El seguimiento farmacoterapéutico: un componente de la calidad en la atención al paciente

The principal aim of management of the Quality of Care is to assure patient satisfaction, through theactive involvement of health care staff and the incorporation of strategies, whose main aim is to achievecontinuous improvement in clinical activities and to incorporate patient safety as one of its principlecomponents.The management of patient safety is a means to minimizing any possible harm to patients in careprocesses, including the use of medicines. The principles of patient safety can be applied to both levelsof patient care and involve all health care professionals. The risk management is an integral part ofpatient care. Patient safety depends on the solution of problems and the prevention of errors.The pharmacist’s role in patient safety is carried out through Pharmaceutical Care processes and especiallythrough Pharmacotherapy follow-up (PF), which aims to prevent, detect and resolve Drug TherapyProblems (DTP).One of the main difficulties associated with this field is the lack of uniformity of the results obtainedthroughout the different studies carried out, where differences in definitions occur, as in the classificationof drug problems themselves, where process and result are constantly intermingled: Adverse effect,undesirable events, medication errors, DTP, etc.The criteria for classifying such aspects should be uniform, so as to make common information available,which will enable pharmacists to obtain greater knowledge on prevalence, their types, causes, severityand consequences.There is a general desire to improve upon patient safety, to assess the technological processes involvedin evaluating effectiveness and safety, and to certify the establishments and health care professionalsresponsible for such processes.This same approach should also be applied to PF, which is subject to the same basic safety principles.As in the case of all work carried out within the health system, the work of the pharmacist involvesthe professional and ethical responsibility of making his knowledge, experience and methodology availableto his patients. Pharmacists now have the opportunity of making a significant contribution to patientsafety, both in general terms and more specifically in the use of medicines, in a field which is currentlyset for future development.La gestión de la Calidad Total busca la satisfacción del usuario, la implicación activa de los profesionalesresponsables de su salud y la incorporación de estrategias para la mejora continua de las actividadesclínicas, incorporando la búsqueda de la seguridad del paciente como componente principal.La gestión de la seguridad del paciente minimiza las lesiones no intencionadas atribuibles a procesosde la atención sanitaria, incluido el uso de medicamentos. Los principios de seguridad del paciente seaplican en ambos niveles asistenciales y a todos los profesionales sanitarios. Gestionar el riesgo escuidar al paciente. La Seguridad del paciente pretende resolver problemas y prevenir errores.La aportación del farmacéutico a la seguridad del paciente se realiza con la Atención Farmacéutica y enconcreto con el Seguimiento Farmacoterapéutico (SFT) que previene, detecta y resuelve ProblemasRelacionados con los Medicamentos (PRM).Uno de los principales problemas para avanzar, es la dificultad para homogeneizar resultados; existendiferencias en las definiciones, al igual que ocurre en el ámbito del medicamento, donde se mezclapermanentemente proceso y resultado: Efecto adverso, Acontecimiento no deseado, Errores de medicación,PRM, etc.Se ha de homogenizar la taxonomia; disponer de una información común permitiría conocer mejor laprevalencia, sus tipos, sus causas, su gravedad así como sus consecuencias.Se quiere caminar hacia la seguridad del paciente evaluando tecnologías su efectividad y su seguridad,acreditando establecimientos y acreditando competencia profesional.Este es el camino también para el SFT que comparte los principios básicos de calidad de la seguridaddel paciente.El farmacéutico tiene la responsabilidad profesional y ética de poner a disposición de los pacientes elconocimiento, la experiencia y el método, igual que las acciones emprendidas por los sistemas sanitarios.Existe la oportunidad de estar, de ser los responsables de esta aportación, porque la seguridad delpaciente, en general, y en relación al uso de los medicamentos en particular, va a desarrollarse

Woody and agricultural biomass diversity in torrefaction: A complete study in solid conversion and volatiles formation on TGA-GCMS

Nowadays, there is an increasing awareness on the importance of biomass waste as a renewable source of energy, materials and chemicals. In this context, the European project MOBILE FLIP aims at developing and demonstrating mobile conversion processes suitable with various underexploited agro- and forest based biomass resources in order to produce energy carriers, materials and chemicals. One of these processes is torrefaction, which consists in a mild thermal treatment, occurring typically between 200 and 300°C during a few tens of minutes in a default-oxygen atmosphere. Please click on the file below for full content of the abstract

La Atención Farmacéutica, requisito para conseguir una atención sanitaria de calidad y basada en la evidencia científica

La salud es un concepto condicionado por diversos determinantes que conjuntamente interactúan y condicionan laaparición y la extensión de alteraciones en la salud de las poblaciones. Por eso es ya evidente la limitada capacidadde los servicios de salud para ser eficaces contra la enfermedad y es necesario articular políticas que involucren aotros sectores a fin de conseguir la máxima eficacia en las actuaciones para mejorar la salud.El medicamento y el farmacéutico han jugado un papel en la eficacia de los servicios sanitarios para resolverproblemas de salud; la Atención Farmacéutica entendida como un método sistemático para la detección, prevencióny resolución de los problemas relacionados con los medicamentos (PRM) se configura con enorme trascendencia paraobtener respuestas sobre los elementos que condicionan la aparición de los diversos PRM y la afectación de sueficacia terapéutica, aportando indicaciones que harán posible conseguir minimizar sus consecuencias.La Atención Farmacéutica responde al enfoque de salud que la OMS ha pretendido desde sus propuestas de Saludpara Todos en el año 2000 que han sido renovadas con la actual estrategia de Salud para Todos en el Siglo XXI.La investigación es una herramienta que se necesita desarrollar de manera eficaz y continua y en este sentido, lainvestigación aplicada en el campo de los PRM en patologías con estas características es la clave para arrojar luzsobre ellos, sus factores determinantes y las respuestas capaces de superar el efecto negativo que sobre la eficaciade los tratamientos tienen los PRM

Assessing the impact of woody and agricultural biomass variability on its behaviour in torrefaction through Principal Component Analysis

The influence of biomass macromolecular composition on its behaviour in torrefaction was statistically assessed through Principal Component Analysis (PCA), both in terms of solid conversion kinetics and volatile species released, in function of the operating conditions. The experimental data obtained in the torrefaction of 14 woody and agricultural biomass samples at lab-scale was analysed. Main biomass macromolecular composition on cellulose, hemicelluloses and lignin was shown to acceptably represent biomass diversity, which can be complemented by the extractives and ash content. Similitudes were found in deciduous and coniferous wood families, respectively, while agricultural and herbaceous crops were shown as more heterogeneous, both in terms of characterization and behaviour in torrefaction. Cellulose, hemicelluloses and lignin content strongly influenced solid and volatile species yields in torrefaction, while biomass family exhibited a lower impact. Ash content in potassium, phosphorous and silicon did not show any influence on the extent of solid degradation through torrefaction. A lower variability was found in solid degradation profiles from woods, while agricultural crop behaviour was more heterogeneous. Different volatile species were released from biomass samples from the same family. Furthermore, different production profiles were found for volatile species chemically close, except for deciduous wood. These results indicate that, when modelling biomass torrefaction, solid mass loss can be represented by an exemplar of deciduous and coniferous wood, while several species would be required for the agricultural family. The variability of the volatile species release would require the consideration of several volatile species and several biomass samples per famil

LA VISITA DOMICILIARIA COMO UNA HERRAMIENTA PARA LA DETECCIÓN DE LA VIOLENCIA HACIA EL ADULTO MAYOR

The violence towards the elderly is a problem that requires the sensitivity from the health team to be noticed. A fundamental tool for the detection of this phenomenon within the primary health care, are house calls, because they allow a comprehensive evaluation of de user, his/her family and/or carers, taking into consideration the physical, social, financial and psychological aspects, that may influence his/her health and become risk factors for the violence to take place. This evaluation makes possible to survey the phenomenon and carry out the necessary interventions with a bioethical perspective to allow putting into practice every one of its principles as in psychological violence and in sexual, physical and financial violence. An effective survey provides the possibility to improve the quality of life of the elderly under our assistance.La Violencia contra el Adulto Mayor, es un problema que requiere de sensibilización por parte del equipo de salud para ser visualizado. Una herramienta fundamental para la detección de este fenómeno dentro de la Atención Primaria en Salud es la Visita Domiciliaria, ya que permite una valoración integral del usuario, su familia y/o cuidadores, tomando en cuenta aspectos físicos, sociales, económicos y psicológicos, que puedan influir en su salud y ser factores de riesgo para que ocurra violencia. Esta valoración entrega la posibilidad de pesquisar el fenómeno y realizar las intervenciones necesarias con una perspectiva bioética, que permita poner en práctica cada uno de sus principios tanto en la violencia psicológica, sexual, física, como económica. Una pesquisa efectiva entrega, la posibilidad de mejorar la calidad de vida de los Adultos Mayores bajo nuestra atención

Quantifying the available capacity and resource needs for provision of CAR-T therapies in the National Health Service in Spain: a survey-based study

Leukaemia; Organisation of health services; TherapeuticsLeucemia; Organización de servicios de salud; TerapéuticaLeucèmia; Organització dels serveis sanitaris; TerapèuticaObjectives To estimate the readiness of Spanish National Health Service (NHS) hospitals to provide chimeric antigen receptor T cell (CAR-T), and to identify and quantify the different resources needed to provide CAR-T considering three scenarios defined by 10, 25 and 50 patients per centre per year. Design Targeted literature review and quantitative study using a questionnaire and telephone interviews. An algorithm was created to determine hospitals’ readiness based on their capacity and capability. All the requirements for quantification were assessed and validated by the steering committee, formed by members of the Spanish Group of Haematopoietic Transplantation and Cell Therapy. A weighting system (from 0 to 1) was established for capability quantification. For resources quantification, a scoring system was established, with 0 points representing the minimum and 3 points the maximum of additional resources that a hospital indicated necessary. Setting 40 Spanish hospital centres that perform allogeneic haematopoietic stem cell transplantation were invited to complete the questionnaire for capacity quantification, 28 of which provided valid responses. Nine hospitals participated in the interviews for resource quantification, eight of which had previously been designated by the Ministry of Health (MoH) to provide CAR-T. Outcome measure Current capacity of NHS Spanish sites to administer CAR-T under different theoretical scenarios with varying numbers of procedures, and the potential healthcare resources that would be needed to realise the theoretical capacity requirements. Results Four hospitals were optimally ready, 17 were somewhat ready and 7 were not ready. The actual extrapolated capacity of the currently designated MoH CAR-T sites would allow treatment of approximately 250 patients per year. Regarding healthcare resource needs, the numbers of haematologists, nurses and beds were the most important limiting factors, and those requiring further growth as patient numbers increased. Conclusions Increasing the number of CAR-T-qualified centres and/or increasing resources in the current designated sites are two potential strategies that should be considered to treat CAR-T-eligible patients in Spain.This study was conducted with a grant from GETH-TC (grant number: N/A)

Lethal and Sublethal Effects of Methoxyfenozide on the Development, Survival and Reproduction on of the Fall Armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae)

The lethal and sublethal effects of the ecdysone agonist methoxyfenozide on the fall armyworm, Spodoptera frugiperda (J. E. Smith), were investigated by feeding a methoxyfenozide-treated diet to fifth instars until pupation in doses corresponding to the LC10 and LC25 for the compound. Larval mortality reached 8% and 26% in the low and high concentration groups, respectively, on the seventh day of the experiment. A progressive larval mortality of 12% for the LC10 and 60% for the LC25 was observed before pupation. Treated larvae exhibited lower pupal weights, higher pupal mortality, presence of deformed pupae, and more deformed adults than untreated larvae. The incorporation of methoxyfenozide into the diet had a significant effect on the timing of larval development. The development period for males and females was about seven days longer than the controls for both concentrations tested. In contrast, the compound affected neither pupae nor adult longevity. Finally, S. frugiperda adults that resulted from fifth instars treated with methoxyfenozide were not affected in their mean cumulative number of eggs laid per female (fecundity), nor percentages of eggs hatched (fertility), or the sex ratio. Our results suggest that the combination of lethal and sublethal effects of methoxyfenozide may have important implications for the population dynamics of the fall armyworm

Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia

The patient plays a fundamental role in the attainment of good results in pharmacotherapy. Noncompliance,self-medication, or insufficient knowledge of the therapy being employed may provide asource for the causes of these negative clinical outcomes, otherwise known as medicine related problems(MRP). he Dader method was used in the evaluation, identification and classification of MRP. Theassociation of variables was established through the statistical Chi square test. Patient knowledge of themedicine, degree of compliance to therapy and self-medication were studied as causes of the negativeoutcomes encountered. 2556 patients were interviewed throughout the year that the study took place,giving a total of 2261 of valid cases. 33% presented an MRP as the cause of his/her visit to the hospitalemergency ward. Knowledge of the medicine, compliance and self-medication were only studied in thepopulation that presented an MRP and in this work it is demonstrated that these are aspects that areassociated with different dimensions of MRP. It is not possible to establish an association between theexistence or not of negative clinical outcomes in patients with the factors of knowledge of medication,compliance and self-medication. This is due to the fact that these variables are not attributable to thepatient himself, but rather are associated with the characteristics of each medicine.El paciente juega un papel primordial en la consecución de los resultados terapéuticos. El incumplimiento,la automedicación, o la falta de conocimiento del la farmacoterapia pueden ser causas de esosresultados clínicos negativos, denominados en ocasiones problemas relacionados con medicamentos(PRM). El método Dáder se utilizó para la evaluación, identificación y clasificación de PRM. Laasociación de variables se estableció mediante el estadístico chi cuadrado. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados como causa de estos resultados negativosde la medicación. Fueron entrevistados 2556 pacientes durante el año de estudio, resultando 2261 casosválidos. El 33 % presentaron un PRM como causa de visita a urgencias. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados solo en la población que presentó unPRM y se demuestra que son aspectos asociados a las distintas dimensiones de PRM. No es posibleestablecer asociación entre la existencia o no de resultados clínicos negativos en los pacientes con elconocimiento de la medicación, el cumplimiento y la automedicación, debido a que estas variables noson atributos del paciente sino que están asociadas a cada medicamento

Las inundaciones recientes en Galicia

Las inundaciones en Galicia tienen un carácter particular. Los factores que intervienen en su desarrollo son variados pero, en general, están más asociadas a eventos derivados de un largo período de abundante precipitación, propios de las condiciones climáticas en que se inscribe\ud la región, que a aquellos otros, menos frecuentes, de corta duradón y elevada intensidad. Por otra parte, al tratarse de un territorio en donde la casi totalidad de sus principales cursos fluviales se encuentran regularizados por embalses para el aprovechamiento hidroeléctrico, los efectos de estas crecidas sólo se dejan sentir en los pequeños cursos que carecen de dicho aprovechamiento, por lo que las consecuencias hidrológicas son limitadas en el espacio y en el tiempo. Finalmente, la ausencia de infomnación hidrométríca de base en estos pequeños cursos fluviales, nos ha llevado a presentar simulaciones de eventos en una de las cuencas más afectadas por las tradicionales inundaciones como es la del río Sar, en la comarca de A Mahía, que se extiende entre la ciudad de Santiago de Compostela y el núcleo urbano de Padrón, en el fondo de la ría de Arousa.The inundations in Galicia have a particular character. The factors that intervene in the development\ud are varied but, generally, are most associated to derived events of a long period of\ud abundant precipitation, proper of the climatic conditions in that inscribes the region, that those\ud other, less frequented, of short duration and elevated intensity.\ud On the other hand, upon be tried of a territory in where the almost totality of the course fluvial principals find regularized by dammed for profit hydroelectric, the grown effects of these alone let to feel in the little courses\ud that lack of tell profit, why the consequences hydro are limited in the space and in the time. Finally,\ud the absence of information hydrologic of little base in these fluvial courses, has at us carried\ud to present simulations of events in one of the most affected basins by traditional inundations\ud as is of the "río Sar", in the "comarca de A Mahía", that extend between the city of "Santiago de\ud Compostela" and the urban nucleus of "Padrón", in the background of to "ría de Arousa"

Estudio cinético de la fotodegradación del ión p-hidroxibencenodiazonio en medio polar

A study on the photodecomposition of p-hydroxybenzenediazonium ion (PDQ) has been made using chromatographicand spectrophotometric data obtained from UV-irradiated (254 nm) PDQ solutions in acetonitrile and aqueous media.The HPLC and HPLC-mass results indicate that 4-acetamidophenol is the main product formed after the irradiationof PDQ in acetonitrile. This is explained as a consequence of the initial formation of the aryl cation which is laterinvolved in a Ritter’s reaction. A kinetic analysis of the spectrophotometric data reveals that PDQ photodegradation isfaster in acetonitrile (observed rate constant (kobs) = 0.1442 s-1) than in acidifi ed acetonitrile (kobs = 0.009 s-1) indicatinga higher photostability of the protonated species derived from PDQ. The second order constant (0.062 M s-1) found forthe PDQ photodecomposition in phosphate buffer (pH 7) is explained in term of the equilibrium between protonatedand non-protonated species coming from the acid dissociation of PDQSe ha realizado un estudio sobre la fotodescomposición del ión p-hidroxibencenodiazonio (PDQ) basado en los datosespectrofotométricos y cromatográfi cos obtenidos con disoluciones de PDQ expuestas a irradiación UV (254 nm) enmedio de acetonitrilo y agua. Los resultados de HPLC y HPLC-masa (HPLC/MS) indican que el 4-acetamidofenoles el principal producto que se forma tras la irradiación de PDQ en acetonitrilo. Esto se explica como consecuenciade la formación inicial del catión arilo, que posteriormente participa en una reacción de Ritter. El análisis cinéticode los datos espectrofotométricos revela que la fotodegradación de PDQ es más rápida en acetonitrilo (constantede velocidad observada, kobs, = 0,1442 s-1) que en acetonitrilo acidifi cado (kobs = 0,009 s-1), lo que indica una mayorfotoestabilidad de la especie protonada derivada de PDQ. La constante de segundo orden (0,062 M s-1) encontradapara la fotodescomposición de PDQ en tampón fosfato (pH 7) se justifi ca por el establecimiento de un equilibrioentre las especies protonada y no protonada procedentes de la disociación ácida de PDQ