Descentralización de la elaboración de los tratamientos antineoplásicos. Optimización de los recursos / Decentralisation of the preparation of antineoplastic treatments. Resources

Objetivos: La metodología “Six Sigma” se basa en el análisis de los flujos de trabajo e identificación de los puntos de mejoras con el fin de lograr una máxima eficiencia en los procesos, tanto industriales como sanitarios. El objetivo de este estudio es comparar la eficiencia entre un sistema “clásico” de elaboración de quimioterapia centralizado en el Servicio de Farmacia frente a un modelo descentralizado. Material y métodos: Estudio observacional en el que se analizó la eficiencia de los modelos de elaboración de preparaciones quimioterápicas: 1.- Modelo clásico (MC), a partir del cual se suministran las preparaciones al Hospital de Día de Hematología: las campanas de elaboración de tratamientos y el farmacéutico están presentes en el Servicio de Farmacia.2.- Modelo descentralizado (MD): el farmacéutico y las campanas de preparación de la medicación se encuentran en Hospital de Día de Oncología. La eficiencia de cada sistema se evaluó mediante el tiempo transcurrido desde la recepción de la orden médica hasta la administración de la quimioterapia (TAQ).Resultados: El TAQ siguiendo el MD fue inferior que para el MC: 13,7 [5-28] minutos versus 71,0 [42-96] minutos (p<0,001) con una diferencia media de 57,3 minutos/preparación. El tiempo potencialmente ahorrado con el modelo descentralizado fue de 40,3 horas/día. Conclusiones: Con el presente trabajo hemos querido cuantificar y comparar la eficiencia de los dos modelos de elaboración de mezclas citostáticas, siendo desfavorable para el sistema clásico de centralización para la preparación de la medicación en los Servicios de Farmacia. (AU)

Aims: The «Six Sigma» methodology is based on the analysis of workflows and the identification of areas for improvement in order to achieve maximum efficiency in industrial and healthcare processes. The aim of this study is to compare the efficiency of a «classic» chemotherapy preparation system centralised in the Pharmacy Service versus a decentralised model.Material and methods: Observational study in which the efficiency of the models for the preparation of chemotherapy treatments was analysed: 1.- Classical model (MC), which has the treatment preparation cabinets and a pharmacist located in the Pharmacy Service, and from which the preparations are supplied to the Haematology Day Hospital. 2.- Decentralised model (MD), where both the pharmacist and the medication preparation cabinets are located in the Oncology Day Hospital .For the evaluation of the efficiency of each system, the time elapsed from the receipt of the medical order to the administration of chemotherapy (TAQ) was compared. Results: The TAQ following MD was less than for MC: 13.7 [5-28] minutes versus 71.0 [42-96] minutes (p<0.001) with a mean difference of 57.3 minutes/prescription. The potential time saved with the decentralised model was 40.3 hours/day. Conclusions: The aim of this study was to quantify and compare the efficiency of the two models for the preparation of cytostatic mixtures, showing that the classical centralised system for the preparation of medication in pharmacy services is unfavourable. (AU)

New multiproxy data obtained from the sedimentary fill of the Ría de Ferrol, NW Iberia.

Several gravity cores and vibro-cores were recovered from selected sites in the inner sector of Ría de Ferrol, NW Iberia (Muñoz Sobrino et al., 2021) [1]. These sediment cores were obtained during the surveys ECOMER-2014 and ECOMER-2015, developed from 2014 to 2015 on-board the R/V Mytilus (Consejo Superior de Investigación Científica) and the Amarradores Mil (Amarradores del Puerto y Ría de Ferrol, S.L.), respectively. Sedimentary and other multiproxy data presented here belong to four selected sediment cores located in the innermost part of the study area. Two were recovered using a gravity corer and another two using a vibro-corer. The depth of the cores and samples obtained is referred to the NMMA (the mean sea level in Alicante), which is the Spanish orthometric datum. One half of each core was subjected to non-destructive analysis using an ITRAX core scanner providing X-ray fluorescence (XRF) elemental data. Particle size distribution was characterised by laser diffraction. For radiocarbon dating, well-preserved articulated valves, small remains of wood and very organic bulk sediment from one location free of biogenic gas were selected. Palynological analyses were performed on selected sections of the sediment. All samples were spiked with Lycopodium spores for absolute palynomorph estimation and analysed using 400x and 600x magnifications. The ratio of dinoflagellate cyst concentrations to pollen, fern spore and dinoflagellate cyst concentrations (D/P ratio, ranging between 0 and 1) was calculated for each sample to show the temporal variation. Combined seismic, lithological, elemental, chronological and palynological data enable reconstructing the environmental changes that occurred during the local marine transgression. Besides, the combination of evidence identified may also be applied to other areas or periods in order to perform local reconstructions of changing coastal ecosystems. This type of high-resolution spatial-temporal reconstructions of past changes in estuarine environments may be a valuable tool for modelling, predicting and managing the changes and threats linked to the global warming and sea-level rise associated.

[Adequacy to diagnostic recommendations in patients with Pneumocystis jirovecii pneumonia treated with intravenous pentamidine]. / Adecuación a las recomendaciones diagnósticas en pacientes con neumonía por Pneumocystis jirovecii tratados con pentamidina intravenosa.

OBJECTIVE: To determine the rate of microbiological confirmation in the diagnosis of Pneumocystis jirovecii pneumonia in patients treated with intravenous pentamidine and the potential correlation with treatment effectiveness and safety. METHODS: Single-centre retrospective study (2010-2020), which included those patients who received intravenous pentamidine treatment for at least 48 hours. The sample collection procedure and the microbiological analysis performed were recorded. Efficacy was determined by 14-day mortality rate and admission to the Intensive Care Unit (ICU), and disease control was determined by length of hospital stay and time from completion of treatment to discharge. The safety profile was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS: A total of 17 patients with P. jirovecii pneumonia were treated with pentamidine (76.5% male (n=13); mean age [standard deviation]: 58.6 [15.5]). Microbiological confirmation of the pathogen was established in 47.1% (n=8) of cases. Targeted use of pentamidine significantly reduced the time from treatment completion to hospital discharge (p=0.019). The safety profile was acceptable, with grade I toxicity occurring in one patient. CONCLUSIONS: The study shows that more than 50% of patients receive treatment based on a presumptive diagnosis and without adhering to the established recommendations, with repercussions on the duration of admission and recovery of the patient. Future studies with a larger sample size will be necessary to consolidate the results obtained.

Redox processes in pore water of anoxic sediments with shallow gas.

The Ría de Vigo (NW Spain) has a high organic matter content and high rates of sedimentation. The microbial degradation of this organic matter has led to shallow gas accumulations of methane, currently distributed all along the ría. These peculiar characteristics favor the development of anoxic conditions that can determine the dynamics of iron and manganese. In order to study the role played by iron and manganese in the processes that take place in anoxic sediments with shallow gas, four gravity cores were retrieved in anoxic sediments of the Ría de Vigo in November 2012. Methane was present in two of them, below 90cm in the inner zone and below 200cm, in the outer zone. Pore water was collected and analyzed for vertical profiles of pH, sulfide, sulfate, iron and manganese concentrations. Sulfate concentrations decreased with depth but never reached the minimum detection limit. High sulfide concentrations were measured in all cores. The highest sulfide concentrations were found in the inner zone with methane and the lowest were in the outer zone without methane. Concentrations of iron and manganese reached maximum values in the upper layers of the sediment, decreasing with depth, except in the outer zone without gas, where iron and manganese concentration increased strongly toward the bottom of the sediment. In areas with shallow gas iron reduction, sulfate reduction and methane production processes coexist, showing that the traditional redox cascade is highly simplified and suggesting that iron may be involved in a cryptic sulfur cycle and in the oxidation of methane.