Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Solvent-Casted Films to Assist Polymer Selection for Amorphous Solid Dispersions During Preclinical Studies: In-vitro and In-vivo Exploration.

PURPOSE: The use of two solvent-casted film methods to select optimal polymer compositions for amorphous solid dispersions prepared to support preclinical pharmacokinetic and toxicology studies is described. METHODS: Evaporation of solvent from cover slips by using nitrogen flow, and solvent removal from vials by using rotary evaporation were employed. The films prepared on cover slips were evaluated under the microscope to determine crystallinity. The methods were validated by scaling up corresponding SDDs, evaluating SDD's dissolution, and comparing those results to the dissolution of drug-polymer films. Subsequently, SDD suspensions were prepared and dosed orally to rats to determine pharmacokinetic parameters. This was done by using three compounds from our pipeline and evaluating multiple polymers. RESULTS: The dissolution of generated films showed good agreement with the dissolution of spray dried dispersions when the films were fully amorphous (Compound A and B). In contrast, there was disagreement between film and SDD dissolution when the films had crystallized (Compound C). The in vivo exposure results indicated that the polymer choice based on the film screening methods would have been accurate for drug-polymer films that were amorphous (Compound A and B). Two additional case studies (Compound D and E) are presented, showing good agreement between in vivo and in vitro results. CONCLUSION: This study established the ability of two film casting screening methods to predict the in vitro and in vivo performance of corresponding SDDs, provided that the films are fully amorphous.

Utilización de ciprofloxacino tópico en el tratamiento de la otitis media crónica / Utilization of topical ciprofloxacin in the treatment of chronic otitis media

Se efectuó una experiencia clínica en el tratamiento de la otitis media crónica (OMC) supurada no colesteatomatosa con ciprofloxacino tópico. En 34 pacientes (38 oídos) con OMC se prescribió ciprofloxacino al 0,3 por ciento, siete gotas tres veces al día durante 10 días como única terapia. Previo al inicio del tratamiento se tomaron cultivos de la secreción ótica aislándose principalmente Proteus mirabilis, Klebsiella pneumoniae, Pseudomona aeruginosa y Staphilococcus aureus, todos los cuales, excepto un caso, fueron sensibles a ciprofloxacino. Se obtuvieron resultados buenos y muy buenos en un 79 por ciento de los casos, tan satisfactorios o mas que aquellos obtenidos en el grupo control de pacientes tratados con aminoglicósidos tópicos. Después de la aplicación de ciclofloxacino tópico no se observaron efectos ototóxicos en los pacientes. Los autores concluyeron que el uso de ciprofloxacino tópico en la OMC supurada no colesteatomatosa da resultados tan buenos o mejores que los obtenidos con aminoglicósidos tópicos y sin los potenciales efectos ototóxicos de estos últimos