Servicio de indicación farmacéutica protocolizado INDICA+PRO y plataforma SEFAC e_XPERT: curso dirigido a estudiantes de farmacia. Diseño y valoración / INDICA+PRO protocolised pharmaceutical indication service and SEFAC e_XPERT platform: course aimed at pharmacy students. Design and assessment

JUSTIFICACIÓN: desde un enfoque eminentemente práctico, del que pueden beneficiarse alumnos de los últimos cursos del Grado en Farmacia, abordamos el diseño de una acción formativa específica sobre aspectos de la indicación farmacéutica: conocimiento de guías de síntomas menores, protocolos consensuados, requisitos, procedimientos de prestación y habilidades de comunicación necesarias para su correcto desarrollo.OBJETIVOS: diseñar el curso “Servicio de Indicación Farmacéutica protocolizado: implantación en la práctica habitual de la farmacia comunitaria”. El diseño se ha dirigido a estudiantes de 4º y 5º del Grado de Farmacia. Evaluar la formación a través de una encuesta de satisfacción.MATERIAL Y MÉTODOS: estructura del curso. 1.- Módulo teórico. 2.- Módulos prácticos: a) registro plataforma SEFAC e_XPERT (manejo y registro de casos reales) y b) sesiones de role- playing (simulación de casos propuestos).Instalaciones propias de la Facultad de Farmacia: salón de grados, aula de informática, aula simulada y anexo con circuito cerrado de TV y sonido. Ponentes: farmacéuticos comunitarios en activo, con experiencia en el Proyecto Indica+PRO® (autores del trabajo).Encuesta de satisfacción (escalas tipo Likert): valora contenido, duración, metodología, organización, profesorado, utilidad formativa percibida y valoración global del curso. Se incluyó pregunta abierta donde proponer aspectos para mejorar la calidad.RESULTADOS: el curso tuvo una duración de 20 horas lectivas y su realización supuso 1 crédito de libre configuración al alumnado. Temario. SPFA: definición y clasificación. Indicación farmacéutica. Técnicas de comunicación y fuentes de información en indicación. Actualización en medicamentos susceptibles de indicación. Síntomas menores: guías, consensos y criterios de derivación. Indica+PRO: protocolo y resultados. Plataforma SEFAC e_XPERT: registro de casos reales. (AU)

Recovery, separation and production of fuel, plastic and aluminum from the Tetra PAK waste to hydrothermal and pyrolysis processes.

The establishment of a method of separation of materials from Tetra Pak waste to obtain products for use as raw material, fuel or other purposes was investigated in this study. First, the feasibility of hydrothermal treatment for the production of a solid fuel (hydrochar) and solid fraction formed by polyethylene and aluminum, called composite was analyzed. The results indicated that hydrothermal treatment performed at 240 °C yield the formation of hydrochar with good properties for its use as fuel and a composite of polyethylene and aluminum. The best conversion and separation of the cardboard and polyethylene/aluminum were obtained using 120 min as operating time. Then, the recovery of the aluminum fraction from the composite by using spent olive oil waste was studied. A partial separation of the composite layers (polyethylene and aluminum) was accomplished with improved aluminum purity for higher operating temperatures. Finally, the operating conditions of the pyrolysis process for the production of a solid (char) and high purity composite (aluminum) were optimized. The characterization results indicated that both char and aluminum resulting from the pyrolysis of the Tetra Pak at 400 °C still have a significant amount of polyethylene while higher purity levels of aluminum can be obtained at temperatures equal of higher than 500 °C.

Liquid Hot Water Pretreatment and Enzymatic Hydrolysis as a Valorization Route of Italian Green Pepper Waste to Delivery Free Sugars.

In this work, liquid hot water pretreatment (autohydrolysis) was used to improve enzymatic hydrolysis of a commonly consumed vegetable waste in Spain, Italian green pepper, to finally produce fermentable sugars. Firstly, the effect of temperature and contact time on sugar recovery during pretreatment (in insoluble solid and liquid fraction) was studied in detail. Then, enzymatic hydrolysis using commercial cellulase was performed with the insoluble solid resulting from pretreatment. The objective was to compare results with and without pretreatment. The results showed that the pretreatment step was effective to facilitate the sugars release in enzymatic hydrolysis, increasing the global sugar yield. This was especially notable when pretreatment was carried out at 180 °C for 40 min for glucose yields. In these conditions a global glucose yield of 61.02% was obtained. In addition, very low concentrations of phenolic compounds (ranging from 69.12 to 82.24 mg/L) were found in the liquid fraction from enzymatic hydrolysis, decreasing the possibility of fermentation inhibition produced by these components. Results showed that Italian green pepper is an interesting feedstock to obtain free sugars and prevent the enormous quantity of this food waste discarded annually.

The potential of microplastics as carriers of metals.

Microplastics can adsorb chemical pollutants such as metals or pharmaceuticals, and transferred them along the food chain. In this work, an investigation of the adsorption of Cd, Co, Cr, Cu, Ni, Pb and Zn by five different types of microplastics was performed in Milli-Q water and natural waters (seawater, urban wastewater and irrigation water) via a series of batch adsorption experiments. The effects of concentration of metals and physicochemical characteristics of polymers were particularly studied. Results revealed a significant adsorption of lead, chromium and zinc on microplastics, especially on polyethylene and polyvinyl chloride. In the case of polyethylene terephthalate, it showed little adsorption capacity. Specific surface, porosity and morphology are characteristics that affect the molecular interactions. The adsorption isotherms were better described by Langmuir model, which indicates that the main adsorption mechanism might be chemical adsorption. Finally, results obtained in natural waters indicated that dissolved organic matter may play a major role on metal adsorption on microplastics. Results showed an enhancement of metal adsorption in waters with high chemical and biological oxygen demands as urban wastewater and irrigation water.

Physical-chemical characterization of microplastics present in some exfoliating products from Spain.

Plastic pollution in oceans is a global problem, with growing research efforts focusing on the threat of microplastics (<5 mm fractions). A source of microplastics pollution is derived from personal care products that contain polyethylene micro-spheres which are not captured by wastewater plants. In this work, ten personal care products (mainly scrubs) containing microplastics and marketed in Spain, were physico-chemically characterized. The obtained results proved that those microplastics had different particle size and are presented in high percentages in some cases, between 6 and 7% of the total product. Products with smaller particles usually showed higher concentrations than products with larger particles. Although all the microplastics were shown to be polyethylene, some impurities were observed that demonstrated the presence of silicates and oxides in the microplastics. Regards to morphology, the shape of the particles was irregular in general, although some completely spherical particles can be observed.

Optimization of the sugar hydrothermal extraction process from olive cake using neuro-fuzzy models.

The optimization of the hydrothermal extraction step in the biorefinery scheme in order to obtain sugars and antioxidants from olive cake was carried out. This process using water and low temperatures for the olive cake has not been previously studied by other authors. Central Composite Design of experiments was carried out. Four variables and three levels for each variable were tested: temperature (50, 70 and 90 °C) time (60, 120, 180 min), average particle diameter (0.42, 0.96 and 1.5 mm) and solid/liquid ratio (0.15, 0.20, 0.25). The main aim was to understand the relationship between the process variables and the yield of extraction of glucose, xylose, polyphenols and oligomers. The variables which most influenced the process were particle diameter and solid/liquid ratio. The experimental values were adjusted to a classical polynomial model and to a neuro-fuzzy system. The neuro-fuzzy demonstrated to be much more accurate when predicting the experimental values.

Kinetic study of thermal degradation of olive cake based on a scheme of fractionation and its behavior impregnated of metals.

This research aims to provide a better knowledge of the thermal decomposition of the olive cake as well as this lignocellulosic material loaded, in a previous stage of biosorption, with heavy metals for its use in processes of energy recovery. Firstly, isolation of constituents of the olive cake was carried out. Then, experiments were performed by thermogravimetric analysis (TGA) and differential thermogravimetry (DTG) under inert and oxidative atmosphere at a heating rate of 15 K/min for each isolated fraction. Next, adequate reactions schemes were proposed to find kinetic parameters. Validation of these schemes were verified by the goodness of fitting between experimental and simulated data. Also, some important combustion characteristics such as ignition and burnout temperatures were determined. With regard to the effect of metals, cadmium, copper, chromium, nickel and lead present in metal-loaded olive cake did not modify values of kinetic parameters which described the thermal decomposition processes.

Scale-up of a packed bed column for wastewater treatment.

After checking the success of the biosorption process to remove heavy metals from wastewater using olive tree pruning as a cheap biosorbent in the laboratory scale, the scale-up is necessary to progress towards industrial applications chance. The aim of this work was the study of the effect of scale-up in the process of biosorption of Pb(II) with olive tree pruning in a packed bed column. Experiments were performed using two different scale-up criteria and results obtained in both scales were compared. Similar parameters were obtained for each pair of equivalent tests, with a slightly advanced of the obtained breakthrough curves in the pilot plant. The experimental results were fitted by the Thomas model and the obtained mean values were KTh = 0.187 mL/min·mg and q0 = 20.59 mg/g for criterion 1 and KTh = 0.217 mL/min·mg and q0 = 20.27 mg/g for criterion 2. Finally, the mathematical model was applied to simulate industrial applications and it was obtained that under optimal operative conditions, a column according to the criterion 1 was able to operate 2.3 h, and a column according to the criterion 2 was able to operate for 3.6 h.

Neural fuzzy modelization of copper removal from water by biosorption in fixed-bed columns using olive stone and pinion shell.

Continuous copper biosorption in fixed-bed column by olive stone and pinion shell was studied. The effect of three operational parameters was analyzed: feed flow rate (2-6 ml/min), inlet copper concentration (40-100 mg/L) and bed-height (4.4-13.4 cm). Artificial Neural-Fuzzy Inference System (ANFIS) was used in order to optimize the percentage of copper removal and the retention capacity in the column. The highest percentage of copper retained was achieved at 2 ml/min, 40 mg/L and 4.4 cm. However, the optimum biosorption capacity was obtained at 6 ml/min, 100 mg/L and 13.4 cm. Finally, breakthrough curves were simulated with mathematical traditional models and ANFIS model. The calculated results obtained with each model were compared with experimental data. The best results were given by ANFIS modelling that predicted copper biosorption with high accuracy. Breakthrough curves surfaces, which enable the visualization of the behavior of the system in different process conditions, were represented.

Physico-chemical characterization of pine cone shell and its use as biosorbent and fuel.

Physico-chemical properties of pine cone shell have been determined. Results of characterization study showed that pine cone shell could be used as biosorbent of nickel from aqueous solutions in a fixed-bed column and later as input material in thermochemical processes. To study the behavior of Ni-loaded pine cone shell as fuel, non-isothermal thermogravimetric tests were performed. These tests showed that, in nitrogen atmosphere, the main decomposition occurs from 200°C to 500°C and, in oxidant atmosphere, the behavior is of type "combustion+pyrolysis" (at higher temperatures there is a clear decomposition of residue formed during the initial steps). Finally, the effect of the presence of Ni was analyzed. Thermogravimetric curves did not change their profile and the total amount of nickel was detected in char-ash fraction and not in flue gases. These results suggest that nickel does not form volatile compounds at considered operational conditions.

Comparative study of isotherm parameters of lead biosorption by two wastes of olive-oil production.

Batch isotherm studies were carried out on a laboratory scale: (i) to investigate the effectiveness to remove lead of two wastes (olive stone (OS) and olive tree pruning (OTP)), untreated and chemically treated; and (ii) to examine the applicability of various adsorption isotherms to fit the experimental data. Results from tests were analyzed using seven equilibrium isotherm correlations (Langmuir, Freundlich, Dubinin-Radushkevich, Temkin, Redlich-Peterson, Sips, and Toth equations). The sum of the squares of the errors was determined for each isotherm and the Langmuir equation provided the best fit. Chemical treatments increased the biosorption properties of these materials. The maximum biosorption capacities were: 6.33, 49.13, 14.83, and 38.93 mg g(-1) for untreated OS, HNO3-OS, H2SO4-OS, and NaOH-OS, respectively, and 26.72, 86.40, 72.78, and 123.80 mg g(-1) for untreated OTP, HNO3-OTP, H2SO4-OTP, and NaOH-OTP, respectively. Finally, the loss of mass for each waste (13.9, 14.3, and 36.8% for HNO3-OS, H2SO4-OS, and NaOH-OS and 35.1, 27.5, and 46.7% for HNO3-OTP, H2SO4-OTP, and NaOH-OTP, respectively) was taken into account and an effectiveness coefficient was determined for each adsorbent material.

Cognitive and emotional alterations in young Alzheimer's disease (3xTgAD) mice: effects of neonatal handling stimulation and sexual dimorphism.

Alzheimer disease is the most common neurodegenerative disorder and cause of senile dementia. It is characterized by an accelerated memory loss, and alterations of mood, reason, judgment and language. The main neuropathological hallmarks of the disorder are ß-amyloid (ßA) plaques and neurofibrillary Tau tangles. The triple transgenic 3xTgAD mouse model develops ßA and Tau pathologies in a progressive manner which mimicks the pattern that takes place in the human brain with AD, and showing cognitive alterations characteristic of the disease. The present study intended to examine whether 3xTgAD mice of both sexes present cognitive, emotional and other behavioral alterations at the early age of 4 months, an age in which only some intraneuronal amyloid accumulation is found. Neonatal handling (H) is an early-life treatment known to produce profound and long-lasting behavioral and neurobiological effects in rodents, as well as improvements in cognitive functions. Therefore, we also aimed at evaluating the effects of H on the behavioral/cognitive profile of 4-month-old male and female 3xTgAD mice. The results indicate that, (1) 3xTgAD mice present spatial learning/memory deficits and emotional alterations already at the early age of 4 months, (2) there exists sexual dimorphism effects on several behavioral variables at this age, (3) neonatal handling exerts a preventive effect on some cognitive (spatial learning) and emotional alterations appearing in 3xTgAD mice already at early ages, and 4) H treatment appears to produce stronger positive effects in females than in males in several spatial learning measures and in the open field test.

Context-dependent differences in grooming behavior among the NIH heterogeneous stock and the Roman high- and low-avoidance rats.

Grooming occurs during/after stress and seems to accompany dearousal. Here, grooming was investigated under testing situations involving different levels of aversiveness, taking advantage of differences among three rat strains in fearfulness/anxiety. Inbred Roman High Avoidance (RHA-I) rats are less anxious/fearful than inbred Roman Low Avoidance (RLA-I). The outbred genetically heterogeneous stock of rats (NIH-HS), which resembles the RLA-I in many behavioral traits, was also studied. Adult male rats (RLA-I: n=9, RHA-I: n=10, NIH-HS: n=12) were observed for 30min in: a novel open-field, a novel hole-board and in the home-cage. They were also observed during two-way active avoidance training. Differences in grooming depended on test situation: (a) No differences were found in the home-cage. (b) While tested in a novel environment, RHA-I showed less grooming activity than the other rats. (c) After avoidance responses appeared, differences among the strains were opposite to the observed in novelty tests. Furthermore, results suggest that (i) grooming is mostly suppressed when assured aversive experience is under way; (ii) rostral grooming prevails when experience with aversive stimuli is unpredictable (novelty) or potential (avoidance training); (iii) body grooming increases for a period in novel environments. In general, our results support that grooming takes place during dearousal.

Study of Cr (III) biosorption in a fixed-bed column.

This research analyzes the potential use of the olive stone as a low-cost biosorbent for Cr (III) from aqueous solutions in a continuous system. First, experiments were carried out in fixed-bed column to test the influence of various parameters on breakthrough and saturation time. The breakthrough and saturation time increase with the decrease of the flow rate. The same effect is shown when the bed depth is increased. The olive stone sorption capacity, q(e), increases as the inlet Cr (III) concentration increases until a value close to 0.800 mg/g is reached, then q(e) remains constant. Column data obtained at different conditions were described using the Adams-Bohart, Thomas, Yoon and Nelson, and Dose-Response models. The breakthrough curve prediction by the Adams-Bohart and Dose-Response models were found to be very satisfactory. In particular, the Adams-Bohart model can be used to represent the initial region of breakthrough curve, whereas the Dose-Response model is the one which best reproduces the whole curve for all the inlet Cr (III) concentrations used. Finally, a study of pH evolution was carried out. The pH increases at the beginning, subsequently decreasing as time passes until practically reaching the initial value.

Modeling behavioral and neuronal symptoms of Alzheimer's disease in mice: a role for intraneuronal amyloid.

The amyloid Abeta-peptide (Abeta) is suspected to play a critical role in the cascade leading to AD as the pathogen that causes neuronal and synaptic dysfunction and, eventually, cell death. Therefore, it has been the subject of a huge number of clinical and basic research studies on this disease. Abeta is typically found aggregated in extracellular amyloid plaques that occur in specific brain regions enriched in nAChRs in Alzheimer's disease (AD) and Down syndrome (DS) brains. Advances in the genetics of its familiar and sporadic forms, together with those in gene transfer technology, have provided valuable animal models that complement the traditional cholinergic approaches, although modeling the neuronal and behavioral deficits of AD in these models has been challenging. More recently, emerging evidence indicates that intraneuronal accumulation of Abeta may also contribute to the cascade of neurodegenerative events and strongly suggest that it is an early, pathological biomarker for the onset of AD and associated cognitive and other behavioral deficits. The present review covers these studies in humans, in in vitro and in transgenic models, also providing more evidence that adult 3xTg-AD mice harboring PS1M146V, APPSwe, tauP301L transgenes, and mimicking many critical hallmarks of AD, show cognitive deficits and other behavioral alterations at ages when overt neuropathology is not yet observed, but when intraneuronal Abeta, synaptic and cholinergic deficits can already be described.

El umbral de inhibición latente en las ratas romanas de alta evitación: ¿un modelo psicogenético de anomalías en el filtraje atencional? / Latent inhibition threshold in Roman high-avoidance rats: a psychogenetic model of abnormalities in attentional filter?

Introducción. Además de los modelos animales basados en la inducción de síntomas «psicóticos» mediante de fármacos psicoestimulantes, en la investigación sobre las alteraciones psicobiológicas de la esquizofrenia y sus tratamientos es cada vez más patente la necesidad de modelos que posean mayor validez de constructo, tales como líneas de animales que presenten espontáneamente singularidades asociadas a los trastornos psicóticos (p. ej., una mayor sensibilidad a los efectos de los psicoestimulantes o las anomalías cognitivas/atencionales típicas de los síndromes esquizofrénicos). Diversas evidencias experimentales indican que la cepa de ratas RHA (romanas de alta evitación) muestra un perfil neurobiológico y conductual consistente con tales requisitos.Métodos. Utilizando ratas RHA, en comparación con ratas Sprague-Dawley (SD) como un control estándar, se evaluó la expresión de inhibición latente (en una sesión de 100 ensayos de evitación activa en dos sentidos) en ambas cepas y en condiciones de umbral (con sólo 15 preexposiciones al estímulo condicionado).Resultados. Las ratas SD muestran en tales condiciones inhibición latente significativa en los 50 primeros ensayos y en el total de la sesión, fenómeno atencional que no aparece en la cepa RHA.Conclusiones. El déficit en inhibición latente en condiciones umbral, que mostraron los animales RHA, es compatible con la idea de que dicha cepa puede representar un modelo útil para el estudio de la vulnerabilidad a las alteraciones del espectro esquizofrénico. Una conclusión avalada por los datos que indican que los déficit en inhibición latente son una anomalía atencional característica de aquellas patologías

Introduction. Basic research devoted to the study of the psychobiological anomalies of schizophrenia, as well as of its treatments, has used animal models in which some psychotic-like symptoms are induced by administration of psychostimulant drugs. There is, however, a growing necessity of having animal models presenting better construct validity, i.e., animal lines spontaneously showing phenotypes associated to the psychotic spectrum (for instance, enhanced sensitivity to psychostimulants, or cognitive and attentional anomalies characteristic of schizophrenic disorders). Several lines of evidence suggest that the RHA (Roman high-avoidance) rat strain presents a neurobehavioral profile which is consistent with such goals. ;;Methods. RHA rats were compared to Sprague-Dawley (SD) rats (as a standard control strain) for the expression of latent inhibition (in a 100-trial session of two-way active avoidance) under threshold conditions (i.e., only 15 preexposures to the conditioned stimulus were administered). Results. Under such experimental conditions SD rats showed significant latent inhibition of the two-way active avoidance response (both during the first 50 trials and in the whole 100-trial session), while that attentional phenomenon did not appear in the RHA strain. Conclusions. The experimental results obtained here indicate that RHA rats display a deficit of latent inhibition at threshold conditions, an information processing (or attentional) anomaly which typically appears in schizophrenic patients. It is proposed that RHA rats might be an useful animal model for the study of vulnerability to some schizophrenic symptoms. This conclusion is supported by data that indicate that latent inhibition deficits are a characteristic attentional abnormality of these diseases

[Latent inhibition threshold in Roman high-avoidance rats: a psychogenetic model of abnormalities in attentional filter?]. / El umbral de inhibición latente en las ratas romanas de alta evitación: un modelo psicogenético de anomalías en el filtraje atencional?

INTRODUCTION: Basic research devoted to the study of the psychobiological anomalies of schizophrenia, as well as of its treatments, has used animal models in which some psychotic-like symptoms are induced by administration of psychostimulant drugs. There is, however, a growing necessity of having animal models presenting better construct validity, i.e., animal lines spontaneously showing phenotypes associated to the psychotic spectrum (for instance, enhanced sensitivity to psychostimulants, or cognitive and attentional anomalies characteristic of schizophrenic disorders). Several lines of evidence suggest that the RHA (Roman high-avoidance) rat strain presents a neurobehavioral profile which is consistent with such goals. METHODS: RHA rats were compared to Sprague-Dawley (SD) rats (as a standard control strain) for the expression of latent inhibition (in a 100-trial session of two-way active avoidance) under threshold conditions (i.e., only 15 preexposures to the conditioned stimulus were administered). RESULTS: Under such experimental conditions SD rats showed significant latent inhibition of the two-way active avoidance response (both during the first 50 trials and in the whole 100-trial session), while that attentional phenomenon did not appear in the RHA strain. CONCLUSIONS: The experimental results obtained here indicate that RHA rats display a deficit of latent inhibition at threshold conditions, an information processing (or attentional) anomaly which typically appears in schizophrenic patients. It is proposed that RHA rats might be an useful animal model for the study of vulnerability to some schizophrenic symptoms. This conclusion is supported by data that indicate that latent inhibition deficits are a characteristic attentional abnormality of these diseases.

Psicología Clínica basada en el paciente: utilidad en Radioterapia / Patient-based clinical psychology in radiotherapy

Propósito: dar respuesta a tres cuestiones que se plantean en el Servicio de Oncología Radioterápica (OR) del Hospital Militar Central de La Defensa: ¿qué necesidades presenta un paciente que se somete a tratamiento de radioterapia (RT)?, ¿cómo pueden afrontar esas necesidades los pacientes y el personal sanitario de esta unidad?, y ¿existe un modelo que cubra esas necesidades? Material y métodos: se han realizado dos estudios, el primero dirigido a detectar los factores que generan burnout en el personal sanitario, y el segundo al estudio de la evolución del dolor de cada paciente en el tratamiento de RT. Resultados: las necesidades que presenta el paciente son de dos tipos: médicas y emocionales. Las primeras son cubiertas por los oncólogos radioterapeutas, y para las segundas el equipo de psicólogos elaboró un programa de asistencia psicológica para pacientes y otro para personal sanitario de esta unidad. Conclusiones: es necesario ofertar un soporte especializado de Psicología Clínica a pacientes para facilitar su adherencia al tratamiento, y al personal sanitario para mejorar la relación terapéutica equipo sanitario-paciente (AU)

Partition coefficients of alpha-amylase in aqueous two-phase systems PEG + MgSO4.7H2O + H2O at 298 K.

Partition coefficients of alpha-amylase have been determined in a polyethylene glycol (average molecular mass 8000)/MgSO4.7H2O aqueous two-phase system at 298 K and the influence of polymer, salt and initial enzyme concentration on partition was investigated. Correlations are proposed which relates the partition coefficient to the initial enzyme concentration and the concentration difference between phases of polymer and salt. The free volume change, related to the densities of the separate phases, has a direct dependence with such polymer and salt concentration differences, respectively, and is then used to facilitate future estimations. Thus, the partition coefficient is a function of this physical parameter and the initial enzyme concentration employed (1.25, 2.50 and 5.00 g dm-3).

[The efficiency of organizational measures in improving the management of the prior appointment program]. / Efectividad de medidas organizativas en la mejora de la gestión del Programa de Cita Previa.

OBJECTIVES: To estimate the organisational impact of the volume of appointments processed in the Primary Care (PC) Administration Units (AU) of Area 10, and to evaluate the effectiveness of organisational measures to correct the excess of appointments processed at particular times of day. DESIGN: Before-and-after intervention study. SETTING: AU of 16 PC teams from Madrid's Area 10. PARTICIPANTS: All the appointments made for users by 78 clerks in the 16 AU in the Area during the two weeks of the study. INTERVENTIONS: Strengthening of administrative staff dealing with the appointment system; and an information campaign for users about the system. MEASUREMENTS AND RESULTS: The percentage of appointments processed by AU was broken down for morning and afternoon, by the way the appointment was made (telephone/counter) and by the scheduling of the list. The hourly development was analysed by a graph. A mean number of appointments per clerk per day was found. The above figures were compared for before and after intervention. CONCLUSIONS: The work load caused by the appointment system was redistributed by internal organisational measures, since user habits did not alter.