Sistemas Personalizados de Dosificación

Los SPD son una herramienta útil para mejorar la adherencia terapéutica de determinados perfiles de pacientes, y es un Servicio que puede prestarse desde la Farmacia Comunitaria. Sin embargo, dado el auge de este servicio no sólo para la Farmacia Comunitaria sino también para otros niveles asistenciales, como hospitales o centros sociosanitarios, existen en el mercado multitud de dispositivos, cada uno de características diferenciadoras, así como herramientas y dispositivos que ayudan u optimizan la elaboración de SPD. Por todo ello es conveniente saber la existencia de los diferentes tipos de SPD en el mercado y sus características, ventajas/inconvenientes y así poder elegir el más adecuado en cada caso. El Objetivo de este TFG es realizar una revisión de los diferentes tipos de SPD que existen en el mercado, analizar las ventajas e inconvenientes de cada uno y evaluar su adecuación en función del uso deseado y del perfil de paciente y tipo de farmacia Resultados y conclusiones: Se han identificado tres grandes grupos de Sistemas Personalizados de Dosificación: manuales, semiautomáticos y automáticos con diferentes subtipos dentro de los mismos. La evaluación de las ventajas e inconvenientes de cada uno nos permite concluir que para una farmacia que desee incorporar el Servicio de SPD como herramienta para mejorar la adherencia de sus pacientes, se recomienda iniciarse con SPD manual no reutilizable por la facilidad de su implantación y el coste mínimo que supone. En función del nivel de elaboración y las disponibilidades de inversión, podría plantearse un SPD semiautomático. Los robots automáticos deberían reservarse para un gran volumen de pacientes puesto que suponen una inversión muy elevada difícilmente amortizable para el actual volumen medio de elaboración de la farmacia española

Study Review of the advantages and disadvantages of Dose Administration Aids (DDA) and evaluation of their adequacy to the patient's profile and type of pharmacy

The Dose Administration Aids (DAA) are a useful tool to improve therapeutic adherence from the community pharmacy. However, there are many systems in the market with differentiating characteristics that you need to know in order to select the most appropriate for each pharmacy./nThe objective of this work has been to conduct a review of the different types of SPD that exist, analyze the advantages and disadvantages of each and evaluate their suitability according to the desired use, patient profile and type of pharmacy. To respond to these objectives, a review of the information has been carried out by different sources and methods. Three types of SPD have been identified: manual, semi-automatic and automatic, differing fundamentally in the closure of the blister, the type of sealing, the duration, the personnel involved and the speed of preparation./nThe selection of the DDA depends mainly on the expected volume and characteristics of the patient. In general, for a pharmacy that wants to start, a non-reusable manual DDA is recommended because of the ease of handling and minimum cost. Depending on the level of processing and the availability of investment, a semi-automatic DDA could be considered. Robots should be reserved for large volumes of processing because it is a high investment that is difficult to amortize for the current average level of preparation of Spanish pharmacies./n Los Sistemas Personalizados de Dosificación (SPD) son una herramienta útil para mejorar la adherencia terapéutica desde la farmacia comunitaria. Sin embargo, existen en el mercado multitud de sistemas con características diferenciadoras que es necesario conocer para poder seleccionar la que mejor se adapte al servicio de SPD. /nEl objetivo de este trabajo ha consistido en realizar una revisión de los diferentes tipos de SPD que existen, analizar las ventajas e inconvenientes de cada uno y evaluar su adecuación en función del uso deseado, perfil de paciente y tipo de farmacia. Para dar respuesta a estos objetivos, se ha realizado una revisión de la información por diferentes fuentes y métodos. Se han identificado tres tipos de SPD: manuales, semiautomáticos y automáticos, diferenciándose fundamentalmente en el cierre del blíster, el tipo de sellado, la duración, el personal implicado y la velocidad de elaboración./nLa selección del SPD depende fundamentalmente del volumen previsto y características del paciente. En general, para una farmacia que desee iniciarse se recomienda un SPD manual no reutilizable por la facilidad de manejo y coste mínimo. En función del nivel de elaboración y las disponibilidades de inversión, podría plantearse un SPD semiautomático. Los robots deberían reservarse para grandes volúmenes de elaboración por suponer una inversión elevada difícilmente amortizable para el actual nivel medio de elaboración de las farmacias españolas./n

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Antioxidant Activity, Total Phenolic and Flavonoid Contents in Floral Saffron Bio-Residues

Saffron spices are composed of dehydrated stigmas of Crocus sativus L. A large amount of bio-residues (stamens, tepals, and stigmas) is generated during the production of this spice (~92 g of bio-residues per 100 g of flowers). These bio-residues are usually discarded losing the chance to obtain interesting bioactive compounds from them. In this work, we use the saffron bio-residues as possible source of natural bioactive compounds. Different extraction conditions were applied obtaining hydrophilic and lipophilic components. The antioxidant activity of the bioactive compounds in the different conditions were analysed using the ABTS method developed by our team. Furthermore, the total content of phenolic compounds and flavonoids present in the bio-residues were estimated. We demonstrated that bio-residues contain a high amount of both phenolic and flavonoid compounds with a strong antioxidant potential effect. Moreover, we compared the antioxidant activities of saffron bio-residues (obtained from stamens, tepals, and stigmas). The extraction was made at two different pH (4.5 and 7.5) and measured (antioxidant activity, flavonoid and phenol content) at pH 7.5. Another extraction done at pH 7.5 measured antioxidant activity, flavonoid and phenol content at time 0 (t = 0 h) and after 24 h (t = 24 h) at pH 4.5 and 7.5. We point out that bioresidues contain antioxidant activity (up to 8.42 µmoles Trolox/100 g DW), total phenols (up to 111.91 µmoles EG/100 g DW) and total flavonoids (up to 109.25 µmoles QE/100 g DW) as bioactive compounds. The applicability of bio-residues as additives is promising, both in the pharmaceutical and in the food industry as nutraceuticals and phytogenics. The variability in pH and the colour originating from it must be taken into account

Effect of a sustained-release formulation of β-alanine on laboratory parameters and paresthesia in recreational trained men: a randomized double-blind placebo-controlled study

IntroductionBeta-alanine is a non-essential amino acid that has been a focus of increasing research by its role as ergogenic aid to improve muscle performance.MethodsA randomized, double-blind and controlled trial was conducted to determine the effect of a nutritional supplement of a sustained-release formulation of β-alanine in recreational trained men. The active product was an innovative sustained-release β-alanine microgranules powder blend, administered at high doses (15 g/day) divided into 3 intakes during 30 days. There were 10 participants in the experimental group and 9 in the placebo group, with a mean age of 22.5 ± 3.3 years. Participants were testing at baseline and at the end of study.ResultsIn the β-alanine group, there were statistically increases in serum triglycerides, LDL-cholesterol, and urea nitrogen at the end of the study as compared with baseline, although there were no differences with the control group. The occurrence of paresthesia, described above all as tickling, was the majority but presented VAS score less than 3/10 in almost all subjects.DiscussionMore studies are required to evaluate the changes in blood parameters that can be caused by high intake of β-alanine during a long period of time.Clinical trial registrationClinicalTrials.gov, identifier (NCT05334121)

The impact of the use of games on student academic performance: gamification as a way to improve the teaching of political, legal and social issues

El juego es una herramienta básica para el aprendizaje, aunque poco utilizada en el Espacio de Educación Superior. El uso de los juegos en las aulas puede contribuir no sólo a mejorar la percepción de la docencia por parte de nuestro alumnado (lo cual a su vez podría transmitirse en una mejor percepción de los estudios de la Universidad Complutense), sino que también pueden conducir a un mayor conocimiento de los procesos dinámicos en los que vivimos hoy día facilitando que los participantes comprendan mejor su naturaleza dinámica. Cuando se simula una situación, los participantes se dan cuenta de cómo funciona el sistema político en movimiento y se preparan para enfrentarlo en la vida real. Además, las simulaciones también son divertidas, hacen que los estudiantes se involucren más en el estudio y profundicen su conocimiento al fomentar su interés. En este Proyecto de Innovación Docente profesores de distintas facultades y universidades analizamos el uso del juego en las aulas y su impacto en el rendimiento de nuestro alumnado.Universidad Complutense de MadridDepto. de Ciencia Política y de la AdministraciónFac. de Ciencias Políticas y SociologíaFALSEsubmitte

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

International audienceImportance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.Design, setting, and participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Main outcomes and measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Conclusions and relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease