Atención farmacéutica especializada: polifarmacia en mayores, problemas y soluciones asociados

[Resumen] Debido al llamativo aumento de la esperanza de vida, cada vez persisten más las pluripatologías asociadas a la edad dando lugar así a una necesidad de sistemas socio-sanitarios para cubrir las demandas específicas de este sector poblacional. La polimedicación, puede producir diversidad de resultados negativos tanto para los pacientes como para los centros sanitarios. Estos resultados negativos incluyen los efectos adversos de los medicamentos, hospitalizaciones, empeoramiento de la calidad de vida y afectación económica por el aumento innecesario del coste sanitario, entre otros. El objetivo del trabajo es demostrar cómo una atención farmacéutica especializada y un seguimiento farmacoterapéutico adecuado pueden resultar piezas fundamentales en el engranaje de la buena calidad de vida de los mayores, reduciendo o eliminando problemas relacionados con los medicamentos a través de una variedad de acciones, como disminuir el número de fármacos empleados, prevenir y detectar las reacciones adversas, aumentar el cumplimiento terapéutico, mejorar el conocimiento terapéutico del enfermo y en definitiva, mejorar la calidad de vida de los pacientes. Se concluye que las intervenciones de la Atención Farmacéutica Especializada son imprescindibles para mejorar los resultados farmacoterapéuticos de los polimedicados y reducir los costes sociosanitarios.[Abstract] Due to the striking increase in life expectancy, ever more persist the pluripatology associated with the age giving rise to a need for socio-sanitary systems to meet the specific demands of this population sector. The polimedicación can produce negative results for both patients and health care diversity. These negative outcomes associated with medications include the adverse effects of medications, hospitalizations, worsening of the quality of life and economic affection as the unnecessary increase in health costs. The objective is to demonstrate as a specialized pharmaceutical care and appropriate pharmacotherapy follow-up may be key pieces in the machinery of the good quality of life of our elderly people, by reducing or eliminating problems related to medications through a variety of interventions, such as reducing the number of drugs used to avoiding self-medication, prevent and detect adverse drug reactions increase treatment adherence, enhance the therapeutic knowledge of illness and ultimately improve the quality of life of patients. This monographic review concludes that the interventions of the specialized pharmaceutical care are essential to improve the results available from the patients. It is also helpful to reduce social costs.Traballo fin de mestrado (UDC.FCS). Mestrado Universitario en Xerontoloxía. Curso 2011/2012

Development of a Tissue-Mimicking Brain Phantom for Neurosurgical Pre-Operative Planning and Training

Direct physical intervention in the treatment of patients in the area of neurosurgery represents a high risk which can be minimized with the employment of 3D physical models. These models provide a thorough physical display in 3D with detailed information related to the morphology of internal structures and their spatial location with surrounding structures. The aim of this study was to develop a brain substitute material based on gelatin that simulates the mechanical properties of brain tissue. Tissue mimicking materials were developed by matching the mechanical properties of porcine brain tissue under compressive loading at strain rates typical of surgical procedures. A brain phantom was fabricated using the tissue mimicking material, the brain (cortex and internal structures) and skull were created in a 3-step process where molds were fabricated with a 3D modeling software, printed in Polylactic Acid (PLA) and finally cast with brain tissue-mimicking material. To further test the quality of the developed material, a haptic test was conducted at Clemson University. A total of 22 bioengineering students assessed the haptic sense of two different tissue-mimicking material brain phantoms comparing them with real brain tissue. It was possible to fabricate two brain substitute materials that resembled the mechanical properties of brain tissue which were used to recreate patient-specific brain replicas in the form of tissue mimicking phantoms. These brain phantoms provide a realistic haptic sense similar to brain tissue which realism has potential as an educational tool and preoperative planning device for neurosurgery procedures

Environmental education, citizenship & participation

Este artículo es una reflexión profesional que retoma la complementariedad existente entre la Educación Ambiental y la participación ciudadana, y la necesidad de transitar hacia una nueva perspectiva educativa que estreche lazos entre el medio ambiente y el ser humano en pro de una convivencia más acorde a las necesidades actuales del planeta. Una educación ambiental que debe promover la adquisición de una conciencia, valores y comportamientos que beneficien la participación eficiente de la ciudadanía en el proceso de toma de decisiones con respecto al entorno en el que se vive. Y es que, la educación ambiental y la participación ciudadana son dos de las mayores preocupaciones socio-ambientales y dos de los grandes desafíos del siglo XXI. Este documento tiene como objetivo proporcionar información e ideas sobre la importancia de los programas de educación ambiental para fomentar la participación ciudadana en la línea de una ciudadanía planetaria, lo que demuestra que la educación ambiental y la educación para la ciudadanía están estrechamente relacionadasThis article is a professional reflection that takes the complementarity between environmental education and public participation and the need to move towards new educational perspective narrow ties between the environment and human coexistence towards a more tailored to the needs current planet. Environmental education should promote the acquisition of an awareness, values and behaviors that benefit the effective participation of citizens in the decision-making process regarding the environment in which we live. And, environmental education and citizen participation are two of the biggest socio- environmental concerns and two of the great challenges of the XXI century. This document aims to provide information and ideas on the importance of environmental education programs to encourage citizen participation in the line of a global citizenship, demonstrating that environmental education and education for citizenship are closely related

Valoração da adoção de embriões humanos congelados do ponto de vista da filosofia moral, a ética laica e duas religiões monoteístas

The search for IVF efficacy leads to a higher embryo production than it is necessary for implantation; this results in an excess of embryos which are kept frozen. This amount of frozen embryos inevitably increases. The donation/adoption are among the possible solutions for these frozen embryos. However, this practice has objective ethical problems. This article considers the ethical aspects of the donation/adoption of frozen human embryos from the point of view of moral philosophy, from what we could call "secular ethics" and from two monotheistic religions: Muslim and Jewish.La búsqueda de la eficacia en la fecundación in vitro hace que se produzcan más embriones que los que se implantarán, lo que produce un excedente de embriones, que es congelado. Esto hace que ineludiblemente el número de embriones humanos congelados aumente. Entre las soluciones para dichos embriones humanos congelados está la donación/adopción de los mismos. Ineludiblemente esta práctica conlleva objetivos problemas éticos. En este trabajo se evalúa la eticidad de la donación/adopción de embriones humanos congelados desde la perspectiva de la filosofía moral, lo que podríamos llamar una “ética laica” y dos de las religiones monoteístas: la musulmana y la judía.A busca da eficácia na fecundação in vitro faz com que se produzam mais embriões dos que se implantarão, o que produz um excedente de embriões, que é congelado. Isto faz com que inquestionavelmente o número de embriões humanos congelados aumente. Entre as soluções para os ditos embriões humanos congelados está na doação/adoção dos mesmos. Ineludivelmente esta prática implica objetivos problemas éticos. Neste trabalho se avalia a eticidade da doação/adoção de embriões humanos congelados a partir da perspectiva da filosofia moral, o que poderíamos chamar uma “ética laica” e duas religiões monoteistas: a mulçumana e a judia

Literature y creativity in kindergarten

El diseño de la secuencia de enseñanza que se expone a continuación tiene como objetivo aproximar a los alumnos de Educación Infantil al conocimiento de una de las grandes obras de la Literatura Española (“Platero y yo”). La secuencia va dirigida a alumnos del tercer nivel de Segundo Ciclo de Educación Infantil y tendrá una duración de ocho días. Tras su puesta en práctica, las conclusiones más relevantes alcanzadas, son que a través de una metodología lúdica, activa y participativa, basada en los intereses y necesidades del alumnado, es posible trabajar contenidos de literatura en Educación Infantil.The design of the teaching sequence set out below aims to bring pupils from kindergarten to the knowledge of one of the greatest works of Spanish literature ("Platero y yo"). The sequence is designed for students in the third level of the second cycle of Pre-School education and the sequence lasts eight days. After the implementation, the most important conclusions reached are that through a playful, active and participative methodology based on the interests and needs of students, it is possible to work contents of literature in kindergarten children

Desarrollo, estabilidad y eficacia de biofertilizantes para la mejora del cultivo de plantas de tomate y maíz

[spa] El aumento de la población mundial en las últimas décadas, junto con la disminución de las tierras cultivables, ha puesto de manifiesto la necesidad de aumentar la producción agrícola para satisfacer la creciente demanda de alimentos de la población. Además, los fertilizantes químicos, utilizados en exceso, conllevan un uso excesivo de recursos limitados del planeta y una contaminación ambiental. En este sentido, el uso de microorganismos en agricultura ha demostrado ser beneficioso, reduciendo estas problemáticas y mejorando el crecimiento de los cultivos. Por estos motivos, el presente estudio tiene como objetivo el desarrollo y ensayo de biofertilizantes, definidos como insumos con una o varias especies de microorganismos, que aplicados a los cultivos mejoran la absorción de nutrientes, proveen de fitohormonas y/o regulan fitohormonas relacionadas con el crecimiento vegetal. Para ello, primeramente se ensayaron tres microorganismos en plantas de tomate, y se demostró la eficacia de Pseudomonas fluorescens, como bacteria promotora del crecimiento vegetal, Azotobacter vinelandii, como bacteria fijadora de nitrógeno, y Bacillus megaterium, como microorganismo solubilizador de fósforo. Por este motivo, se formularon tres fertilizantes sólidos: Fertilizante 6-4-4 con mezcla de microorganismos, fertilizante P30 con B. megaterium y fertilizante N7 con A. vinelandii. Por otro lado, se formularon tres biofertilizantes líquidos: Materia orgánica con mezcla de microorganismos, Superamino (basado en aminoácidos) con mezcla de microorganismos y Vegtop (basado en materia orgánica y aminoácidos) con mezcla de microorganismos. En los biofertilizantes sólidos, la reducción de la humedad demostró estabilizar los microorganismos incorporados en los formulados durante un año. Por otro lado, los microorganismos incorporados en los formulados líquidos fueron estables cuando se adicionó glicerol como protector celular. Por último, los biofertilizantes obtenidos se ensayaron en cultivos. Los fertilizantes 6-4-4 con mezcla de microorganismos y P30 con B. megaterium mostraron un aumento de la producción en plantas de tomate, independientemente de la dosis. Por otro lado, el fertilizante N7 con A. vinelandii consiguió un aumento de nitratos en el suelo cuando se ensayó en maíz. Además, el fertilizante de materia orgánica con mezcla de microorganismos en plantas de tomate fue el más eficaz, aumentando el rendimiento del cultivo y la calidad de los frutos. Los resultados obtenidos en los diferentes estudios demuestran que, por un lado, los formulados desarrollados mantienen la viabilidad de los microorganismos durante un año, y además, estos son efectivos en el cultivo de plantas de tomate, aumentando el rendimiento del cultivo y/o mejorando la calidad del fruto

Long-term evolution of Valsalva retinopathy: a case series

INTRODUCTION: Valsalva retinopathy may occur as a sudden, dramatic loss of central vision due to the premacular location of the haemorrhage. It has been described in different clinical settings, and there are several options for its treatment. CASE PRESENTATIONS: We present the cases of six patients with sudden visual acuity loss caused by Valsalva retinopathy, treated in our hospital in the last ten years. Case 1 involves a 32-year-old Caucasian man with a unilateral premacular haemorrhage after vomiting. A neodymium-doped yttrium aluminium garnet laser was used due to sufficient depth of the haemorrhage pocket, but it was unsuccessful. Instead, 20G pars plana vitrectomy was performed with excellent visual recuperation (visual acuity:1.0). Case 2 was of a 36-year-old Caucasian woman with Valsalva retinopathy after vomiting during pregnancy. A neodymium-doped yttrium aluminium garnet laser was also insufficient due to the coagulated blood. After labour, 23G pars plana vitrectomy was performed, and her final visual acuity was 1.0. Case 3 involved a 52-year-old Caucasian man with premacular bleeding due to vomiting after general anaesthesia. The haemorrhage did not resolve spontaneously, so 23G pars plana vitrectomy was performed, with excellent visual outcomes (visual acuity:1.0). Case 4 was a 24-year-old Caucasian man with a macular haemorrhage after thoracic trauma. He was observed over four weeks, after which we performed 23G pars plana vitrectomy, with complete visual restoration (visual acuity:1.0). Case 5 involved a 28-year-old man who developed a premacular bleed after vigorous dancing. After a period of observation, 23G pars plana vitrectomy was performed. A retinal break with a small haemorrhage around the break occurred, related to the peribulbar anaesthesia manoeuvers, but was resolved successfully. His final visual acuity was 1.0. Case 6 was a 22-year-old Caucasian woman who developed a premacular haemorrhage after weightlifting. Conservative management was performed due to the small size of her haemorrhage. It resolved spontaneously within one month, and her final visual acuity was 1.0. CONCLUSION: Valsalva retinopathy is a rare condition that causes a sudden loss of visual acuity. In patients with too dense haemorrhage, the best option could be the vitrectomy, with excellent visual outcomes, although surgery is not free of risks

Space Suit CO2 Washout During Intravehicular Activity

Space suit carbon dioxide (CO2) washout refers to the removal of CO2 gas from the oral-nasal area of a suited astronaut's (or crewmember's) helmet using the suit's ventilation system. Inadequate washout of gases can result in diminished mental/cognitive abilities as well as headaches and light headedness. In addition to general discomfort, these ailments can impair an astronaut s ability to perform mission-critical tasks ranging from flying the space vehicle to performing lunar extravehicular activities (EVAs). During design development for NASA s Constellation Program (CxP), conflicting requirements arose between the volume of air flow that the new Orion manned space vehicle is allocated to provide to the suited crewmember and the amount of air required to achieve CO2 washout in a space suit. Historically, space suits receive 6.0 actual cubic feet per minute (acfm) of air flow, which has adequately washed out CO2 for EVAs. For CxP, the Orion vehicle will provide 4.5 acfm of air flow to the suit. A group of subject matter experts (SM Es) among the EVA Systems community came to an early consensus that 4.5 acfm may be acceptable for low metabolic rate activities. However, this value appears very risky for high metabolic rates, hence the need for further analysis and testing. An analysis was performed to validate the 4.5 acfm value and to determine if adequate CO2 washout can be achieved with the new suit helmet design concepts. The analysis included computational fluid dynamic (CFD) modeling cases, which modeled the air flow and breathing characteristics of a human wearing suit helmets. Helmet testing was performed at the National Institute of Occupational Safety and Health (NIOSH) in Pittsburgh, Pennsylvania, to provide a gross-level validation of the CFD models. Although there was not a direct data correlation between the helmet testing and the CFD modeling, the testing data showed trends that are very similar to the CFD modeling. Overall, the analysis yielded results that were better than anticipated, with a few unexpected findings that could not easily be explained. Results indicate that 4.5 acfm is acceptable for CO2 washout and helmet design. This paper summarizes the results of this CO2 washout study

Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults

Aims and objectives: The objectives of this study were to assess the benefits of a car-egiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver).Background: Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years.Design and Methods: The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three- month training programme (treat-ment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi-experimental, pre- post design. We followed SQUIRE 2.0 guidelines for reporting.Results: The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cog-nitive ability and maintenance of functional ability. Within the treatment group, al-though everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub-items than did their peers in the professional caregiver group.Conclusions: The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health-related quality- of- life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work.Relevance to clinical practice: The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving.Funding information This work was supported by the Spanish Ministry of Education under Grant FPU15/03966. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Funding for open access charge: Universidad de Granada/CBUA