The pharmacist in the administration of the autonomous community of Andalusia

Objetivo: En primer lugar determinar las condiciones de acceso al Cuerpo de Farmacéuticos adscrito a la Administración Sanitaria de la Junta de Andalucía y en segundo lugar, conocer las distintas modalidades, cómo se han organizado los distintos cuerpos y cómo se estructuran en sus diferentes subgrupos. Además se analiza y define su régimen laboral. En tercer lugar, determinar la estructura orgánica y funciones de los distintos Cuerpos a los que tiene acceso el farmacéutico en la Administración de la Comunidad Autónoma Andaluza Metodología: Revisión de la normativa, vigente y derogada, que regula los cuerpos y el sistema de acceso para Farmacéutico en la Comunidad Autónoma Andaluza. Conclusión: La figura del farmacéutico como agente sanitario en la legislación autonómica andaluza, se encuentra regulada en distintas normas que exigen una interpretación de acuerdo a los criterios de la Ley 6/185 de Ordenación de la Función Pública de la Junta de Andalucía. Las distintas modalidades de ejercicio profesional, ya sea como agente sanitario de la autoridad autonómica o como profesional especializado se definen en distintos estatutos orgánicos necesarios para definir claramente sus funciones y responsabilidades.Objetive: First to determine the conditions of access to the Pharmacists' Body assigned to the Sanitary Administration of the Meeting of Andalusia and secondly, to know the different modalities, how the different bodies have been organized and how they are structured in his different subgroups. In addition his labor regime is analyzed and defines. Thirdly, to determine the organic structure and functions of the different Bodies to which the pharmacist has access in the Administration of the Autonomous Andalusian Community Methodology: Review of the regulation, in force and repealed, that regulates the bodies and the system of access for Pharmacist in the Autonomous Andalusian Community. Conclusion / discussion The figure of the pharmacist like sanitary agent in the autonomous Andalusian legislation, is regulated in different procedure that demand an interpretation of agreement to the criteria of the Law 6/185 of Arrangement of the Public Function of the Meeting of Andalusia. The different modalities of professional exercise, already be like a sanitary agent of the autonomous authority or as specialized professional they are defined in different organic necessary bylaws to define clearly his functions and responsibilities

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Optimización del tiempo de adquisición de imágenes dinámicas pet

El análisis de imágenes dinámicas obtenidas mediante tomografía por emisión de positrones (PET) proporciona medidas relacionadas con diversos procesos fisiológicos, para obtenerlas es necesario imágenes con un tiempo de adquisición relativamente largo (60-90 min), lo cual se ve reflejado en diversos problemas técnicos a nivel clínico y de investigación. Por lo anterior, optimizar el tiempo de adquisición es de suma importancia, sobre todo cuando se utilizan radiofármacos de vida media corta

Biodistribución y dosimetría interna de 68Ga-DOTA-UBI, radiofármaco para la evaluación específica de procesos infecciosos mediante PET

En los últimos años la medicina nuclear ha tenido un gran crecimiento gracias al desarrollo de nuevos radiofármacos para el diagnóstico de diversas patologías. En la Unidad Radiofarmacia-Ciclotrón de la Facultad de Medicina de la UNAM se desarrolló un radiofármaco para PET específico para procesos infecciosos utilizando un péptido catiónico antimicrobiano que se une a las membranas de las bacterias y es capaz de discriminar entre inflamaciones benignas de infecciones bacterianas

Measurement of percentage dose at the surface for a 6MV photon beam

AimTo evaluate if a radiochromic film (RF) Gafchromic EBT3 is suitable for surface dose measurements of radiotherapy treatments performed with a 6MV linear accelerator. Two aspects of RF were analyzed, beam energy dependence and surface dose determination.BackgroundThe measurements done at the surface or near the radiation source are done without charged electronic equilibrium and also have contribution of electron contamination. The detectors used for these measurements should not alter the dose to the target. To counteract these dosimetric problems it is proposed to do the measurements with radiochromic films which are thin detectors and have tissue equivalent properties.Materials and MethodsThe measurements were done using a Novalis linear accelerator (LINAC) with nominal energy of 6MV. To determine the surface dose, the total scatter factors (TSF) of three different field sizes were measured in a water phantom at 5cm depth. Energy dependence of EBT3 was studied at three different depths, using a solid water phantom. The surface measurements were done with the RF for the same field sizes of the TSF measurements. The value of the percentage depth dose was calculated normalizing the doses measured in the RF with the LINAC output, at 5cm depth, and the TSF.ResultsThe radiochromic films showed almost energy independence, the differences between the curves are 1.7% and 1.8% for the 1.5cm and 10cm depth, respectively. The percentage depth doses values at the surface measured for the 10cm×10cm, 5cm×5cm and 1cm×1cm were 26.1±1.3%, 21.3±2.4% and 20.2±2.6%, respectively.ConclusionsThe RF-EBT3 seems to be a detector suitable for measurements of the dose at the surface. This suggests that RF-EBT3 films might be good candidates as detectors for in vivo dosimetry

Association beetwen folic acid levels with cardiovascular risk biomarkers in high performance athletes

INTRODUCCIÓN: La deficiencia de ácido fólico y de vitamina B12 disminuye el rendimiento físico. Los atletas de alto rendimiento podrían tener una ingesta insuficiente de vitaminas del grupo B si se alimentan con dietas monótonas o de bajo consumo energético. Se ha demostrado que niveles bajos de homocisteína (Hcy) en sangre están normalmente asociados con la vitamina B12 y fólico, y con un menor riesgo cardiovascular, mostrándose el entrenamiento relacionado intenso con la hiperhomocisteinemia (HHcy) (> 12 mg / mL). OBJETIVO: Valorar el estado nutricional en B12 y fólico, y la situación cardiovascular en una muestra de deportistas de élite y estudiar el efecto de una suplementación en la población, donde el riesgo cardiovascular está presente. METODOLOGÍA: El estudio se ha llevado a cabo con 14 jugadores profesionales de balonmano > 18 años, llevando un seguimiento durante dos meses de entrenamiento intermitente intenso y suplementado con 200 mg/d de ácido fólico y 2,5μg/d de vitamina B12. Tanto al inicio como a los dos meses y a los cuatro meses se valoró la ingesta de ácido fólico y vitamina B12 (mediante recordatorio de 72h y el software Nutriber®), y se determinaron los niveles de B12, fólico y Hcy mediante enzimoinmunoensayo. CONCLUSIÓN /DISCUSIÓN: Tanto la ingesta de vitamina B12 como su nivel plasmático fueron adecuados. La ingesta de fólico estaba de acuerdo con las RDIs en humanos sanos, pero por debajo de la ingesta diaria recomendada para deportistas (300μg/d) en el 14,3% de los sujetos al comienzo del estudio; ninguno se mostró deficiente después de la suplementación. Otros autores recomiendan un consumo más alto de ácido fólico para entrenamiento intermitente intenso (400- 500 mg/d), y teniendo en cuenta estas recomendaciones, nuestros resultados muestran un 50-85,5%, respectivamente, de deportistas con una ingesta deficiente de ácido fólico. Aun así, los niveles de ácido fólico en plasma se encuentran dentro de los niveles de referencia (ref. 4,2-19,9 ng/ml), aunque se encuentra una asociación negativa significativa entre los niveles plasmáticos de fólico y Hcy (p <0,05). ¿Cuál es la ingesta real recomendada de fólico y vitamina B12 en deportistas con entrenamiento intermitente intenso? Los atletas de élite deben ser controlados mediante un exhaustivo asesoramiento y seguimiento nutricional y clínico. Es necesario el ajuste de las recomendaciones de vitamina B12 y ácido fólico para optimizar el rendimiento deportivo y prevenir problemas cardiovasculares comunes asociados.INTRODUCTION: The deficiency of folic acid and vitamin B12 reduced physical performance. Highperformance athletes may have an insufficient intake of vitamins of group B if they are fed monotonous diets with low energy consumption. It has been shown that low levels of homocysteine (Hcy) levels are usually associated with vitamin B12 and folic acid, and reduced cardiovascular risk, showing the intense training associated with hyperhomocysteinemia (HHcy) (> 12 mg / mL). OBJECTIVE: To assess the nutritional status of B12 and folate, and cardiovascular status in a sample of elite athletes and to study the effect of supplementation in the population where cardiovascular risk is present. METHODS: The study was conducted with 14 professional handball players> 18 years, followed for two months of intense intermittent training and supplemented with 200 mg / d of folic acid and 2.5μg / d of vitamin B12. At baseline and at two months and four months we evaluated the intake of folic acid and vitamin B12 (72h-recall and Nutriber ® software), and determined the levels of B12, folate and Hcy by enzyme immunoassay. CONCLUSION / DISCUSSION: Both the intake of vitamin B12 and its plasma level was adequate. Folate intake was according to the RDIs in healthy humans, but below the recommended daily intake for athletes (300μg / d) in 14.3% of subjects at baseline, none were poor after the supplementation. Other authors recommend a higher intake of folic acid to intense intermittent training (400 - 500 mg / d), and taking into account these recommendations, our results showed a 50-85.5%, respectively, Athletes with an inadequate intake of folic acid. Still, folic acid levels in plasma are within the reference levels (ref. 4.2 to 19.9 ng / ml), although there is a significant negative association between plasma levels of folate and Hcy (p <0.05). What is the recommended intake of folic real and vitamin B12 in intense intermittent training athletes? Elite athletes should be monitored by a comprehensive nutritional counseling and clinical monitoring. Adjustment is needed on the recommendations of vitamin B12 and folic acid to optimize athletic performance and prevent cardiovascular problems commonly associated