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

Influence of shielding arrangement on ECT sensors

This paper presents a full 3D study of a shielded ECT sensor. The spatial resolution and effective sensing field are obtained by means of Finite Element Method based simulations and are the compared to a conventional sensor's characteristics. An effective improvement was found in the sensitivity in the pipe cross-section, resulting in enhanced quality of the reconstructed image. The sensing field along the axis of the sensor also presents better behaviour for a shielded sensor.This job was financed for the Spanish Education and Science Ministry with a CICYT grant (reference DPI2002/04550/C07/04)

Pharmaceutical care, prerequisite for quality in evidence based health care

La salud es un concepto condicionado por diversos determinantes que conjuntamente interactúan y condicionan la aparición y la extensión de alteraciones en la salud de las poblaciones. Por eso es ya evidente la limitada capacidad de los servicios de salud para ser eficaces contra la enfermedad y es necesario articular políticas que involucren a otros 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 resolver problemas de salud; la Atención Farmacéutica entendida como un método sistemático para la detección, prevención y resolución de los problemas relacionados con los medicamentos (PRM) se configura con enorme trascendencia para obtener respuestas sobre los elementos que condicionan la aparición de los diversos PRM y la afectación de su eficacia 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 Salud para 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, la investigación aplicada en el campo de los PRM en patologías con estas características es la clave para arrojar luz sobre ellos, sus factores determinantes y las respuestas capaces de superar el efecto negativo que sobre la eficacia de los tratamientos tienen los PRM.Health is a concept conditioned by various determinants interacting jointly and which condtions the appearance and extension of the changes in the population´s health. Therefore the limited capacity of the health services in the fight against illnesses, thus it is necessary to make policies which includes the other sectors so as to obtain maximum efficiency in bettering health care performances. The drugs and the pharmacist have played an important role in the health´s services efficiency in solving health problems; Pharmaceutical Care understood as a systematic method for the detection, prevention and resolution of the problems related to drugs (PRM), is worked out with great significance so as to obtain answers about the elements which condition the appearance of the various PRM and the effectiveness of its therapeutical efficiency; supplying the indications which will make possible the lessening of its consequences. Pharmaceutical Care, answers the health view prevailing proposal, “Health for all in the year 2000”. This has been renewed by the actual strategy of “Health for All in the XXIst Century”. Research is a tool which needs to be developed in an efficient and continuous manner, and in this sense, research applied to the PRM field in pathologies which show these characteristics, is the key to throw some light on them, on their determinant factors and the answers which are capable of overcoming the negative effect which the PRM has over the treatments efficiency

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

Continuous Transmission of Spatially Coupled LDPC Code Chains

We propose a novel encoding/transmission scheme called continuous chain (CC) transmission that is able to improve the finite-length performance of a system using spatially coupled low-density parity-check (SC-LDPC) codes. In CC transmission, instead of transmitting a sequence of independent code words from a terminated SC-LDPC code chain, we connect multiple chains in a layered format, where encoding, transmission, and decoding are performed in a continuous fashion. The connections between chains are created at specific points, chosen to improve the finite-length performance of the code structure under iterative decoding. We describe the design of CC schemes for different SC-LDPC code ensembles constructed from protographs: a (J,K) -regular SC-LDPC code chain, a spatially coupled repeat-accumulate (SC-RA) code, and a spatially coupled accumulate-repeat-jagged-accumulate (SC-ARJA) code. In all cases, significant performance improvements are reported and it is shown that using CC transmission only requires a small increase in decoding complexity and decoding delay with respect to a system employing a single SC-LDPC code chain for transmission.This material is based upon work supported in part by the National Science Foundation under Grant Nos. CCF-1161754 and CCSS-1710920, in part by NSERC Canada, and in part by the Spanish Ministry of Economy and Competitiveness and the Spanish National Research Agency under grants TEC2016-78434-C3-3-R (AEI/FEDER, EU) and Juan de la Cierva Fellowship IJCI-2014-19150

Readout circuit with improved sensitivity for contactless LC sensing tags

In this work we present a novel technique to estimate the resonance frequency of LC chipless tags (inductor-capacitor parallel circuit) with improved sensitivity and linearity. The developed reader measures the power consumption of a Colpitts oscillator during a frequency sweep. The readout circuit consists of a Colpitts oscillator with a coil antenna, varactor diodes to change the oscillator frequency, analog circuitry to measure the power consumption and a microcontroller to control the whole system and send the data to a PC via USB. When an LC tag is inductively coupled to the oscillator, without contact, a maximum power peak is found. As shown by an experimental calibration using an LC tag made on FR4 substrate, the frequency of this maximum is related to the resonance frequency. Both parameters, power consumption and resonance frequency, present an excellent linear dependence with a high correlation factor (R 2 = 0.995). Finally, a screen-printed LC tag has been fabricated and used as relative humidity sensor achieving a sensitivity of (−2.41 ± 0.21) kHz/% with an R 2 of 0.946

Spatially coupled generalized LDPC codes: asymptotic analysis and finite length scaling

Generalized low-density parity-check (GLDPC) codes are a class of LDPC codes in which the standard single parity check (SPC) constraints are replaced by constraints defined by a linear block code. These stronger constraints typically result in improved error floor performance, due to better minimum distance and trapping set properties, at a cost of some increased decoding complexity. In this paper, we study spatially coupled generalized low-density parity-check (SC-GLDPC) codes and present a comprehensive analysis of these codes, including: (1) an iterative decoding threshold analysis of SC-GLDPC code ensembles demonstrating capacity approaching thresholds via the threshold saturation effect; (2) an asymptotic analysis of the minimum distance and free distance properties of SC-GLDPC code ensembles, demonstrating that the ensembles are asymptotically good; and (3) an analysis of the finite-length scaling behavior of both GLDPC block codes and SC-GLDPC codes based on a peeling decoder (PD) operating on a binary erasure channel (BEC). Results are compared to GLDPC block codes, and the advantages and disadvantages of SC-GLDPC codes are discussed.This work was supported in part by the National Science Foundation under Grant ECCS-1710920, Grant OIA-1757207, and Grant HRD-1914635; in part by the European Research Council (ERC) through the European Union's Horizon 2020 research and innovation program under Grant 714161; and in part by the Spanish Ministry of Science, Innovation and University under Grant TEC2016-78434-C3-3-R (AEI/FEDER, EU)

Calcifediol mensal versus calcifediol quinzenal no tratamento de pacientes com osteoporose.

GOALS: To evaluate the serum concentrations of 25-hydroxyvitamin D, 25(OH)D, in osteoporotic patients treated for one year with calcifediol. METHODS: We studied 156 patients with osteoporosis (23 men and 133 women) aged 71.9 ± 9.6 years who had been treated with calcifediol for at least one year. Ninety-two of them received 0.266 mg calcifediol every 15 days and he remaining 64 received the same dose once a month. Serum levels of 25(OH)D, intact PTH (iPTH), amino-terminal procollagen type I propeptide (PINP) and carboxy-terminal collagen type I telopeptide (CTX) were determined before and one year after the start of treatment . RESULTS: With both treatment regimens, a significant increase in 25(OH)D concentration was observed (p<0.001). The percentage of patients achieving 25(OH)D levels greater than 20 and 30 ng/ml was similar with both regimens, whereas that of patients exceeding 60 ng/ml was higher with the biweekly dose (p < 0.01 ) . The iPTH concentration significantly decreased after administration of calcifediol, although on this occasion there were no differences between the two forms of treatment. Both markers, PINP and CTX, similarly decreased in patients treated with antiresorptives (p < 0.0001), without these changes being related to the calcifediol regimen. CONCLUSIONS: A monthly administration of 0.266 mg calcifediol is adequate to achieve effective levels of vitamin D, and is also safe enough to avoid potentially harmful levels of vitamin D, so it would be preferable to the biweekly regimen in standard clinical practice.METAS: Avaliar as concentrações séricas de 25-hidroxivitamina D, 25 (OH) D, em pacientes osteoporóticos tratados por um ano com calcifediol. MÉTODOS: Foram estudados 156 pacientes com osteoporose (23 homens e 133 mulheres) com idade de 71,9 ± 9,6 anos que haviam recebido tratamento com calcifediol por pelo menos um ano. Noventa e dois deles receberam 0,266 mg de calcifediol a cada 15 dias e os 64 restantes receberam a mesma dose uma vez por mês. Os níveis séricos de 25 (OH) D, PTH intacto (iPTH), propeptídeo amino-terminal do procolágeno tipo I (PINP) e telopeptídeo carboxi-terminal do colágeno tipo I (CTX) foram determinados antes e um ano após o início do tratamento. RESULTADOS: Com ambos os regimes de tratamento, um aumento significativo na concentração de 25 (OH) D foi observado (p <0,001). A porcentagem de pacientes que atingiram níveis de 25 (OH) D maiores que 20 e 30 ng / ml foi semelhante com ambos os regimes, enquanto a de pacientes que ultrapassaram 60 ng / ml foi maior com a dose quinzenal (p <0,01) . A concentração de iPTH diminuiu significativamente após a administração de calcifediol, embora nesta ocasião não houvesse diferenças entre as duas formas de tratamento. Ambos os marcadores, PINP e CTX, diminuíram de forma semelhante em pacientes tratados com antirreabsortivos (p <0,0001), sem que essas alterações estivessem relacionadas ao regime de calcifediol. CONCLUSÕES: A administração mensal de 0,266 mg de calcifediol é adequada para atingir níveis eficazes de vitamina D, e também é segura o suficiente para evitar atingir níveis potencialmente prejudiciais desta, por isso seria preferível ao regime quinzenal na prática clínica habitual

Pabellón polideportivo cubierto en Cuéllar/ Segovia/España

The present work pretends to show out criteria and elements adopted to carry out a pavilion with a capacity of 1.000 spectators, in Cuellar, with three basic aims: security, functionalism and low cost.El presente trabajo pretende mostrar los criterios y adoptados para llevar a cabo el proyecto y ejecución de un pabellón cubierto para 1.000 espectadores, en Cuéllar, con tres objetivos básicos: seguridad, funcionalidad y economía

Pabellón polideportivo cubierto en Cuellar, Segovia/España

RESUMEN. El presente trabajo pretende mostrar los criterios y adoptados para llevar a cabo el proyecto y ejecución de un pabellón cubierto para 1.000 espectadores, en Cuéllar, con tres objetivos básicos: seguridad, funcionalidad y economía.ABSTRACT. The present work pretends to show out criteria and elements adopted to carry out a pavilion with a capacity of 1.000 spectators, in Cuéllar, with three basic aims: security, functionalism and low cost