Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

A Large-Scale Genetic Analysis Reveals a Strong Contribution of the HLA Class II Region to Giant Cell Arteritis Susceptibility

We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10−40, OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1∗04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10−43) and HLA-DQα1 47 (p = 4.02 × 10−46), 56, and 76 (both p = 1.84 × 10−45) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10−6, OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10−6, OR = 1.20), and REL (rs115674477, p = 1.10 × 10−5, OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function

Comparative response of biosensing platforms based on synthesized graphene oxide and electrochemically reduced graphene

Trabajo presentado al 14th International Conference on Electroanalysis (ESEAC 2012) celebrado en Eslovenia.-- et al.In this work, we report the synthesis and characterization of different kinds of graphene nanomaterials and their applicability to the development of biosensing platforms. We have synthesized graphene oxide (GO) following a modified Hummer's method, which has been subsequently reduced by electrochemical procedures. This reduction strategy precludes the employment of toxic solvents, leading to a product, electrochemically reduced graphene (ERG), free of contaminants. The characterization of the synthesized nanomaterials has been performed by different techniques such as X-ray diffraction spectroscopy (XRD), Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and atomic force microscopy (AFM). The information gathered by this combination of techniques confirms that i) the synthesis methodology affords the production of GO nanosheets, which present a typical lateral dimension of several hundreds of nanometers and a thickness value of 1.3±0.1nm, ii) the reduction step has been successfully achieved leading to graphene nanosheets free of oxygen functionalities with an average lateral dimension of at least 1micrometer and a thickness value of 2.8±0.2nm. Once we have confirmed that both materials have been successfully synthesized, we have studied the effect of the effect of their inclusion in biosensing platforms on the analytical response, selecting a lactate oxidase based biosensor as a model system. We have demonstrated that although the incorporation of GO or ERG to the device results in an enhancement of the analytical response of the resulting biosensing platform, the former system offers slightly better analytical properties and a more reproducible response than the ERG one. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.Funded by: Comunidad Autónoma de Madrid. Grant Numbers: S2009/PPQ-1642, S2009/MAT-1756; Ministerio de Ciencia e Innovación. Grant Numbers: CTQ2008-05775, CTQ2011-28157, FIS2009-12964-C05-04, CSD2007-00010; CSIC for a postdoctoral contract (Program JAE-DOC) and INTA for a “Rafael Calvo Rodés” FPI scholarshipPeer Reviewe

Neutral Red-carbon nanodots for selective fluorescent DNA sensing

Carbon nanodots modified with Neutral Red covalently inserted in the nanostructure (NR-CDs) have been prepared by a simple synthesis method based on microwave irradiation under controlled temperature and pressure. The synthetized NR-CDs have been characterized by different techniques, demonstrating the covalent bonding of Neutral Red molecules to the carbon dots nanostructure. Fluorescence activity of the prepare NR-CDs has been explored showing different interaction pathways with singled and doubled stranded DNA. These studies have been successfully applied to develop a new fluorescence DNA hybridization assay to the detection of a specific DNA sequence of Escherichia coli bacteria. Graphical abstract: [Figure not available: see fulltext.]Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work has been supported by the Spanish Ministerio de Ciencia, Innovación y Universidades (CTQ2017- 84309-C2-1-R; RED2018-102412-T) and Comunidad Autónoma de Madrid (SI3/PJI/2021–00341, P2018/NMT-4349 TRANSNANOAVANSENS Program

Lactate biosensor based on a bionanocomposite composed of titanium oxide nanoparticles, photocatalytically reduced graphene, and lactate oxidase

El pdf del artículo es la versión post-print.-- et al.We have developed a lactate biosensor based on a bionanocomposite (BNC) composed of titanium dioxide nanoparticles (TiO2-NPs), photocatalytically reduced graphene, and lactate oxidase. Graphene oxide was photochemically reduced (without using any chemical reagents) in the presence of TiO2-NPs to give graphene nanosheets that were characterized by atomic force microscopy, Raman and X-ray photoelectron spectroscopy. The results show the nanosheets to possess few oxygen functionalities only and to be decorated with TiO2-NPs. These nanosheets typically are at least 1 μm long and have a thickness of 4.2 nm. A BNC was obtained by mixing lactate oxidase with the nanosheets and immobilized on the surface of a glassy carbon electrode. The resulting biosensor was applied to the determination of lactate. Compared to a sensor without TiO2-NPs, the sensor exhibits higher sensitivity (6.0 μA mM-1), a better detection limit (0.6 μM), a wider linear response (2.0 μM to 0.40 mM), and better reproducibility (3.2 %). [Figure not available: see fulltext.] © 2013 Springer-Verlag Wien.This work has been supported by Comunidad Autónoma de Madrid (project No. S2009/PPQ-1642, AVANSENS), Ministerio de Ciencia e Innovación (project No. CTQ2011-28157) and Ministerio de Economía y Competitividad (project No. FIS2012-38866-C05-05).Peer Reviewe

Sistema modular tramo formación básica II

Continua el proyecto del curso 95-96 sobre la experimentación del sistema modular que se propone para la Educación Secundaria de personas adultas. Además presenta un modelo para solucionar el problema que se presenta en los centros de personas adultas con el alumnado recurrente. Está centrado en el tramo II y en el área del Lenguaje por ser donde mayores dificultades y estancamiento se han detectado. En el plan de trabajo se tiene en cuenta el conocimiento y valoración del alumnado, y se experimenta y trabaja la parte teórica, evaluando y corrigiendo las deficiencias que se puedan detectar. Elabora materiales didácticos y curriculares adaptados a las necesidades detectadas. Evalúa el grado de participación del alumnado y profesorado y los cambios en la organización del centro y el proceso de enseñanza-aprendizaje por medio de reuniones del equipo docente, fichas, pruebas, observación directa y sistemática e informes.Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Sistema Modular tramo formación básica

Se trata de la planificación y experimentación del Sistema Modular de Secundaria en educación de persona adultas. El objetivo es solucionar la situación de estancamiento del alumnado en el tramo de formación inicial. Para ello se recopila documentación, se elabora un plan de funcionamiento y se organizan grupos de trabajo en los ciclos I y II para trabajar las áreas de Matemáticas y Lenguaje. En el desarrollo práctico se tiene en cuenta el conocimiento y valoración del alumnado, y se experimenta y trabaja la parte teórica evaluando y corrigiendo las deficiencias que se puedan detectar. La valoración es positiva por la participación tanto del equipo directivo como de los agentes educativos implicados..Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE)

[ES] La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas.[EN] Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions

Red de coordinación y seguimiento de la titulación Máster Universitario en Prevención de Riesgos Laborales

El profesorado de la red participó durante el curso 2016/17 en un proyecto de coordinación y seguimiento de la titulación Máster Universitario en Prevención de Riesgos Laborales. En el curso 2016-17 la titulación Máster en Prevención de Riesgos Laborales desarrolla la quinta edición desde su implantación en el curso 2012-13. En el curso 2015-16 la titulación recibió informe favorable de renovación de acreditación emitido por la Agencia para la evaluación, acreditación y prospectiva del sistema de educación superior y de la innovación en la Comunitat Valenciana. En base al mismo la presente red pretende proponer acciones voluntarias para mejorar los criterios que recibieron una calificación de adecuada y contribuir así al plan de acciones de mejora de la titulación para el curso 2016-17. La red ha resultado ser un instrumento útil para coordinación y seguimiento de la titulación Máster Universitario en Prevención de Riesgos Laborales