Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. / Atención farmacéutica en enfermedades respiratorias: situación y oportunidades de la farmacia hospitalaria en España.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS: Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Consensus on the approach to hydrosaline overload in acute heart failure. SEMI/SEC/S.E.N. recommendations.

Most of the signs and symptoms of heart failure can be explained by fluid overload, which is also related to disease progression. Fluid overload is a complex phenomenon that extends beyond increased intravascular pressures and poses challenges for accurate diagnosis and effective treatment. Current recommendations advise a multiparametric approach, including clinical data (symptoms/signs), imaging tests, and biomarkers. This article proposes a practical therapeutic approach to managing hydrosaline overload in heart failure in both inpatient and outpatient settings. This document is an initiative of the Spanish Society of Internal Medicine (SEMI) in collaboration with the Spanish Society of Cardiology (SEC) and the Spanish Society of Nephrology (S.E.N.).

Efficient Design of Thin Wall Seating Made of a Single Piece of Heavy-Duty Corrugated Cardboard.

Corrugated cardboard has waved cores with small flutes that prevent the use of detailed numerical models of whole structures. Many homogenization methods in the literature overcome this drawback by defining equivalent homogeneous plates with the same mechanical behaviour at a macro-mechanical scale. However, few homogenization works have considered complete structures, focusing mainly on beams or plates. For the first time, this study explores the application of homogenization approaches to larger structures as an aid in their design process. We also considered triple-wall boards rather than single- and double-wall configurations commonly addressed in the literature. To this end, we adapted the homogenization methods proposed by Talbi and Duong to analyze thin-walled stools made of triple-wall corrugated cardboard. Using a progressive design process, we performed an efficient stool design by removing material zones with lower stresses, with 35% less material, 35% lower vertical deflections, and 66% lower stresses than the initial design. Unlike other corrugated cardboard stools, this design comprises just one folded piece instead of three, thus saving storage space. These results demonstrate the utility of homogenization techniques as an aid in the design process of whole structures made of corrugated cardboard. Further research will consider buckling analysis.

Enhancing the Accuracy of Linear Finite Element Models of Vehicle Structures Considering Spot-Welded Flanges.

Structural engineering simulations have required increasingly complex computational models to replace physical tests accurately. This work focuses on the numerical analysis of vehicle body structures, whose size and complexity make the use of very accurate nonlinear models unfeasible due to the prohibitive computational costs involved. The purpose of this study is to find a new approach to model spot-welded joints in linear finite element models of thin-wall vehicle body structures, improving the accuracy of the model without increasing its complexity. Using a set of simplified nonlinear models, we fitted the stiffness and damping properties of these welded joints and used those adjusted values into a linear model of the entire vehicle body structure. The results were compared with experimental tests, showing a clear improvement in the accuracy of the modal and frequency responses provided by the linear finite element model, but keeping its initial complexity level. The adjusted model was then used in an optimization analysis to reduce the structure's weight, leading to interesting cost savings and important reductions in the use of natural resources and carbon emissions.

Numerical modelling of blood clot extraction by aspiration thrombectomy. Evaluation of aspiration catheter geometry.

Aspiration thrombectomy is one of the most effective systems for blood clot removal and vessel recanalization. We present the results of a study involving the modelling and extraction of blood clots in the arteries of the human body using the following computer tools: Bond-Graph methodology for the fluid domain and Multi-Body Simulation for the mechanical domain. The modelling for the mechanical domain focuses on the clot and the distal end section of an aspiration device. Our final model considers an elastic characterization of the blood clot with progressive detachment from the vessel wall. We conclude that the results of such modelling could potentially improve the effectiveness of blood clot removal by reducing the risk of clot fragmentation. Such modelling could also potentially provide an adjunct technique in improving recanalization of arteries over a range of given parameters (mechanical properties of the vessel, mechanical properties of the blood clot, blood clot length, suction pressure, catheter - clot distance, catheter shape, catheter diameter and vessel occlusion).

Relationship between Serum Adalimumab Levels and Clinical Outcome in the Treatment of Inflammatory Bowel Disease.

BACKGROUND: Adalimumab (ADA) is an anti-tumor necrosis factor agent that has been shown to be effective in inducing and maintaining remission in adult patients with inflammatory bowel disease. The relationship between the ADA trough levels and clinical efficacy has been demonstrated, but there is variability in the definition of the most suitable range for its clinical applicability. SUMMARY: A review of published studies during the last 5 years on ADA serum levels and its relationship with the clinical outcome was performed. The studies selected included 7 observational studies, a systematic review, a meta-analysis and a post hoc analysis of a clinical trial. The reported ADA levels that discriminate patients in clinical remission from those with active disease range from 4.5 to 8 µg/mL. This therapeutic range varies when considering endoscopic remission (7.5 to >13.9 µg/mL). Although the sample of patients with ulcerative colitis is small, a tendency to reach higher levels of ADA is observed in both clinical and endoscopic remission. Key Messages: The optimal therapeutic cut-off point of serum ADA levels ranges from 4.5-5 to 12 µg/mL, where ADA levels are associated with an adequate clinical monitoring of the disease during maintenance therapy. These ranges vary according to the target, suggesting levels of 4.8 µg/mL as the cut-off for clinical remission and levels ≥7.5 µg/mL for mucosal healing/endoscopic response. Controlled prospective studies are required to determine the optimal therapeutic interval of ADA serum levels both as induction and as maintenance therapy.

Validation of a population pharmacokinetic model of adalimumab in a cohort of patients with inflammatory bowel disease.

BACKGROUND: therapeutic monitoring of anti-TNF drugs and anti-drug antibody levels are useful for clinical decision-making, via the rationalization and optimization of the use of anti-TNF treatments. The objective of the present study was to validate the model of Ternant et al., in a cohort of patients with inflammatory bowel diseases (IBD). This model was originally established for patients with rheumatoid arthritis and was used in this study to optimize the adalimumab (ADA) dose and predict ADA trough levels (ATL). METHODS: this study used concentration data points from 30 IBD patients who received ADA treatment between 2014 and 2015. A goodness-of-fit of the model was determined by evaluating the relationship between the observed ATL values and population model-predicted values (PRED) or individual model-predicted values (IPRED). RESULTS: a total of 51 ADA concentration points were analyzed. The bias of the model was 2.39 (95% CI, 1.63-3.15) for PRED and 0.63 (95% CI, 0.23-1.03) for IPRED. The precision was 3.57 (95% CI, 2.90-4.13) and 1.53 (95% CI, 1.22-1.80), respectively. CONCLUSIONS: therapeutic drug monitoring involving ATL may allow the optimization of the treatment of IBD patients. The validation results of the phamacokinectic (PK) model for ADA in IBD patients are inadequate. However, additional studies will strengthen the bias and precision of the model.

Macaque remains from the early Pliocene of the Iberian Peninsula.

Macaques dispersed out of Africa into Eurasia in the framework of a broader intercontinental faunal exchange that coincided in time with the sea level drop associated with the Messinian Salinity Crisis. They are first recorded in Europe (Italy and Spain) by the latest Miocene, being subsequently recorded all over Europe, albeit sparsely, throughout the Pliocene and Pleistocene. These fossil European macaques are attributed to several (sub)species of the extant Barbary macaque (Macaca sylvanus). In Iberia, fossil macaques are best documented by Macaca sylvanus florentina from various Early Pleistocene sites, whereas their published Pliocene record is very scarce. Here we report the oldest post-Messinian occurrence of macaques in the Iberian Peninsula, based on the description and metrical comparisons of two upper teeth (a male canine and a third molar of two different individuals) from the early Pliocene (MN14, 5.0-4.9 Ma) site of Puerto de la Cadena (Murcia, SE Spain). The male C1 is fully comparable in morphology with those of extant and fossil M. sylvanus, and larger than those of Mesopithecus. The M3, in turn, displays the typical papionin morphology that characterizes the dentally-conservative genus Macaca-thereby discounting an alternate assignment to either the extinct colobine monkey Mesopithecus or the more dentally-derived papionin Theropithecus. Dental size and proportions of the M3 further support an attribution to an extinct subspecies of M. sylvanus instead of the larger papionin Paradolichopithecus. Mostly on biochronologic grounds, the two macaque teeth from Puerto de la Cadena are here assigned to Macaca sylvanus cf. prisca, albeit tentatively, given the lack of clear-cut criteria to distinguish this subspecies from the younger Macaca sylvanus florentina. The described material represents the oldest well-dated Pliocene record of macaques in Iberia, predating the record of Paradolichopithecus by almost 1.5 million years.

Blood clot simulation model by using the Bond-Graph technique.

The World Health Organization estimates that 17 million people die of cardiovascular disease, particularly heart attacks and strokes, every year. Most strokes are caused by a blood clot that occludes an artery in the cerebral circulation and the process concerning the removal of this obstruction involves catheterisation. The fundamental object of the presented study consists in determining and optimizing the necessary simulation model corresponding with the blood clot zone to be implemented jointly with other Mechanical Thrombectomy Device simulation models, which have become more widely used during the last decade. To do so, a multidomain technique is used to better explain the different aspects of the attachment to the artery wall and between the existing platelets, it being possible to obtain the mathematical equations that define the full model. For a better understanding, a consecutive approximation to the definitive model will be presented, analyzing the different problems found during the study. The final presented model considers an elastic characterization of the blood clot composition and the possibility of obtaining a consecutive detachment process from the artery wall. In conclusion, the presented model contains the necessary behaviour laws to be implemented in future blood clot simulation models.