Examination of the Protein Drug Supply Chain in a Swedish University Hospital: Focus on Handling Risks and Mitigation Measures.

Protein drugs, such as monoclonal antibodies, have proved successful in treating cancer and immune system diseases. The structural complexity of these molecules requires careful handling to ensure integrity and stability of the drug. In this study, a failure mode and effects analysis was performed based on a Gemba Walk method in a Swedish University Hospital. The Gemba Walk is focused on pharmacists observing the actual supply process steps from distributor, pharmacy cleanroom to patient administration. Relevant protein drugs are chosen based on sales statistics within the hospital and the corresponding wards were observed. Further is the Double Diamond design method used to identify major risks and deliver mitigation strategies. The study identified potential stress factors such as temperature, shock by impact, shaking, vibration and light exposure. There were also risks associated with porters' and healthcare professionals' lack of awareness and access to information. These risk factors may cause loss of efficacy and quality of the protein drug, potentially leading to patient safety concerns. In this study, a simulation is also performed to list measures that theoretically should be in place to ensure the quality of the protein drug, for example validated and protocol-based compounding in cleanroom, training and validated transports.

Treatment of Porokeratosis Ptychotropica With a Topical Combination of Cholesterol and Simvastatin.

This case report describes 2 patients with Ptychotropic porokeratosis who were treated with a combination of cholesterol and simvastatin.

Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study.

BACKGROUND: Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic. METHODS: Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.). DISCUSSION: The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies. Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].

Daily sitting time and its association with non-communicable diseases and multimorbidity in Catalonia.

BACKGROUND: Non-communicable diseases (NCDs) account for 71% of deaths worldwide and individual behaviours such as sedentariness play an important role on their development and management. However, the detrimental effect of daily sitting on multiple NCDs has rarely been studied. This study sought (i) to investigate the association between sitting time and main NCDs and multimorbidity in the population of Catalonia and (ii) to explore the effect of physical activity as a modifier of the associations between sitting time and health outcomes. METHODS: Cross-sectional data from the 2016 National Health Survey of Catalonia were analyzed, and multivariable logistic regression, adjusting for socio-demographics and individual risk factors (tobacco and alcohol consumption, diet, hyperlipidaemia, hypertension, body mass index) was used to estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between sitting time and NCDs. RESULTS: A total of 3320 people ≥15 years old were included in the study. Sitting more than 5 h/day was associated with a higher risk of cardiovascular disease (OR 1.90, 95% CI: 1.21-2.97), respiratory disease (OR 1.61, 95% CI: 1.13-2.30) and multimorbidity (OR 2.80, 95% CI: 1.53-5.15). Sitting more than 3 h/day was also associated with a higher risk of multimorbidity (OR 2.26, 95% CI: 1.23-4.16). Physical activity did not modify the associations between sitting time and any of the outcomes. CONCLUSIONS: Daily sitting time might be an independent risk factor for some NCDs, such as cardiovascular disease, respiratory disease and multimorbidity, independently of the level risk of physical inactivity.

Robotic chemotherapy compounding: A multicenter productivity approach.

INTRODUCTION: The aim of this study is to compare productivity of the KIRO Oncology compounding robot in three hospital pharmacy departments and identify the key factors to predict and optimize automatic compounding time. METHODS: The study was conducted in three hospitals. Each hospital compounding workload and workflow were analyzed. Data from the robotic compounding cycles from August 2017 to July 2018 were retrospectively obtained. Nine cycle specific parameters and five productivity indicators were analysed in each site. One-to-one differences between hospitals were evaluated. Next, a correlation analysis between cycle specific factors and productivity indicators was conducted; the factors presenting a highest correlation to automatic compounding time were used to develop a multiple regression model (afterwards validated) to predict the automatic compounding time. RESULTS: A total of 2795 cycles (16367 preparations) were analysed. Automatic compounding time showed a relevant positive correlation (ǀrs|>0.40) with the number of preparations, number of vials and total volume per cycle. Therefore, these cycle specific parameters were chosen as independent variables for the mathematical model. Considering cycles lasting 40 minutes or less, predictability of the model was high for all three hospitals (R2:0.81; 0.79; 0.72). CONCLUSION: Workflow differences have a remarkable incidence in the global productivity of the automated process. Total volume dosed for all preparations in a cycle is one of the variables with greater influence in automatic compounding time. Algorithms to predict automatic compounding time can be useful to help users in order to plan the cycles launched in KIRO Oncology.

Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru / Trasplante hepático en la Unidad de Cuidados Intensivos: veinte años de experiencia en un centro de mediano ingreso en el Perú

ABSTRACT Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.

RESUMEN El trasplante de hígado es el principal tratamiento para la enfermedad hepática en etapa terminal. El cuidado postoperatorio es un gran desafío para disminuir la morbimortalidad en los pacientes. En este sentido, el manejo en la UCI hepática permite manejo hemodinámico, monitoreo de coagulación, soporte renal, alteraciones electrolíticas, soporte respiratorio y destete temprano de ventilación mecánica y evaluación del injerto hepático. Objetivo: El presente estudio muestra los resultados del manejo de pacientes trasplantados de hígado en 20 años de experiencia en un centro de trasplante en un país de ingresos bajos a medios. Materiales y métodos: Se revisaron las historias clínicas de 273 pacientes adultos en UCI en el posoperatorio inmediato de trasplante hepático, desde el 20 de marzo de 2000 hasta el 30 de noviembre de 2020, incluyendo el efecto de la pandemia provocada por el COVID-19. Se excluyeron los pacientes con trasplante de hígado-riñón, retrasplantados, SPLIT y dominó. Resultados: La etiología más frecuente para LTx fue NASH (35%), la edad promedio fue de 49 años, MELD Score varió 15 - 20 (47,5%), 21 - 30 (46%) > 30 (6,2%). Estancia pretrasplante en UCI 7%, estancia media en UCI: 7,8 días. Admisión media APACHE: 14,9 puntos. Extubación weaning del 91,8% de los pacientes en UCI y Fast Track en el 8,2%. La complicación respiratoria más frecuente fue atelectasia 56,3%, neumonía (31,3%); FRA 1 (60,9%) y 11,1% con soporte de hemodiálisis (FRA 3). Inmunosupresión: Tacrolimus (8,9%). La mortalidad postoperatoria en la UCI fue del 6,2%. Conclusiones: El manejo del trasplante hepático en UCI es fundamental para lograr resultados óptimos en pacientes que presentan enfermedad hepática avanzada y requieren soporte vital avanzado en el postoperatorio inmediato y así optimizar la supervivencia del injerto.

Stability of 5% vancomycin ophthalmic solution prepared using balanced salt solution after freezing for 90 days.

PURPOSE: To evaluate the stability of 5% vancomycin ophthalmic solution prepared using balanced salt solution (BSS) and stored at -20°C in polypropylene containers. METHODS: Six batches of vancomycin 50 mg/mL eyedrops were aseptically prepared. One bottle of each batch was analyzed immediately after preparation, and the rest were stored at -20°C and analyzed using high-performance liquid chromatography (HPLC) at 30, 60, and 90 days to test their physicochemical stability and sterility. Thereafter, bottles were removed from the freezer and stored at 5°C for 30 days, with HPLC and other analyses repeated 105 and 120 days after preparation. All samples were analyzed in triplicate. Stability was defined as the absence of particles, color variation, or changes in pH and a remaining vancomycin concentration of 90% to 110% of the initial concentration. The sterility of the ophthalmic solution was evaluated by using soybean-casein digest broth with resins; samples were incubated for 7 days and checked daily for signs of microbial growth. RESULTS: There was no particle formation or sign of precipitation in any of the solutions throughout the duration of the study, regardless of the storage conditions. No change in color or turbidity was observed. The pH and osmolarity remained unchanged during storage at -20°C and after thawing. The vancomycin concentration remained within 10% of the initial concentration during the 90-day period of storage at -20°C and the subsequent 30 days after thawing. Sterility was preserved in all samples. CONCLUSION: A 5% solution of vancomycin prepared using BSS was physicochemically and microbiologically stable when stored at -20°C for 90 days. After thawing, this extemporaneous formulation remained stable when refrigerated at 5°C for 30 days.

Efficacy of tailored recommendations to promote healthy lifestyles: a post hoc analysis of a randomized controlled trial.

Prevention is the key to stopping the ravages of cardiovascular diseases, the main cause of death worldwide. The objective was to analyze the efficacy of tailored recommendations to promote healthy lifestyles. Parallel-arm randomized controlled trial with 1 year follow-up. Individuals aged 35-74 years from Girona (Spain) randomly selected from a population with no cardiovascular diseases at baseline were included. Participants in the intervention group received a brochure with tailored healthy choices according to the individual risk profile and a trained nurse explained all recommendations in detail in a 30 min consultation. One year changes in smoking, Mediterranean diet adherence, physical activity, and weight were analyzed with McNemar, Student's t, Wilcoxon, and Fisher exact tests according to an intention-to-treat strategy. Of 955 individuals (52.3% women; mean age 50 [±10] years) randomly allocated to the intervention or control group, one participant in each group presented a cardiovascular event and 768 (81%) were reexamined at 1 year follow-up. The prevalence of nonsmokers increased in both the intervention and control groups (78.1%-82.5%, p = <.001, and 76.7% to 78.8%, p = .015, respectively); however, significance persisted only in the intervention group when stratified by sex, age group, and educational level. Adherence to a Mediterranean diet increased in the intervention group (22.3%-26.5%, p = .048). In conclusion, a brief personalized intervention with science-based recommendations according to individual risk profiles appears to improve healthy lifestyles, particularly nonsmoking and adherence to a Mediterranean diet. This promising intervention system offers evidence-based recommendations to develop healthy lifestyles.

No función primaria del injerto hepático: 18 años de experiencia del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud / Primary non function of hepatic allograft: 18 years' experience of Guillermo Almenara Irigoyen National Hospital - EsSalud

RESUMEN Introducción : La no función primaria del injerto (NFPI) después del trasplante hepático es la falla aguda del injerto, en ausencia de algún factor causal, como trombosis aguda de arteria hepática o vena porta. Objetivos : Describir las características perioperatorias de los pacientes trasplantados de Hígado que presentaron NFPI en el Departamento de Trasplantes del Hospital Guillermo Almenara Irigoyen. Materiales y métodos : Estudio retrospectivo, descriptivo y transversal. Desde marzo del 2000 a marzo del 2018 se realizaron 249 Trasplantes de hígado. La NFPI fue definida con los criterios de OPTN/UNOS, se manifiesta por aumento de transaminasas (>3 000 UI/ml), coagulopatía (INR >2,5), niveles altos de lactato (>4 mEq/l), PH en acidosis: PH arterial ≤7,30 y/o PH venoso ≤7,25 e inestabilidad hemodinámica que requiere soporte con drogas vasoactivas; puede llevar a la muerte sin retrasplante de emergencia. Resultados : Se diagnosticaron 8 pacientes con NFPI siendo una prevalencia de 3,7% de 216 trasplantes de hígado en adultos, la edad de los receptores fue 51,5±8,45 años, score de MELD basal 13,13±3,8 (rango 6-18). Las características de los donantes, la edad fue 38,5±14,48, todos ABO idénticos al receptor, la distribución geográfica: 7 de Lima metropolitana y 1 en Tacna. La causa de muerte encefálica 75% ACV Hemorrágico y 25% TEC grave. Respecto a factores transoperatorios el TIF 431±143 min [265 - 645 min], y TIC 81,8±46 min [57- 195 min], La estancia en UCI hasta el deceso del paciente fue 11,13±9,3 días (rango 2-31 días), el 12,5% fue retrasplantado. Conclusiones : La prevalencia de NFPI en nuestro centro después del trasplante hepático es 3,7% similar a las series reportadas por otros centros, y se asocia con mortalidad alta sin retrasplante hepático.

ABSTRACT Introduction : The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. Objectives : Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. Materials and methods : Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. Results : 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. Conclusions : The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.

Impact of a single-age cohort human papillomavirus vaccination strategy in Catalonia, Spain: Population-based analysis of anogenital warts in men and women.

Extensive multiple-age cohort human papillomavirus (HPV) vaccination has proved to be highly effective. We aimed to determine the 8-year population impact of a female single-age cohort HPV vaccination programme on the incidence of anogenital warts (AGW). In 2008, Catalonia initiated a school-based quadrivalent HPV vaccination programme targeting 11-year-old girls, achieving coverage over 80%. Data on diagnoses of AGW and genital herpes were obtained from a population-based database of electronic health records covering 74% of the population. The annual incidence rates from 2009 to 2016 were calculated, stratified by age and sex using Joinpoint regression to estimate trends and annual percentage changes (APC). Among women aged 16-19 years, the AGW incidence decreased by 61% from 2012 to 2016 (APC -19.4%; 95% CI: -30.0 to -7.3). In contrast, the incidence of genital herpes in same-aged women increased throughout the study period (APC 11.1%; 95% CI: 7.2-15.2). Among men aged 20-22 years, the increasing incidence of AGW shifted to a downward trend in 2013 (APC 2009-2013: 17.0%; 95% CI: 8.2-26.5; and APC 2013-2016: -4.5%; 95% CI: -14.6 to 6.9). A similar pattern was observed among men aged 23-25 years (APC 2009-2014: 16.0%; 95% CI: 12.0-20.2; and APC 2014-2016: -6.0%; 95% CI: -18.4 to 8.3). In contrast to AGW, among men aged 20-25 years, the incidence of genital herpes increased over this period. Our study strongly suggests that a single-cohort HPV vaccination strategy with high vaccine uptake not only provides direct benefit in the vaccinated cohorts but also extends protection through a herd effect to unvaccinated men.

[Smoking control in Spain: current situation and priorities]. / El control del tabaquismo en España: situación actual y prioridades.

This paper presents a strategic analysis of the prevention of smoking in Spain. After a review of the situation of the epidemic and of the current prevention policies with the data available in 2019, it identifies the main problems to improve the prevention of smoking, while proposing strategies and key actions for the future. Considering as major objectives reducing the initiation of smoking and helping smokers quit, the different strategies of action and the key actions to be developed. In addition to helping smokers to stop smoking from the health services, key preventive actions include several public policies including taxation, banning advertising and other forms of promotion, the regulation of tobacco packaging, the expansion of smoke-free spaces, and information to the public on its effects. Some of them have followed a positive path for prevention in Spain but for others there is wide room for improvement. The MPOWER strategy of the WHO offers a guide for the development of the most effective tobacco control policies. In its light it is recommended to put emphasis on actions related to expanding smoke-free areas, to develop distance support services to stop smoking, to periodically carry out advertising campaigns of wide coverage to encourage quitting, to reinforce support for quitting in health care services, to finance pharmacological treatments, to expand the advertising ban to electronic devices that release nicotine, and to increase the tax burden on tobacco and other products delivering nicotine.

Este trabajo presenta un análisis estratégico de la prevención del tabaquismo en España. A partir de una revisión de la situación de la epidemia y de las políticas de prevención vigentes con los datos disponibles en el año 2019, se plantean los problemas prioritarios para mejorar la prevención del tabaquismo, proponiendo unas estrategias y acciones clave para el futuro. Considerando como grandes objetivos evitar el inicio en el tabaquismo y ayudar a los fumadores a dejar el consumo de tabaco, se valoran las diversas estrategias de actuación y las acciones clave a desarrollar. Además de ayudar a los fumadores a dejar de fumar desde los servicios sanitarios, destacan como acciones clave de prevención diversas políticas públicas como la política fiscal, la prohibición de la publicidad y otras formas de promoción, la regulación de los envases del tabaco, la generalización de los espacios sin humo, y la información a la ciudadanía sobre sus efectos perjudiciales. Algunas han seguido una evolución favorable en España, pero en otras hay amplio margen de mejora. La estrategia MPOWER de la Organización Mundial de la Salud ofrece una guía para el desarrollo de las políticas más efectivas de control del tabaquismo. A su luz, se recomienda poner énfasis en acciones relativas a ampliar las normas sobre aire limpio, en desarrollar servicios de apoyo a distancia para dejar de fumar, en realizar periódicamente campañas publicitarias de amplia cobertura para fomentar el abandono del tabaco, en reforzar el apoyo para dejar de fumar desde los servicios sanitarios, en financiar los tratamientos farmacológicos, en ampliar la prohibición de la publicidad de tabaco a los dispositivos electrónicos que liberan nicotina, y en incrementar la carga fiscal sobre el conjunto de labores de tabaco y otros productos con nicotina.

Prevención cuaternaria: como hacer, como ensiñar / Quaternary prevention: how to do, how to teach / Prevenção quaternária: como fazer, como ensinar

La prevención cuaternaria o P4 se define como las acciones que disminuyen los efectos de las intervenciones innecesarias, generadas por el contacto de las personas con los sistemas de salud. Se planteó como objetivo general desarrollar una estrategia para promover y difundir P4 em Iberoamérica; para cumplir dicha meta se realizó una investigación bibliográfica sobre los conceptos relacionados con P4; se aplicó una encuesta exploratoria para indagar sobre el conocimiento que tenían los participantes en la Cumbre y el Congreso respecto a P4. Existe múltiple literatura que define los términos relacionados con P4, lo que facilita su delimitación. Respecto a la encuesta, de las 309 personas que contestaron; 34% tenían entre 36 y 45 años; 88% eran profesionales en medicina; 69% conocía sobre P4 y más del 50% afirmó estar informado sobre los conceptos relacionados a P4; 92% consideró que P4 no es exclusiva de medicina familiar; 15% aseguró que después de la VI Cumbre se hicieron publicaciones sobre P4 en sus países; menos del 20% consideró que los políticos conocen sobre P4; 27% afirmó que los médicos de familia educan a los pacientes sobre P4. Se recomienda ampliar las campañas de educación sobre P4; facilitar el acceso a la información sobre P4 para profesionales del campo de la salud; incluir P4 en los programas académicos de pregrado y postgrado de las profesiones de la salud; crear alianzas con las entidades políticas de cada país para incluir P4 en políticas públicas.

Quaternary prevention or P4 is defined as any action taken to diminish the effects of unnecessary interventions generated when people interact with a health system. Methodology.The general objective was to develop a strategy to promote and spread P4 in Iberoamerica; to fulfill this goal a literature research was carried out, on the concepts related to P4; an exploratory survey was applied to inquire about the knowledge of the participates in the Summit and Congress, regarding P4 Results. There multiple literature sources that define the terms related to P4, which facilitated its delimitation. Regarding the survey, 69% knew about P4 and more that 50% declared that they where informed about the concepts related to P4; 92% considered that P4 is not only limited to family medicine; 15% assured that after the VI Summit publication regarding P4 where published in their countries; less than 20% stated that politicians knew about P4; 27% affirmed that family medicine doctors educate their patients about P4 Conclusions. It is recommended to expand the educational campaigns about P4; facilitate the access to information about P4 for professionals in the health field; include P4 in the academic programs of health professional for both graduate and post-graduate students; create alliances with political entities of each country to include P4 in public health policies.

A prevenção quaternária ou P4 é definida como ações que reduzem os efeitos de intervenções desnecessárias, geradas pelo contato das pessoas com os sistemas de saúde. O objetivo geral foi desenvolver uma estratégia para promover e disseminar o P4 na Ibero-América; Para atingir este objetivo, foi realizada uma pesquisa bibliográfica sobre os conceitos relacionados a P4; Uma pesquisa exploratória foi aplicada para indagar sobre o conhecimento que os participantes da Cúpula e do Congresso tinham sobre P4. Há uma diversidade de literatura que define os termos relacionados a P4, o que facilita sua delimitação. Em relação à pesquisa, das 309 pessoas que responderam; 34% tinham entre 36 e 45 anos; 88% eram profissionais de medicina; 69% conheciam o P4 e mais de 50% disseram que estavam informados sobre os conceitos relacionados ao P4; 92% consideraram que P4 não é exclusivo de medicina de família; 15% disseram que, após a VI Cúpula, foram feitas publicações sobre P4 em seus países; menos de 20% considerou que os políticos conhecem o P4; 27% disseram que os médicos de família educam os pacientes sobre o P4. Recomenda-se expandir as campanhas de educação sobre P4; facilitar o acesso à informação sobre P4 para profissionais da área da saúde; incluir P4 nos programas acadêmicos de graduação e pós-graduação das profissões de saúde; criar parceiras com as entidades políticas de cada país para incluir P4 nas políticas públicas

Validity of a method for the self-screening of cardiovascular risk.

BACKGROUND: The validity of a cardiovascular risk self-screening method was assessed. The results obtained for self-measurement of blood pressure, a point-of-care system's assessment of lipid profile and glycated hemoglobin, and a self-administered questionnaire (sex, age, diabetes, tobacco consumption) were compared with the standard screening (gold standard) conducted by a health professional. METHODS: Crossover clinical trial on a population-based sample from Girona (north-eastern Spain), aged 35-74, with no cardiovascular disease at recruitment. Participants were randomized to one of the two risk assessment sequences (standard screening followed by self-screening or vice versa). Cardiovascular risk was estimated with the Framingham-REGICOR function. Concordance between methods was estimated with the intraclass correlation coefficient (ICC). Sensitivity, specificity, and positive and negative predictive values were estimated, considering 5% cardiovascular risk as the cutoff point. ClinicalTrials.gov Registration #NCT02373319. Clinical Research Ethic Committee of the Parc de Salut Mar Registration #2014/5815/I. RESULTS: The median cardiovascular risk in men was 2.56 (interquartile range: 1.42-4.35) estimated by standard methods and 2.25 (1.28-4.07) by self-screening with ICC=0.92 (95% CI: 0.90-0.93). In women, the cardiovascular risk was 1.14 (0.61-2.10) by standard methods and 1.10 (0.56-2.00) by self-screening, with ICC=0.89 (0.87-0.90). The sensitivity, specificity, and positive and negative predictive values for the self-screening method were 0.74 (0.63-0.82), 0.97 (0.95-0.99), 0.86 (0.77-0.93), and 0.94 (0.91-0.96), respectively, in men. In women, these values were 0.50 (0.30-0.70), 0.99 (0.98-1), 0.81 (0.54-0.96), and 0.97 (0.95-0.99), respectively. CONCLUSION: The self-screening method for assessing cardiovascular risk provided similar results to the standard method. Self-screening had high clinical performance to rule out intermediate or high cardiovascular risk.

Infección diseminada por Strongyloides stercoralis en dos receptores de trasplante renal de un único donante / Disseminated Strongyloides stercoralis infection in two persons receiving transplanted kidneys from a single donor: reported cases

La infección por Strongyloides stercoralis a partir de donantes de órganos es infrecuente, pero cuando se presenta genera diversas complicaciones. Se reportan dos casos de estrongiloidiasis diseminada derivado de un único donante cadavérico en dos receptores de trasplante renal. Ambos pacientes se presentaron con síntomas gastrointestinales y síntomas respiratorios más lesiones dermatológicas en región abdominal. El diagnóstico se basó en el hallazgo de larvas en lavado broncopulmonar, lesiones dermatológicas, y aspirado duodenal. A pesar del manejo con albendazol e ivermectina por vía oral el curso clínico fue fatal en uno de ellos. El segundo paciente recibió precozmente ivermectina por vía subcutánea y sobrevivió con falla intestinal persistente

A Strongyloides stercoralis infection acquired from the donor in a transplant receptor is not a common occurrence, but its complications have been well known. We report two cases of disseminated strongyloidiasis derived from a single cadaveric donor at two renal transplant recipients. Both patients presented gastrointestinal and respiratory symptoms plus dermatological lesions in the abdominal region. The diagnosis was based on the finding of larvae in bronchopulmonary lavage, dermatological lesions, and duodenal aspiration. Despite the oral administration of albendazole and ivermectin, the clinical course was fatal in one of them. The second patient received precociously ivermectin by subcutaneous administration and survived with persistent bowel failure

Participación y Comunicación Social en Medicina Familiar y Comunitaria y Atención Primaria en Salud / Participation and Social Communication in Family and Community Medicine and Primary Health Care / Participação e Comunicação Social em Medicina de Família e Comunidade e Atenção Primária à Saúde

Se conformó el Grupo de trabajo # 2, de la V Cumbre Iberoamericana de Medicina Familiar, Quito, Ecuador 2014. Se realizaron encuestas, entrevistas, y reuniones vía skype, internet y correo electrónico; los resultados de esta investigación fueron analizados y se presentaron en el marco de la V Cumbre Iberoamericana de Medicina Familiar. Se recopilaron todas las actividades de participación social realizadas en los países Iberoamericanos. Se pretenden establecer proyectos que fomenten alianzas y permanezcan trabajando después de la Cumbre en el tema de "Participación y Comunicación Social en MF y APS" junto a instituciones que tienen este asunto como su misión.

Group # 2 from the V Iberoamerican Summit of Family Medicine, Quito, Ecuador 2014 was formed. There were surveys, interviews, and reunions via Skype, internet, and e-mails and the results from this investigation were presented and analyzed in the V Iberoamerican Summit of Family Medicine, which was focused in: "Participation and Social Communication in Family Medicine and Primary Health Care".

Inicialmente, foi conformado o Grupo de trabalho #2 da V Cúpula Ibero-Americana de Medicina de Família, Quito, Equador, 2014. Foram realizados inquérito, entrevistas e reuniões via Skype, internet e correio eletrônico; os resultados desta pesquisa foram analisados e se apresentaram no marco da V Cúpula Ibero-Americana de Medicina de Família. Foram recompiladas todas as atividades de participação social realizadas nos países Ibero- Americanos. Se pretende estabelecer projetos que fomentem alianças e parcerias e que permaneçam trabalhando após a Cúpula acerca do Tema "Participação e Comunicação Social em Medicina de Família e Atenção Primária à Saúde" junto a instituições que tenham este assunto como missão.

Maintenance of tobacco cessation programmes in public hospitals in Catalonia, Spain.

INTRODUCTION: The provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. METHODS: A cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. RESULTS: Responses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. CONCLUSIONS: Through a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals.

Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis.

BACKGROUND: Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS). METHODS: Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction. RESULTS: Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed. CONCLUSIONS: Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.