resultados obtenidos en este colectivo fueron de un 37,25% con altos niveles de Burnout (Síndrome de quemarse por el trabajo), 50% con nivel intermedio y 12,75% con bajo nivel. Estos profesionales presentan mayores niveles de baja realización personal en el trabajo (26,47%) y menores niveles de despersonalización (11,76%) y agotamiento emocional (10,78%). También se encontraron diferencias en los niveles cuando fueron comparados con otros profesionales del deporte.</p><b>Abstract</b><p align="justify">It is widely accepted in organizational and health psychology literatures that burnout is a consequence of chronic job stress wh+ºich causes an array of negative work related performance and health outcomes. Burnout was conceptualized as a 3-dimensional psychological syndrome consisting of emotional exhaustion, depersonalization and decreased personal accomplishment. The purpose of this study was to assess the presence of Burnout syndrome in High performance sport professionals. The sample consisted of 102 employees from 20 High performance sport organizations in the city of Madrid, Spain. Maslach Burnout Inventory (MBI) was used to measure burnout. Results point to the presence of the syndrome in this collective in the following percentages: high level of burnout (37,25%), intermediate level (50%) and low level (12,75%). This professionals displayed a higher level of personal accomplishment (26,47%) and lower levels of depersonalization (11,76%) and emotional exhaustion (10,78%). Differences were found in the levels when compared to others sport professionals.</p