Development and Validation of a Scoring System to Predict Response to Obeticholic Acid in Primary Biliary Cholangitis.

BACKGROUND & AIMS: Obeticholic acid (OCA) is the only licensed second-line therapy for primary biliary cholangitis (PBC). With novel therapeutics in advanced development, clinical tools are needed to tailor the treatment algorithm. We aimed to derive and externally validate the OCA response score (ORS) for predicting the response probability of individuals with PBC to OCA. METHODS: We used data from the Italian RECAPITULATE (N = 441) and the IBER-PBC (N = 244) OCA real-world prospective cohorts to derive/validate a score including widely available variables obtained either pre-treatment (ORS) or also after 6 months of treatment (ORS+). Multivariable Cox regressions with backward selection were applied to obtain parsimonious predictive models. The predicted outcomes were biochemical response according to POISE (alkaline phosphatase [ALP]/upper limit of normal [ULN]<1.67 with a reduction of at least 15%, and normal bilirubin), or ALP/ULN<1.67, or Normal range criteria (NR: normal ALP, alanine aminotransferase [ALT], and bilirubin) up to 24 months. RESULTS: Depending on the response criteria, ORS included age, pruritus, cirrhosis, ALP/ULN, ALT/ULN, GGT/ULN, and bilirubin. ORS+ also included ALP/ULN and bilirubin after 6 months of OCA therapy. Internally validated c-statistics for ORS were 0.75, 0.78, and 0.72 for POISE, ALP/ULN<1.67, and NR response, which raised to 0.83, 0.88, and 0.81 with ORS+, respectively. The respective performances in validation were 0.70, 0.72, and 0.71 for ORS and 0.80, 0.84, and 0.78 for ORS+. Results were consistent across groups with mild/severe disease. CONCLUSIONS: We developed and externally validated a scoring system capable to predict OCA response according to different criteria. This tool will enhance a stratified second-line therapy model to streamline standard care and trial delivery in PBC.

[Treatment adherence and effectiveness of extended-release antipsychotics in a hospital setting]. / Adherencia y efectividad de fármacos antipsicóticos de liberación prolongada en el ámbito hospitalario.

Schizophrenia is a chronic mental disorder that affects young patients in which antipsychotic treatment is essential for sympto- matic control and preventing progression. The high rate of relapse in these patients (10%) is mainly due to the abandonment of the medication. It is necessary to find tools to increase adherence. The long acting injectable antipsychotics (depot antipsychotics) represent a useful alternative in the recent years, since there is great evidence that they improve therapeutic compliance. OBJECTIVE: To evaluate the effectiveness and adherence to pharmacological treatment with depot antipsychotics in patients with psychotic disorders. METHODOLOGY: A retrospective longitudinal observational study was performed on a population of 89 subjects from Hospital Universitario Fundación Alcorcón (HUFA) with psychotic disorders, who received depot antipsychotics since September 2015 until June 2017. The incidences of new symptomatic episodes (assessed as visits to Emergency Department, general hospital admissions and psychiatric admissions) were compared at 6, 12, 24 months before and 6, 12, 14 months after the start of the depot treatment. RESULTS: There is a significant reduction in the relative risk of general and psychiatric admissions with all depot antipsychotics. Paliperidone Palmitate is superior to the others, being the only one that reduces the number of visits to general Emergencies. Aripiprazole only decreased the relative risk of psychiatric admissions. The depot antipsychotics used had a high adherence (73%). Among the causes of non-adherence to treatment (23%), the most important is non-compliance with the prescribed regimen. CONCLUSION: Depot antipsychotics are an effective alternative to improve therapeutic adherence in patients with psychotic disorders, which means a lower incidence of symptoms and lower hospital requirements.

[Inverse correlation between psychotic disorders and tumor development]. / Correlación inversa entre trastornos psicóticos y el desarrollo de tumores.

Patients suffering from psychotic disorders have an increased morbidity compared with control population. Moreover, these patients are prone to habits such as smoking or obesity, which in fact are risk factors for developing neoplasias. OBJECTIVE: The current study is aimed to determine the prevalence of oncologic processes (lung, colon and prostate cancer) among patients diagnosed with psychotic disorders. METHODS: A total of 365 patients from the Hospital Universitario Fundación Alcorcón (HUFA) were included in the study. All of them were diagnosed with a psychotic disorder from 2013 to 2016. RESULTS: Studying the prevalence of oncologic processes (lung, colon and prostate cancer) between both groups revealed a significant reduction in patients diagnosed with a psychotic disorder compared with the control populations (p-value <0,05). CONCLUSIONS: Even though patients diagnosed with a psychotic disorder have a considerable morbidity and several risk factors related with the development of neoplasias, we can conclude that these patients are less likely to suffer from the aforementioned types of cancer.

[Hematologic response predictor factors in adults with myelodysplastic syndromes (SMD) treated with cyclosporin A (CSA)]. / Factores predictivos de respuesta hematológica en adultos con síndrome mielodisplásico (SMD) tratados con ciclosporina A (CSA).

BACKGROUND: Myelodysplastic syndromes (MDS) are clonal diseases of hematopoietic cells. The International Prognostic Scoring System (IPSS) is the risk scale most employed in MDS. Cyclosporin A (CsA) has been used in the treatment of cytopenias in MDS. OBJECTIVE: To evaluate hematologic response and identify response predictive factors in adults with MDS treated with CsA. MATERIAL AND METHODS: Patients with MDS diagnosed according World Health Organization (WHO) classification were recruited from January 1997 to June 2012. All patients were classified with IPSS, IPSS revised (IPSS-R),WHO Prognostic Scoring System (WPSS), and WPSS revised (WPSS-R) risk scales. Cyclosporin A was administered orally at a dose of 5 mg/kg/day. Hematologic response was evaluated following the International Working Group for MDS (2006 version) criteria. RESULTS: Inclusion criteria were met by 32 patients. Median age was 56.5 years, with a median follow-up of 3.1 years. Hematologic response was 56.2% and erythrocyte independence transfusion was found in 42.9% of patients. Age,hemoglobin level, and WPSS at diagnosis were independent predictive factors for CsA response. Survival was longer in responder than in nonresponder CsA patients (p=0.06). CONCLUSIONS: Cyclosporin A induced hematologic response in >50% of patients with MDS aged <57 years, with Hb<8 g/dl and low WPSS at diagnosis.

Survival Differences in High-Risk Prostate Cancer by Age.

PURPOSE: Age is an established determining factor in survival in low-risk prostate cancer (PC), being this evidence weaker in high-risk tumors. Our aim is to evaluate the survival of patients with high-risk PC treated with curative intent and to identify differences across ages at diagnosis. METHODS: We did a retrospective analysis of patients with high-risk PC treated with surgery (RP) or radiotherapy (RDT) excluding N+ patients. We divided patients by age groups: < 60, 60-70, and > 70 years. We performed a comparative survival analysis. A multivariate analysis adjusted for clinically relevant variables and initial treatment received was performed. RESULTS: Of a total of 2383 patients, 378 met the selection criteria with a median follow-up of 8.9 years: 38 (10.1%) < 60 years, 175 (46.3%) between 60-70 years, and 165 (43.6%) >70 years. Initial treatment with surgery was predominant in the younger group (RP:63.2%, RDT:36.8%), and with radiotherapy in the older group (RP:17%, RDT:83%) (p = 0.001). In the survival analysis, significant differences were observed in overall survival, with better results for the younger group. However, these results were reversed in biochemical recurrence-free survival, with patients < 60 years presenting a higher rate of biochemical recurrence at 10 years. In the multivariate analysis, age behaved as an independent risk variable only for overall survival, with a HR of 2.8 in the group >70 years (95%CI: 1.22-6.5; p = 0.015). CONCLUSION: In our series, age appeared to be an independent prognostic factor for overall survival, with no differences in the rest of the survival rates.

Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study.

PURPOSE: Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. METHODS: We retrospectively analyzed patients with WM diagnosed between 1991 and 2019 from 24 centers in seven Latin American countries. The study outcomes were overall survival (OS) and progression-free survival (PFS). RESULTS: We identified 159 cases (median age 67 years, male 62%). Most patients (95%) were symptomatic at diagnosis. The International Prognostic Scoring System for WM (IPSSWM) at diagnosis was available in 141 (89%) patients (high-risk 40%, intermediate-risk 37%, and low-risk 23%). Twenty-seven (17%) patients were tested for MYD88L265P, with 89% (n = 24 of 27) carrying the mutation. First-line and second-line therapies were administered to 142 (89%) and 53 (33%) patients, respectively. Chemoimmunotherapy was the most commonly used first-line (66%) and second-line (45%) approach; only 18 (11%) patients received ibrutinib. With a median follow-up of 69 months, the 5-year OS rate was 81%. In treated patients, the 5-year OS and PFS rates were 78% and 59%, respectively. High-risk IPSSWM at treatment initiation was an independent risk factor for OS (adjusted hazard ratio: 4.73, 95% CI, 1.67 to 13.41, P = .003) and PFS (adjusted hazard ratio: 2.43, 95% CI, 1.31 to 4.50, P = .005). CONCLUSION: In Latin America, the management of WM is heterogeneous, with limited access to molecular testing and novel agents. However, outcomes were similar to those reported internationally. We validated the IPSSWM score as a prognostic factor for OS and PFS. There is an unmet need to improve access to recommended diagnostic approaches and therapies in Latin America.

Achievements and gaps to provide pre-exposure prophylaxis (PrEP) for women across the European Region - Results from a European survey study.

INTRODUCTION: The use of pre-exposure prophylaxis (PrEP) is a safe and effective prevention option to all people at substantial risk of HIV acquisition, irrespective of gender. However, in most European countries PrEP services focus on key populations, in particular men who have sex with men (MSM). This study aims to explore PrEP availability and implementation for women across the European region. METHODS: An online survey was sent to all members of Women Against Viruses in Europe (WAVE) from 50 countries in September 2019. It consisted of 19 questions, including both multiple choice and free text answers. RESULTS: In total, responses from 34 countries were included in the study (Western Europe n â€‹= â€‹12, Central Europe â€‹= â€‹12, Eastern Europe n â€‹= â€‹6). PrEP was accessible in 30 WHO European countries. More than half of them stated that PrEP was available for all groups at-risk of HIV acquisition (n â€‹= â€‹18), while in many countries PrEP was only available to MSM and transgender persons. Two-thirds of country respondents confirmed the availability of a national guideline for PrEP (n â€‹= â€‹23), of which six countries had specific recommendations for PrEP in women. The most cited obstacles for PrEP access were lack of information about PrEP, lack of political support, and high cost for the individual. Fifteen country respondents stated that there were specific obstacles for PrEP access for women, such as guidelines prioritizing MSM, women not being seen as a target population for PrEP, and lack of knowledge about which subgroup of women would benefit most from PrEP. Seven countries had made efforts to encourage women's access to PrEP, most of which were individually based or initiated by local NGOs. CONCLUSIONS: PrEP is an important addition to HIV combination prevention. Women's access to PrEP in Europe remains limited. Women are often not included in the guidelines or targeted with education or information, resulting in a general lack of information about the use of PrEP for women.

[Increased homocysteine levels in polycystic ovary syndrome]. / Concentraciones elevadas de homocisteína en el síndrome de ovario poliquístico.

BACKGROUND AND OBJECTIVE: Women with polycystic ovary syndrome (PCOS) exhibit frequently risk factors that predispose to cardiovascular disease. Hyperhomocysteinemia is an independent risk factor for this disease. The aim of this study was to know whether young women with PCOS have increased homocysteine levels. We also analyzed their possible relation with folate and vitamin B12 levels. PATIENTS AND METHOD: Thirty nine patients with PCOS were studied; (age: mean [standard deviation] 28.9 [5.8] years), and 39 healthy women similar in age. We evaluated in all of them: smoking, menstrual cycles, hirsutism, body mass index, metabolic syndrome and levels of homocysteine, lipids, glucose, creatinine, folate, vitamin B12, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and androstendione. RESULTS: Menstrual cycles, hirsutism, androstendione, LH levels and LH/FSH were higher, as we expected, in patients with PCOS. Moreover, patients had increased homocysteine (9.1 [2.1] vs 6.4 [1.8] micromol/L; p < 0.001) and glucose levels (99 [13] vs 88 [10] mg/dl; p < 0.001), a higher frequency of abnormal fasting glycemia (> 110 mg/dl) (23% vs 2.5%; p =.01) and lower folate levels (7.6 [3.7] vs 10.2 [3.6] ng/ml; p = 0.02). A multiple linear regression showed a negative association between homocysteine and folate levels (r2 = 0.05; p =.02). CONCLUSIONS: Homocysteinemia is increased in women with PCOS, and it is negatively associated with folate levels.

Implementing nursing grand rounds in a community hospital.

PURPOSE: The purpose of this article is to describe the process of implementing Nursing Grand Rounds in a community hospital. METHODS: The Advanced Practice Council of clinical nurse specialists and nurse practitioners used Benner's theoretical framework of skill acquisition to guide the process. The development and implementation included the following: (1) conducting a convenient interest survey, (2) establishing targeted marketing strategies and a delivery format template for Nursing Grand Rounds, (3) mentoring clinical nurses, and (4) evaluation. CONCLUSION: Our institution has established Nursing Grand Rounds as a forum "For our Nurses, By our Nurses." The forum was held quarterly with survey feedback demonstrating increased awareness by clinical nurses and growing attendance. IMPLICATIONS: As a designate Magnet hospital, our Advanced Practice Council established a forum to promote and demonstrate excellence in nursing. The attributes of advanced practice nursing are the cornerstone to successful implementation of Nursing Grand Rounds. The involvement of clinical nurses across the 5 stages of proficiency in skill acquisition is a means to retain clinical experts and foster the development of nurses from novice to expert.

Combined assessment of nutritional status in patients with peritoneal dialysis using bioelectrical impedance vectors and malnutrition inflammation score.

BACKGROUND AND OBJECTIVE: Protein energy wasting (PEW) is a common syndrome in patients with chronic kidney disease, related to changes in hydration status, decreased food intake and inflammation. There are several tools for the assessment and diagnosis of such alterations. Bioimpedance vector analysis (BIVA) assess the state of nutrition and hydration, but not the inflammatory component, while the malnutrition inflammation score (MIS) comprises the inflammatory and nutritional factors, but not the state of hydration. The aim of the study was to determine the concordance between MIS and BIVA to assess nutritional status in peritoneal dialysis patients. METHODS: We studied 50 patients on peritoneal dialysis which underwent  bioelectrical impedance measurements with an empty peritoneal cavity, also MIS was applied and biochemical parameters were evaluated. RESULTS: The prevalence of malnutrition with VIBE and MIS was 38% and 24% respectively. Statistically significant differences in body mass index (BMI) and phase angle between normally nourished and wasted patients by both methods were found. Body composition, biochemical parameters and impedance vectors were not statistically different between normally nourished and wasted patients. Concordance between methods was 0.314 (p = 0.019). CONCLUSIONS: Combined nutritional assessment with MIS and BIVA is necessary for the diagnosis of protein energy wasting syndrome in patients undergoing peritoneal dialysis.

Identificación y evaluación de actividad celulolítica en aislamientos nativos de Trichoderma spp obtenidos de biomasa de palma de aceite / Identification and screening of lignocellulosic activity in native isolates of Trichoderma spp., obtained from palm oil biomass

RESUMEN Se aislaron previamente ocho cepas nativas de racimos de palma de aceite en descomposición de Trichoderma sp. provenientes de la región de Cumaral, Meta, Colombia. Se utilizó la región de los ITS1-ITS4 para la identificación molecular y se determinó la actividad celulolítica (actividad sobre papel filtro) del complejo producido por las cepas utilizando residuos de palma como sustrato. Siete aislamientos nativos presentarón 100% de similaridad con hongos del género Trichoderma. Se observó para siete cepas, la presencia de las cinco anclas que identifican hongos del género Trichoderma, identificándose cuatro de los hongos nativos como Trichoderma koningiopsis (HR-04-89; HR-11-89; HR-19-89; y HR-06-89) y cuatro como Trichoderma asperellum (HR-01-89; HR-03-89; HR-16-89; HR-18-89). El bioensayo mostró que las cepas evaluadas de Trichoderma son estadísticamente significativas sobre la actividad enzimática de celulasas sobre papel filtro (p<0.05). Además, las cepas HR-01-89, HR-03-89, HR-11-89, HR-04-89 y HR-18-89 no presentaron diferencias en la actividad enzimática. La cepa Trichoderma reesei utilizada como referencia, presentó un comportamiento superior y diferente comparado con las cepas nativas. La cepa nativa HR-18-89 (Trichoderma asperellum) presentó mayores niveles de actividad enzimática, 78% del valor de la cepa referencia. Es importante identificar y evaluar cepas nativas de Trichoderma sp. con novedosas actividades biológicas que permitan degradar la celulosa recalcitrante de los racimos de palma africana.

ABSTRACT Previously, there were isolated eight native strains of Trichoderma sp. from a cluster of decomposing oil palm from Cumaral, Meta, Colombia. The ITS1-ITS4"s region was used for the molecular identification and the cellulase activity (filter paper activity) of the complex produced by strains was determined using palm waste as substrate. Seven native isolations showed between 97-100% similarity with fungi of the genus Trichoderma. It was observed for seven of the eight strains the presence of the five anchors which identify fungi of the genus Trichoderma, finding five of the native fungi such as Trichoderma koningiopsis (HR-04-89; HR-11-89; HR-19-89; y HR-06-89) four as Trichoderma asperellum (HR-01-89; HR-03-89; HR-16-89; HR-18-89). The bioassay showed that Trichoderma strains tested are statistically significant on the enzymatic activity of cellulases on filter paper (p <0.05). In addition, strains HR-01-89, HR-03-89, HR-11-89, HR-04-89 and HR-18-89 showed no differences in enzymatic activity. The reference strain used, Trichoderma reesei produce a superior and different behavior compared with the native strains. The native strain HR-18-89 (Trichoderma asperellum) had higher levels of enzyme activity, 78% of the value of the reference strain. It is important to identify and evaluate native strains of Trichoderma sp. with innovative biological activities that allow to degrade the recalcitrant cellulose of the African palm clusters.

Interferon-γ release assay for the diagnosis of tuberculosis in children.

AIMS: To compare the QuantiFERON-TB GOLD In Tube test (QTF) and the tuberculin skin test (TST) in children. METHODS: A prospective study was carried out in nine hospitals in Madrid, Spain. TST and QTF were performed in immigrants, tuberculosis (TB) contacts and patients with TB disease (TBD). RESULTS: 459 children were included. Disagreement between the tests was more frequently observed among latent tuberculosis infection (LTBI) cases (54%; 38/70) than in non-infected or TBD cases (0.8%; 3/369) (p<0.01). There were more BCG-vaccinated children among LTBI cases with negative QTF (76%) than among LTBI cases with positive QTF (40%) (p<0.001). Agreement between tests in BCG-vaccinated children was lower than in non-vaccinated cases (p<0.05). Tests in TB exposed patients showed better agreement than in non-exposed children (p<0.05). CONCLUSIONS: Agreement of both tests was excellent in TBD cases, non-vaccinated children and non-infected patients. A significant number of QTF negative results were observed among LTBI cases, especially in BCG-vaccinated children. Agreement was better in exposed children.

Optimizing interpretation of the tuberculin test using an interferon-gamma release assay as a reference standard.

The interferon-gamma release assays have greater specificity than the tuberculin skin test (TST), and at least equal sensitivity. We analyzed the sensitivity and specificity of the TST in immunocompetent children considering QuantiFERON as the referent standard. A TST cut-off point of ≥ 5 mm indicates excellent sensitivity (100%) and specificity (93%) in children without Bacillus Calmette-Guérin. In Bacillus Calmette-Guérin-vaccinated children, the TST cut-off point of ≥ 10 mm had poorer specificity (86%), and a cut-off point of ≥ 15 mm resulted in reduced sensitivity (60%).

Analgesia postoperatoria con bupivacaína, fentanilo y morfina raquídea en pacientes sometidos a resección transuretral de cáncer de próstata / Postoperative analgesia whit espinal bupivacaine, fentanyl and morphine in patients undergoing transurethal resection for cancer prostate

Objetivo: Establecer los niveles de dolor postoperatorio y los cambios hemodinámicos no invasivos en los pacientes sometidos a resección transuretral de próstata de próstata con la combinación de bupivacaína, fentanilo y morfina raquídea. Material y métodos: Se realizó un estudio descriptivo y prospectivo en 46 pacientes con cáncer de próstata sometidos a resección transuretral que cumplieron los criterios de inclusión y exclusión en el Instituto Nacional de Enfermedades Neoplásicas durante los meses de enero a junio del 2009. El análisis estadístico se realizó con el programa SPSS 19.0. Se consideró significativo un valor de p < 0.05. Resultados: El 96% de los pacientes tuvo una clasificación de ASA II. A partir de las 12 horas postoperatorias se evidenció aumento en la valoración de la escala visual análoga del dolor, además se evidenció aumento (p=0.001, 95% de confianza) de los valores de presión arterial media y frecuencia cardíaca. El 8.7% de los pacientes presentó náuseas mientras que el 86% no tuvo eventos adversos. Conclusión: La técnica con bupivacaína, fentanilo y morfina raquídea en pacientes con cáncer de próstata representa una alternativa para reducir el dolor en cirugía urológica oncológica.

Objective: To evaluate the postoperative pain levels and noninvasive hemodynamic changes in patients undergoing transurethal resection of the prostate with the combination of spinal bupivacaine, fentanyl and morphine. Material and methods: A prospective descriptive study was perfomed in 46 patients with prostate cancer undergoing transurethral resection who met the inclusion and exclusion criteria at the Instituto Nacional de Enfermedades Neoplásicas from January to June 2009. Statistical analysis was performed using SPSS 19.0. Ap < 0.05 was considered a significant value. Results: 96% of patients were ASA II. After 12 hours, in the portoperative period, there was an increase in the valuation of the visual analogue scale of pain and there was an evident increase (p = 0.001, 95% confidence) in the mean arterial pressure and heart rate. 8.7% of patients experienced nausea while 86% had no adverse events. Conclusion: The technique with bupivacaine, spinal fentanyl and morphine in patients with prostate cancer represents an alternative for reducing pain in urologic oncology.

Pertinencia y ajustes del plan de estudios de la carrera de Tecnología de la salud en sistemas de información en salud / Relevance and curriculum adjustments of technology career in health information systems in health

Objetivos: evaluar la pertinencia de los ajustes y modificaciones del diseño del currículo y su aplicación Métodos: es una investigación aplicada, de tipo descriptivo y carácter retrospectivo. Fueron seleccionadas 5 provincias que imparten esta carrera desde sus inicios en el año 2003. Se aplicaron técnicas cualitativas como grupo focal, encuesta de evaluación a alumnos y profesores, entrevista a profesores y metodólogos del claustro de la carrera, así como, observación dirigida al proceso de aplicación para obtener criterios por consenso que permitió el alcance del objetivo trazado. Todo ello fue procesado a través de método de concordancia y diferencias, análisis, síntesis y generalización de los resultados. Resultados: se obtuvieron resultados del completamiento, categorización y preparación del claustro profesoral, tras el proyecto de intervención para elevar su categoría; las características y conformación del plan de estudios en cuanto a disciplinas y contenidos, la disponibilidad de bibliografía básica digitalizada e impresa, así como el uso de las TICs y Entornos Virtuales en y para la docencia, la selección y acreditación de escenarios docentes, el aseguramiento metodológico y las condiciones materiales requeridos, lo cual permitió el rediseño del plan de estudio. Conclusiones: se obtuvo la caracterización del claustro profesoral y se elaboraron los planes de perfeccionamiento y promoción, así como, la conformación un nuevo diseño curricular, ajustado a las nuevas perspectivas educativas, el cual presenta un currículo, basado en competencias, con mayor flexibilidad, pertinencia, sistematicidad, integración y contextualización al entorno en que se desempeñarán los graduados

Objectives: to evaluate the relevance of adjustments and changes in the curricular design and their implementation. Methods: a retrospective and descriptive research study covering 5 selected provinces where the medical studies are performed since 2003. Some qualitative techniques were used like focal group, evaluative survey of students and professors, interviews to professors and methodologists from the faculty of this career, as well as direct observation of the implementation process to obtain consensus criteria according to the scope of the set objective. All this information was processed through concordance and difference methods, analysis, synthesis and generalization of results. Results: completion, categorization and preparation of the faculty, after the intervention project to raise their category levels; characteristics and composition of the curricula in terms of disciplines and contents; the availability of basic digital and printed literature as well as the use of ICTs and virtual environments in and for teaching; the selection and accreditation of teaching scenarios, the assurance of methodologies and material conditions, all of which led to the re-design of the curriculum. Conclusions: characterization of the faculty and drawing up of the improvement and promotion plans, as well as the preparation of a novel curricular design, adapted to the new educational prospects, which comprises a competence-based curriculum with more flexibility, relevance, systematization, integration and contextualization

Effect of adverse drug reactions on length of stay in surgical intensive care units.

OBJECTIVE: To determine the frequency of adverse drug reactions in surgical intensive care units and evaluate their effect on the length of stay. DESIGN: Prospective cohort study. Between May 1997 and December 1999, while the patients were staying in the surgical intensive care unit, data were gathered regarding suspected adverse drug reactions and on different variables related to the length of stay. SETTING: Surgical intensive care units of our hospital. PATIENTS: A total of 401 patients hospitalized in the surgical intensive care unit. MAIN RESULTS: In 37 of the 401 patients seen (9.2%; 95% confidence interval, 6.6-12.5), 39 different adverse drug reactions were detected. The adverse drug reactions were most frequently caused by the following drugs: morphine hydrochloride (n = 13), meperidine hydrochloride (n = 9), and metamizole (n = 7). Five adverse drug reactions were severe, the suspected medication had to be discontinued in 14 cases, and new drugs were necessary to manage the adverse drug reaction in 28 cases. The crude estimation of the effect of adverse drug reactions performed on the length of stay with a bivariant regression model indicated that each adverse drug reaction was related to an increase of 3.39 days (95% confidence interval, 1.47-5.31) in the length of stay. This estimation was reduced to 2.31 days (95% confidence interval, 0.64-3.99) when considering other variables that might cause confusion for analysis, although it is still important. CONCLUSIONS: Adverse drug reactions are a significant clinical and economic problem in surgical intensive care units.

Los registros médicos en Cuba / Health registries in Cuba

Cuba posee experiencia de trabajo relativamente prolongada con los registros demográficos y, dentro de éstos, con los de mortalidad. A pesar de ello, la deficiente cobertura y la falta de integridad de la información han sido características constantes que se mantuvieron por más de un siglo. Durante la etapa colonial se realizaron 7 censos de población, dos de ellos en el siglo XVIII. En los siglos XVII y XVIII las fuentes de información para las estadísticas de salud fueron los libros registros de bautizos, enterramientos, ingresos y egresos de hospitales. En el siglo XIX las disposiciones de la Junta Superior de Sanidad, sobre la certificación de la muerte y la fundación de la Academia de Ciencias Médicas Físicas y Naturales de La Habana, propiciaron la realización de numerosos trabajos científicos sobre los problemas sanitarios. Estos y las tablas mortuorias de La Habana fueron publicadas en las revistas médicas de la época. No es hasta el siglo XX que se organiza la recolección de los certificados médicos de defunción de todo el país y se obtienen estadísticas nacionales, se establece el reporte de enfermedades de declaración obligatoria y recolección de información solamente de los hospitales dependientes de la Secretaría de Sanidad y Beneficencia. Alrededor de los años 60 se consideró el subregistro de defunciones en un 10(por ciento) y el de enfermedades de declaración obligatoria mucho más alto. Nunca se publicaron estadísticas de nacimientos y las de recursos para la salud y servicios prestados a la población eran incompletas. Al triunfo de la Revolución se incorporan al Ministerio de Salud Pública todos los centros que brindaban atención médica y se creó un organismo rector de las estadísticas del país. El trabajo conjunto de la Dirección General de Estadísticas de la Junta Central de Planificación (JUCEPLAN) y los Ministerios de Justicia y Salud Pública, permitió a este último desarrollar una estrategia de trabajo para alcanzar cobertura en los registros cada vez más próxima al 100(por ciento) y desarrollar investigaciones para evaluar ésta y la calidad de la información obtenida