Successful treatment of granulomatous reactions secondary to injection of esthetic implants

In recent years, various injectable materials have come into use to improve esthetic appearance. OBJECTIVE: We describe the clinical and histopathologic aspects of two patients who received intradermal injections of an unknown dermal filler and the different diagnostic tools used to identify the unknown injected material (reflexion electron microscopy, electron dispersing x-ray) and discuss the possibility of a metastatic granulomatous reaction in one patient. We also describe two treatments for this complication and evaluate the legal considerations of the use of materials that have been adulterated and/or whose composition is unknown to the patient. METHODS: We present two patients who developed a granulomatous foreign-body reaction after the subcutaneous injection of an esthetic implant. We treated patient 1 with isotretinoin and 2 months later with doxycycline. We administered isotretinoin to patient 2. RESULTS: We observed a partial improvement in patient 1 after isotretinoin treatment and a remarkable improvement after administration of doxycycline. In patient 2, we observed an excellent response to isotretinoin. CONCLUSION: Isotretinoin and doxycycline, when administered separately, seem to offer effective treatment for reactions resulting from silicone implants. However, further studies that include a larger number of patients and those with reactions secondary to other fillers are clearly needed before the effectiveness of this treatment can be confirmed

BIM aplicado al patrimonio cultural

La asociación buildingSMART tiene como principal objetivo fomentar la eficacia en el sector de la construcción a través del uso de estándares abiertos de interoperabilidad con la metodología BIM (Building InformationMode-ling). Para ello, cuenta con una estructura de grupos de trabajo a nivel internacional para abordar diferentes cues-tiones al respecto. Sin embargo, en el ámbito del Patrimonio Cultural, no existe en la actualidad una aproximación internacional sobre el uso de BIM, y es por lo que buildingSMART Spanish Chapter ha puesto en marcha un grupo de trabajo abierto, denominado LEGEND–HBIM, y que está centrado en BIM aplicado al Patrimonio Cultural. De este modo, buildingSMART Spanish Chapter continua la laborde promover el uso de la metodología BIM a través de guías como esta, que supone una continuación de las guías uBIM publicadas en el año 2014

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Impacto clínico y económico de las intervenciones del farmacéutico clínico sobre antimicrobianos en el paciente crítico

Up to 52% of the patients in acute care hospitals may receive an antibiotic, and 30-50% of the treatments are estimated to be inadequate. Pharmacists have an important role in their optimization. In addition, critically ill patients may benefit more from pharmacist interventions (PIs). Few comparative studies have evaluated the clinical and the economic impact of PIs on antimicrobials in these patients, and none of them was conducted in Europe. Moreover, there have been no reviews analyzing the clinical and economic impact of interventions on antimicrobials conducted specifically by pharmacists (not by a multidisciplinary group, even though it includes a pharmacist) in the hospital setting. Therefore, our main objective was to determine the clinical and economic impact of PIs related to antimicrobials in critical care. Firstly we conducted a review of the evidence in Pubmed from 2003 to March 2016 of the clinical and economic impact of PIs in the hospital setting, in general. Secondly, we developed a retrospective observational study in the Critical Care Area (CCA) of our university hospital to analyze the clinical and economic impact of the clinical pharmacist (CP) interventions (CPI) on antimicrobials over a 5-month period. Thirdly, we conducted another retrospective observational cohort study to determine the effectiveness of a specific intervention promoted by the CP, which consisted of adding inhaled antibiotics in critically ill patients with respiratory infections, as the role of this therapy in these patients remained uncertain. In the review, 23 studies were included. All of them had high risk of bias. Patient-specific recommendations were included in every study; five also included policy strategies and four education. Significant impact of PIs was found in 14 of the 18 studies (77.8%) that evaluated costs, 15 of the 20 (75.0%) that assessed treatment related outcomes, 12 of the 22 (54.5%) that analyzed clinical outcomes and 1 of the 2 studies (50.0%) that evaluated microbiological outcomes. None of the studies found significant negative impact of PIs. It could not be concluded that adding other strategies to patient-specific recommendations improves results. Acceptance of recommendations varied from 70 to 97.5%. Therefore, PIs on antimicrobials in the hospital setting improve clinical and treatment related outcomes, and decrease costs. This positive clinical and economic impact of the PIs was confirmed in our CCA. The CP performed 212 interventions in response to 212 Drug Related Problems (DRPs) detected during the study period, corresponding to 114 patients. Eighteen DRPs (8.5%) were medication errors. A total of 96.2% of the CPIs were considered important with improvement in patient care. None of the CPIs had any negative impact on patients. Physicians accepted 98% of the CPIs. We estimated a 10,905 decrease in costs as a result of CPIs (the estimation could vary from 374 to 127,772 in the worst and best case scenarios, respectively). This means that 4.8 were avoided per euro invested in the CP. The CP initiative of adding inhaled antibiotics to critically ill patients was also positive. We analyzed data from adults admitted to the CCA during a 2-year period with respiratory infections in which respiratory fluid samples were obtained. A total of 136 patients were included: 43 in the treated group (that received inhaled antibiotics in addition to systemic antimicrobials), 93 in the control group (that only received systemic antimicrobials). After adjusting for confounders, treated group had higher odds of clinical improvement (adjusted odds ratio: 7.13; 95% confidence interval: 1.17-43.3). There were no significant differences in creatinine clearance reduction between groups. In conclusion, clinical pharmacist interventions on antimicrobials in the hospital and critical care setting have a positive impact on clinical and treatment related outcomes, and decrease costs

A systematic review of drug allergy alert systems

Background and objective: Drug allergy alert systems (DAAS), have been considered an effective strategy to reduce preventable adverse drug events (ADEs), improving patient’s safety. To date, no review has been conducted analyzing characteristics of DAAS in the hospital setting. Therefore, the aim of this study is to identify, describe and summarize the DAAS used in hospitals. The secondary objectives are to analyse drug allergy alerts (DAA) characteristics, the override rate (OvR) and the clinical consequences of alert overrides. Methods: Searches were conducted in Medline and Cochrane Library to identify studies describing DAAS. Systems characteristics, generated alerts, DAA, OvR, and its clinical consequences were extracted and analyzed. Results: Twenty-eight articles were included in the review. Seventeen different electronic DAAS were identified, of which 53% were commercially available. Systems differed in drug allergy information and rules for generating alerts. DAA were generally interruptive, triggered by non-exact match at drug prescribing and when ignored, an override reason was mandatory. The OvR ranged from 43.7% to 97%. The main override reason given by pro- viders was that ‘patient had previously tolerated or had taken the drug without allergic reaction’. Clinical consequences of overriding DAA were only analyzed in four studies, with an ADE incidence between 0% and 6%. Conclusions: Different DAAS are used in hospitals with some degree of heterogeneity. Accurate and updated drug allergy information is important to generate only high value alerts. A regular review of DAAS and a standard- ization of alert rules, alert information and override reasons are necessary to optimize systems. Future studies should evaluate the impact of the DAAS aspects on preventing ADEs

A systematic review of drug allergy alert systems

Background and objective: Drug allergy alert systems (DAAS), have been considered an effective strategy to reduce preventable adverse drug events (ADEs), improving patient’s safety. To date, no review has been conducted analyzing characteristics of DAAS in the hospital setting. Therefore, the aim of this study is to identify, describe and summarize the DAAS used in hospitals. The secondary objectives are to analyse drug allergy alerts (DAA) characteristics, the override rate (OvR) and the clinical consequences of alert overrides. Methods: Searches were conducted in Medline and Cochrane Library to identify studies describing DAAS. Systems characteristics, generated alerts, DAA, OvR, and its clinical consequences were extracted and analyzed. Results: Twenty-eight articles were included in the review. Seventeen different electronic DAAS were identified, of which 53% were commercially available. Systems differed in drug allergy information and rules for generating alerts. DAA were generally interruptive, triggered by non-exact match at drug prescribing and when ignored, an override reason was mandatory. The OvR ranged from 43.7% to 97%. The main override reason given by pro- viders was that ‘patient had previously tolerated or had taken the drug without allergic reaction’. Clinical consequences of overriding DAA were only analyzed in four studies, with an ADE incidence between 0% and 6%. Conclusions: Different DAAS are used in hospitals with some degree of heterogeneity. Accurate and updated drug allergy information is important to generate only high value alerts. A regular review of DAAS and a standard- ization of alert rules, alert information and override reasons are necessary to optimize systems. Future studies should evaluate the impact of the DAAS aspects on preventing ADEs

Successful treatment of granulomatous reactions secondary to injection of esthetic implants

In recent years, various injectable materials have come into use to improve esthetic appearance. OBJECTIVE: We describe the clinical and histopathologic aspects of two patients who received intradermal injections of an unknown dermal filler and the different diagnostic tools used to identify the unknown injected material (reflexion electron microscopy, electron dispersing x-ray) and discuss the possibility of a metastatic granulomatous reaction in one patient. We also describe two treatments for this complication and evaluate the legal considerations of the use of materials that have been adulterated and/or whose composition is unknown to the patient. METHODS: We present two patients who developed a granulomatous foreign-body reaction after the subcutaneous injection of an esthetic implant. We treated patient 1 with isotretinoin and 2 months later with doxycycline. We administered isotretinoin to patient 2. RESULTS: We observed a partial improvement in patient 1 after isotretinoin treatment and a remarkable improvement after administration of doxycycline. In patient 2, we observed an excellent response to isotretinoin. CONCLUSION: Isotretinoin and doxycycline, when administered separately, seem to offer effective treatment for reactions resulting from silicone implants. However, further studies that include a larger number of patients and those with reactions secondary to other fillers are clearly needed before the effectiveness of this treatment can be confirmed