¿Es la cartera de servicios un instrumento útil para la asignación de recursos farmacéuticos en atención primaria?

ObjetivoConocer si en ciertos equipos de atención primaria ha existido asociación entre el grado de cobertura en determinados servicios y el gasto en fármacos para las patologías incluidas en ellos.DiseñoEstudio descriptivo, retrospectivo.EmplazamientoAtención primaria. INSALUD. Área 1, Huesca.Mediciones y resultados principalesUsando los datos de coberturas de cartera de servicios de 1999 y de gasto en farmacia por subgrupos terapéuticos durante el período enero-octubre del mismo año se analizó:–El servicio de atención a pacientes crónicos: hipercolesterolemia, y se comparó con el gasto en el subgrupo B04A (hipolipemiantes/antiateromatosos).–El servicio de atención a pacientes crónicos: diabetes, y se comparó con el gasto en los subgrupos A10A (insulinas) y A10B (antidiabéticos orales).El gasto se expresó como gasto ajustado por 100 asegurados, usando para el ajuste los coeficientes del INSALUD (coeficiente activos, 0,732; coeficiente pensionistas, 0,268).La relación entre ambas variables se representó gráficamente por una nube de puntos.La existencia de asociación entre ellas se midió utilizando el coeficiente de correlación de Pearson.No se ha encontrado asociación estadísticamente significativa entre el resultado en coberturas y el gasto en farmacia en estos subgrupos.Hipercolesterolemia/hipolipemiantescoeficiente de Pearson, 0,334; IC del 95%, −0,115 a 0,669.Diabetes/antidiabéticos orales e insulinacoeficiente de Pearson < 0,1.ConclusionesExtraemos dos conclusiones:–Las diferencias en coberturas de los servicios analizados no tienen relación directa con el gasto en fármacos.–La cartera de servicios no resulta un buen método en la asignación de recursos para el consumo de fármacos.ObjectiveTo find whether in certain primary care teams an association exists between the level of coverage in determined services and expenditure on drugs for pathologies included in these services.DesignRetrospective descriptive study.SettingPrimary care, INSALUD, Area 1, Huesca.Measurements and main resultsUsing the data on coverage of the service portfolio in 1999 and pharmacy expenditure by therapeutic sub-groups during January-October of the same year, the following was analysed:–The service caring for chronic patients: Hypercholesterolaemia and comparison with expenditure in sub-group B04A (lipid-lowerers/ anti-atheroma drugs).–The service caring for chronic patients: Diabetes and comparison with expenditure in sub-groups A10A (insulin) and A10B (oral antidiabetic drugs).Expenditure was expressed as cost adjusted per 100 insured persons, using the INSALUD coefficients for the adjustment (active person coefficient: 0.732; pensioner coefficient: 0.268). The relationship between the two variables was represented graphically by a cloud of dots. Association between them was measured by Pearson's correlation coefficient. No statistically significant correlation was found between coverage and pharmacy expenditure in these sub-groups. Hypercholesterolaemia/lipidlowerers: Pearson's coefficient=0.334, 95% CI (−0.115 to 0.669). Diabetes/oral diabetic drugs and insulin: Pearson's coefficient < 0.1.ConclusionsThe differences in coverage of the services analysed bear no direct relationship to pharmacy expenditure. The portfolio of services is not a good method of allocation of pharmaceutical resources

Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines

BACKGROUND: Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. AIM: To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. METHODS: We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. RESULTS: 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. CONCLUSIONS: Our findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is

Análisis de variables morfométricas de Toxaster roulini Agassiz (Echinoides: Toxasteriidae) de la Formación Rosa Blanca, municipio de Zapatoca (Santander, Colombia)

En la secuencia aflorante de la Formación Rosa Blanca sobre la carretera Zapatoca - Mina el Platanalito, se&nbsp;recolectaron directamente de los estratos que los contenían, 188 especímenes de Toxaster roulini Agassiz&nbsp;del Aptiano (Camacho, 1979). Se realizaron las respectivas mediciones de las variables morfométricas de&nbsp;los especímenes colectados: Largo 1, largo 2, ancho, alto, alto ano, distancia de la boca, con el fin de evaluar&nbsp;el tipo de crecimiento de estos individuos y la influencia de dichas variables en la deformación de los&nbsp;mismos durante el proceso de fosilización. Estos datos se procesaron aplicando regresiones lineales y correlaciones que utilizaron el programa STATISTICA versión 4.0. En el sitio de colección los individuos&nbsp;que predominaron (un 74.4%) se encontraban entre los 20 y 33 mm de longitud, con un ancho entre 17 y&nbsp;30 mm, y una altura entre 11 y 18 mm, mostrando así, que éste es el tamaño común de la población de muestreo. Las variables alto ano y distancia de la boca constituyeron áreas específicas que no se vieron&nbsp;modificadas durante el crecimiento de los individuos, lo cual se confirma a partir de los bajos valores de&nbsp;correlación que presentan estas dos variables morfométricas con las demás. Los resultados de las regresiones&nbsp;y las correlaciones indican que el crecimiento de T. roulini Agassiz es isométrico y que además, existe una&nbsp;alteración en la variable altura inducida muy probablemente, por la presión de los estratos superiores durante&nbsp;el proceso de fosilización. Se plantea una hipótesis para la distribución en el hábitat de T. roulini Agassiz en la que los individuos de&nbsp;tamaños más pequeños, habitaban en la superficie del fondo marino y los individuos más grandes, se encontraban completamente enterrados en el fondo marino, basados en la posición del ano ya que para los&nbsp;primeros el ano se encontraba ubicado por debajo de la mitad de la altura total de cada individuo y para los&nbsp;más grandes, el ano se encontraba ubicado por encima de la mitad de la altura total de estos.In the outcroping sequence of the Rosa Blanca Formation on the highway Zapatoca - the Platanalito Mines&nbsp;188 specimens of Toxaster roulini Agassiz of the Aptiano (Camacho, 1979) were gathered directly from&nbsp;the strata that contained them. The respective measurements of the variable morphometrics of the collected&nbsp;specimens of Toxaster roulini Agassiz were carried out: long 1, long 2, width, high, high anus, distance of&nbsp;the mouth, with the purpose of evaluating the type of growth of these individuals and the influence of this&nbsp;variables in their deformation during the fossilization process. These data were processed applying lineal&nbsp;regressions and correlationships using the program STATISTICA version 4.0. In the sampling place the&nbsp;individuals that prevailed (74.4%) between 20 and 33 mm in length, between 17 and 30 mm in width, and&nbsp;between 11 and 18 mm in height, showing this way that this is the size common of the sampling population.&nbsp;The variables high anus and distance of the mouth constituted specific areas that were not modified during&nbsp;the growth of the individuals, which confirms from the low correlationship values that present these two&nbsp;variables morphometrics with the other ones. The results of the regressions and correlationships indicate&nbsp;that the T. roulini growth is isometric and alteration exists in the variable height very probably induced by&nbsp;the pressure of the superior strata during the fossilization process.&nbsp;We thinks about a hypothesis for the distribution in the habitat of T. roulini Agassiz in which the individuals&nbsp;of smaller sizes inhabited the surface of the marine bottom and the biggest individuals were totally buried in&nbsp;the marine bottom, based on the position of the anus for the first one the anus it is located bellow half of each&nbsp;individual's total height and for the biggest the anus it is located above half of the total height of these

Análisis de variables morfométricas de Toxaster roulini Agassiz (Echinoides: Toxasteriidae) de la Formación Rosa Blanca, municipio de Zapatoca (Santander, Colombia)

En la secuencia aflorante de la Formación Rosa Blanca sobre la carretera Zapatoca - Mina el Platanalito, se&nbsp;recolectaron directamente de los estratos que los contenían, 188 especímenes de Toxaster roulini Agassiz&nbsp;del Aptiano (Camacho, 1979). Se realizaron las respectivas mediciones de las variables morfométricas de&nbsp;los especímenes colectados: Largo 1, largo 2, ancho, alto, alto ano, distancia de la boca, con el fin de evaluar&nbsp;el tipo de crecimiento de estos individuos y la influencia de dichas variables en la deformación de los&nbsp;mismos durante el proceso de fosilización. Estos datos se procesaron aplicando regresiones lineales y correlaciones que utilizaron el programa STATISTICA versión 4.0. En el sitio de colección los individuos&nbsp;que predominaron (un 74.4%) se encontraban entre los 20 y 33 mm de longitud, con un ancho entre 17 y&nbsp;30 mm, y una altura entre 11 y 18 mm, mostrando así, que éste es el tamaño común de la población de muestreo. Las variables alto ano y distancia de la boca constituyeron áreas específicas que no se vieron&nbsp;modificadas durante el crecimiento de los individuos, lo cual se confirma a partir de los bajos valores de&nbsp;correlación que presentan estas dos variables morfométricas con las demás. Los resultados de las regresiones&nbsp;y las correlaciones indican que el crecimiento de T. roulini Agassiz es isométrico y que además, existe una&nbsp;alteración en la variable altura inducida muy probablemente, por la presión de los estratos superiores durante&nbsp;el proceso de fosilización. Se plantea una hipótesis para la distribución en el hábitat de T. roulini Agassiz en la que los individuos de&nbsp;tamaños más pequeños, habitaban en la superficie del fondo marino y los individuos más grandes, se encontraban completamente enterrados en el fondo marino, basados en la posición del ano ya que para los&nbsp;primeros el ano se encontraba ubicado por debajo de la mitad de la altura total de cada individuo y para los&nbsp;más grandes, el ano se encontraba ubicado por encima de la mitad de la altura total de estos.In the outcroping sequence of the Rosa Blanca Formation on the highway Zapatoca - the Platanalito Mines&nbsp;188 specimens of Toxaster roulini Agassiz of the Aptiano (Camacho, 1979) were gathered directly from&nbsp;the strata that contained them. The respective measurements of the variable morphometrics of the collected&nbsp;specimens of Toxaster roulini Agassiz were carried out: long 1, long 2, width, high, high anus, distance of&nbsp;the mouth, with the purpose of evaluating the type of growth of these individuals and the influence of this&nbsp;variables in their deformation during the fossilization process. These data were processed applying lineal&nbsp;regressions and correlationships using the program STATISTICA version 4.0. In the sampling place the&nbsp;individuals that prevailed (74.4%) between 20 and 33 mm in length, between 17 and 30 mm in width, and&nbsp;between 11 and 18 mm in height, showing this way that this is the size common of the sampling population.&nbsp;The variables high anus and distance of the mouth constituted specific areas that were not modified during&nbsp;the growth of the individuals, which confirms from the low correlationship values that present these two&nbsp;variables morphometrics with the other ones. The results of the regressions and correlationships indicate&nbsp;that the T. roulini growth is isometric and alteration exists in the variable height very probably induced by&nbsp;the pressure of the superior strata during the fossilization process.&nbsp;We thinks about a hypothesis for the distribution in the habitat of T. roulini Agassiz in which the individuals&nbsp;of smaller sizes inhabited the surface of the marine bottom and the biggest individuals were totally buried in&nbsp;the marine bottom, based on the position of the anus for the first one the anus it is located bellow half of each&nbsp;individual's total height and for the biggest the anus it is located above half of the total height of these

Distribución espacial y relación entre organismos fósiles. Breve síntesis paleoecológica de Toxaster colombianus y Thalassinoides

In a strata from the upper bioesparudite from the Rosablanca Formation that outcrops by the Zapatoca Bucaramanga road at 1430 meters sea level, a counting of organisms was carried out using a grid of 1 mt2&nbsp;divided into squares of 20X20 centimeters as sample units. The grid in mention was placed in a 5 meters&nbsp;long transect over the top of the strata. With the obtained data, using the Ludwing statistic package and the&nbsp;paried - quadrant variances method (PQV), it was determined that the spatial distribution patterns of the&nbsp;Toxaster colombianus correspond to an uniform model. Initially, a hypothesis was presented&nbsp; &nbsp;suggesting&nbsp;the existence of an assembly between the T. colombianus and the Thalassinoides. But applying a contingency&nbsp;frame of 2X2, it was proved that there was no such assembly between these two organisms. On the contrary,&nbsp;the value of intensity index suggests some sort of negative interaction between them.En un estrato de los niveles más superiores de las bioesparuditas de la Formación Rosablanca que aflora&nbsp;sobre la carretera que conduce desde Bucaramanga hasta Zapatoca a 1430 msnm, se realizó el conteo de los&nbsp;organismos que contenía la capa empleando como unidad de muestreo una cuadrícula de 1 m2 &nbsp;dividida en&nbsp;cuadrantes de 20x20 cm. La cuadrícula en mención se usó en un transecto de 5 metros de largo sobre el&nbsp;techo del estrato. Con los datos obtenidos se determinó que el patrón de distribución espacial de Toxaster&nbsp;colombianus corresponde a un modelo uniforme. Utilizando el paquete estadístico Ludwig y el método&nbsp;paried - quadrant variances (PQV), se planteó inicialmente la hipótesis en la que se sugiere la existencia de&nbsp;una asociación entre T. colombianus y los Thalassinoides, pero, aplicando un cuadro de contingencia de&nbsp;2x2 se comprobó que no existe ningún tipo de asociación entre estos organismos, por el contrario, el valor&nbsp;del índice de intensidad de asociación sugiere un tipo de interacción negativa entre ellos

Valproic acid restricts mast cell activation by Listeria monocytogenes.

Mast cells (MC) play a central role in the early containment of bacterial infections, such as that caused by Listeria monocytogenes (L.m). The mechanisms of MC activation induced by L.m infection are well known, so it is possible to evaluate whether they are susceptible to targeting and modulation by different drugs. Recent evidence indicates that valproic acid (VPA) inhibits the immune response which favors L.m pathogenesis in vivo. Herein, we examined the immunomodulatory effect of VPA on L.m-mediated MC activation. To this end, bone marrow-derived mast cells (BMMC) were pre-incubated with VPA and then stimulated with L.m. We found that VPA reduced MC degranulation and cytokine release induced by L.m. MC activation during L.m infection relies on Toll-Like Receptor 2 (TLR2) engagement, however VPA treatment did not affect MC TLR2 cell surface expression. Moreover, VPA was able to decrease MC activation by the classic TLR2 ligands, peptidoglycan and lipopeptide Pam3CSK4. VPA also reduced cytokine production in response to Listeriolysin O (LLO), which activates MC by a TLR2-independent mechanism. In addition, VPA decreased the activation of critical events on MC signaling cascades, such as the increase on intracellular Ca2+ and phosphorylation of p38, ERK1/2 and -p65 subunit of NF-κB. Altogether, our data demonstrate that VPA affects key cell signaling events that regulate MC activation following L.m infection. These results indicate that VPA can modulate the functional activity of different immune cells that participate in the control of L.m infection

Fluorescence enhancement of fungicide thiabendazole by van der Waals interaction with transition metal dichalcogenide nanosheets for highly specific sensors

Many molecules quench their fluorescence upon adsorption on surfaces. Herein we show that the interaction of thiabendazole, a widespread used fungicide of the benzimidazole family, with nanosheets of transition metal dichalcogenides, particularly of WS2, leads to a significant increase, more than a factor of 5, of the fluorescence yield. This surprising effect is rationalized by DFT calculations and found to be related to the inhibition of the intramolecular rotation between the benzimidazole and thiazole groups due to a bonding rigidization upon interaction with the MoS2 surface. This non-covalent adsorption leads to a redistribution of the molecular LUMO that blocks the non-radiative energy dissipation channel. This unusual behaviour does not operate either for other molecules of the same benzimidazole family or for other 2D materials (graphene or graphene oxide). Moreover, we found that a linear dependence of the emission with the concentration of thiabendazole in solution, which combined with the specificity of the process, allows the development of a highly sensitive and selective method towards thiabendazole determination that can be applied to real river water samples. An excellent detection limit of 2.7 nM, comparable to the best performing reported methods, is obtained with very good accuracy (Er ≤ 6.1%) and reproducibility (RSD ≤ 4.1%) in the concentration range assayedThe authors acknowledge financial support from the Spanish MINECO (MAT2017-85089-C2-1-R, MAT2017-85089-C2-2-R) and the EU via the ERC-Synergy Program (grant ERC-2013-SYG-610256 NANOCOSMOS) and Horizon 2020 Research and Innovation Program (Graphene Flagship-core2 – 785219) and the Comunidad Autónoma de Madrid (P2018/NMT-4349, TRANSNANOAVANSENS-CM and P2018/NMT-4367 FOTOART). J. I. M. acknowledges the support by the “Ramón y Cajal” Program of MINECO (grant RYC-2015-17730

Distribución espacial y relación entre organismos fósiles. Breve síntesis paleoecológica de Toxaster colombianus y Thalassinoides

In a strata from the upper bioesparudite from the Rosablanca Formation that outcrops by the Zapatoca Bucaramanga road at 1430 meters sea level, a counting of organisms was carried out using a grid of 1 mt2&nbsp;divided into squares of 20X20 centimeters as sample units. The grid in mention was placed in a 5 meters&nbsp;long transect over the top of the strata. With the obtained data, using the Ludwing statistic package and the&nbsp;paried - quadrant variances method (PQV), it was determined that the spatial distribution patterns of the&nbsp;Toxaster colombianus correspond to an uniform model. Initially, a hypothesis was presented&nbsp; &nbsp;suggesting&nbsp;the existence of an assembly between the T. colombianus and the Thalassinoides. But applying a contingency&nbsp;frame of 2X2, it was proved that there was no such assembly between these two organisms. On the contrary,&nbsp;the value of intensity index suggests some sort of negative interaction between them.En un estrato de los niveles más superiores de las bioesparuditas de la Formación Rosablanca que aflora&nbsp;sobre la carretera que conduce desde Bucaramanga hasta Zapatoca a 1430 msnm, se realizó el conteo de los&nbsp;organismos que contenía la capa empleando como unidad de muestreo una cuadrícula de 1 m2 &nbsp;dividida en&nbsp;cuadrantes de 20x20 cm. La cuadrícula en mención se usó en un transecto de 5 metros de largo sobre el&nbsp;techo del estrato. Con los datos obtenidos se determinó que el patrón de distribución espacial de Toxaster&nbsp;colombianus corresponde a un modelo uniforme. Utilizando el paquete estadístico Ludwig y el método&nbsp;paried - quadrant variances (PQV), se planteó inicialmente la hipótesis en la que se sugiere la existencia de&nbsp;una asociación entre T. colombianus y los Thalassinoides, pero, aplicando un cuadro de contingencia de&nbsp;2x2 se comprobó que no existe ningún tipo de asociación entre estos organismos, por el contrario, el valor&nbsp;del índice de intensidad de asociación sugiere un tipo de interacción negativa entre ellos

Narrow band imaging and serology in the assessment of premalignant gastric pathology

Background: Patient outcomes in gastric adenocarcinoma are poor due to late diagnosis. Detecting and treating at the premalignant stage has the potential to improve this. Helicobacter pylori is also a strong risk factor for this disease.Aims: Primary aims were to assess the diagnostic accuracy of magnified narrow band imaging (NBI-Z) endoscopy and serology in detecting normal mucosa, H. pylori gastritis and gastric atrophy. Secondary aims were to compare the diagnostic accuracies of two classification systems using both NBI-Z and white light endoscopy with magnification (WLE-Z) and evaluate the inter-observer agreement.Methods: Patients were prospectively recruited. Images of gastric mucosa were stored with histology and serum for IgG H. pylori and Pepsinogen (PG) I/II ELISAs. Blinded expert endoscopists agreed on mucosal pattern. Mucosal images and serological markers were compared with histology. Kappa statistics determined inter-observer variability for randomly allocated images among four experts and four non-experts.Results: 116 patients were prospectively recruited. Diagnostic accuracy of NBI-Z for determining normal gastric mucosa was 0.87(95%CI 0.82–0.92), H. pylori gastritis 0.65(95%CI 0.55–0.75) and gastric atrophy 0.88(95%CI 0.81–0.94). NBI-Z was superior to serology at detecting gastric atrophy: NBI-Z gastric atrophy 0.88(95%CI 0.81-0.94) vs PGI/II ratio