Guía para el abordaje del paciente oncológico por el farmacéutico comunitario / Guide for the community pharmacist's approach to the oncology patient

INTRODUCCIÓN: el aumento del número de pacientes oncológicos, la aparición de nuevos fármacos orales, así como la cronicidad de algunos tratamientos, hacen necesario ofrecer desde la farmacia comunitaria, una atención integral al paciente oncológico y a sus familias.OBJETIVOS. Principal: Establecer pautas de actuación profesional a pacientes oncológicos y a sus familias por el farmacéutico comunitario (FC). Secundarios: 1. Elaborar una guía que incluya apartados relativos a la comunicación, psicología, derivación a los servicios de la Asociación Contra el Cáncer en Barcelona (ACCB) y revisión de los tratamientos oncológicos, que minimice sus efectos adversos, interacciones y mejore la adherencia al tratamiento. 2. Difundir la guía a los FC de Barcelona y resto de España.MATERIALES Y MÉTODOS: la edición de los contenidos se realizó conjuntamente por dos FC de SEFAC y un psicólogo de la ACCB, llevando la coordinación la Fundación Sefac, mediante reuniones telemáticas y revisiones en línea. Se analizaron las principales estrategias psicológicas y terapéuticas actualmente empleadas en la clínica, revisando diversas fuentes de información (artículos originales, bases de datos como Pubmed/Medline o Cochrane Plus, libros, guías de práctica clínica y cursos de formación editados por sociedades científicas, boletines terapéuticos y fichas técnicas de medicamentos) publicadas especialmente en los últimos 10 años.RESULTADOS: la Guía fue publicada en noviembre del 2021 y presentada en una sesión webinar a los socios de SEFAC. Se encuentra disponible gratuitamente para socios de SEFAC en la dirección: https://www.sefac.org/documentos-para-profesionales- publicaciones-sefac/proyecto-del-abordaje-del-paciente-oncologico-porConsta de dos bloques diferenciados: Bloque 1. Orientado al acompañamiento del paciente oncológico y familiares por el FC. (AU)

Experiencia SEFAC Semana Sin Humo 2021 / Experience SEFAC Smoke-free Week 2021

JUSTIFICACIÓN: para el Día Mundial Sin Tabaco, Fundación SEFAC y SEFAC, realizaron su campaña “Semana Sin Humo 2021”, en redes sociales dirigida tanto a Farmacéuticos Comunitarios como a pacientes, para concienciar a ambos de que el farmacéutico comunitario puede ayudar de manera eficaz a dejar de fumar. Objetivos: -Potenciar y dar herramientas que empoderen a los farmacéuticos comunitarios para realizar el consejo breve a través de videos cortos formativos e informativos.-Informar, promover y dar a conocer entre los pacientes la oportunidad del cese tabáquico que de manera accesible y profesional pueden hacer en la farmacia comunitaria.MATERIAL Y MÉTODOS: se editaron 6 videos cortos realizados por FC del grupo de Respiratorio y Tabaquismo de SEFAC, difundidos en las redes sociales (Twitter e Instagram) durante la “Semana Sin Humo 2021”, 4 dirigidos a farmacéuticos comunitarios y 2 a pacientes.RESULTADOS: durante la duración de la campaña, los videos tuvieron un total de 3167 visualizaciones, con una media de 527,8 por video. Los dirigidos a los farmacéuticos comunitarios tuvieron una media de 488 visualizaciones, frente a 607,5 los de los pacientes. Contenido del vídeo. Visualizaciones. Las 5As del consejo breve para ayudar a dejar de fumar en farmacia comunitaria 880 'Semana sin humo': cinco razones para dejar de fumar 665 Intervención según el tipo de paciente fumador 425¿Qué tratamientos pueden encontrarse en la farmacia comunitaria? 550Caso práctico: intervención breve en cesación tabáquica 291 Guía de actuación farmacéutica a pie de mostrador: la terapia sustitutiva con nicotina 356 TOTAL3.167 (AU)

Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: regional analysis of the impact of COVID-19.

INTRODUCTION: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). METHODS: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. RESULTS: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. CONCLUSION: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

[Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19]. / Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19.

Introduction: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). Materil and methods: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. Results: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months. Conclusion: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

Nature (Hole or Electron) of Charge-Transfer Ability of Substituted Cyclopyrenylene Hoop-Shaped Compounds.

We theoretically investigate here by means of DFT methods how the selective substitution in cyclic organic nanorings composed of pyrene units may promote semiconducting properties, analyzing the energy needed for a hole- or electron-transfer accommodation as a function of the substitution pattern and the system size (i.e., number of pyrene units). We choose to study both [3]Cyclo-2,7-pyrenylene ([3]CPY) and [4]Cyclo-2,7-pyrenylene ([4]CPY) compounds, the latter already synthesized, with substituents other than hydrogen acting in ipso and ortho positions, as well as the effect of the per-substitution. As substituents, we selected a set of electroactive halogen atoms (F, Cl, and Br) and groups (CN) to disclose structure-property relationships allowing thus to anticipate the use of these systems as organic molecular semiconductors.

Importance of Footwear Outsole Rigidity in Improving Spatiotemporal Parameters in Patients with Diabetes and Previous Forefoot Ulcerations.

We aimed to identify if any differences existed in spatiotemporal parameters during gait among different densities of rocker soles in patients with a history of neuropathic ulcerations and the differences in comfort between shoe conditions. This study was a cross-sectional study of 24 patients with diabetes and a history of neuropathic diabetic foot ulcers (DFUs). Spatiotemporal parameters (duration of stance phase (ms), stride length (cm), and step velocity (m/s)) were analyzed in barefoot, semirigid outsole, and rigid outsole footwear conditions. A dynamic pressure measurement system (Footscan® system, RSscan International, Belgium) was used to assess shoe conditions. We also analyzed differences in comfort between the shoe conditions using a visual analog scale. A Wilcoxon test for paired samples was used to assess gait differences. Result showed that a rigid outsole causes changes in the subphases of the stance phase (p < 0.001; Cohen d = 0.6) compared to a semirigid outsole. Stride length (p < 0.001; Cohen d = 0.66) and step velocity were significantly longer (p < 0.001; Cohen d = 2.03) with the use of rigid outsole footwear. A rigid rocker sole reduces the time of the stance phase, in addition to increasing the stride length and velocity of step in patients with a previous history of DFUs.

Incidencia de la encefalopatía hipóxico-isquémica e implementación de la hipotermia terapéutica por regiones en España / Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain

INTRODUCCIÓN: La incidencia de la encefalopatía hipóxico-isquémica perinatal (EHI) y la implementación de la hipotermia terapéutica (HT) es desconocida en España. MÉTODO: Estudio transversal nacional en recién nacidos vivos (RNV) ≥ 35 semanas de gestación mediante cuestionario on-line en las 90 unidades neonatales de nivel III. Se solicitaron datos de los RNV con EHI moderada-grave en los años 2012 y 2013, y de la implementación de la HT en junio del 2015. RESULTADOS: Se recibieron datos de los 90 hospitales. La incidencia de EHI moderada-grave fue 0,77/1.000 RNV (IC del 95%, 0,72; 0,83). El 86% de los RNV con EHI recibieron HT (activa o pasiva), aumentando los que recibieron HT activa del 78% en 2012 al 85% en 2013 (p = 0,01). El 14% no recibió HT principalmente por retraso en el diagnóstico o en el traslado, o por no indicarse el tratamiento. El 57% de los RN nació en hospitales sin HT, siendo el traslado en hipotermia pasiva; en el 39% por equipos sin formación adecuada. En junio del 2015, 57/90 centros realizaban HT: 54 HT corporal total activa (todos con dispositivos servocontrolados). Existió heterogeneidad en la distribución por comunidades autónomas (CC. AA.) de centros con HT activa y en el número de RN que recibieron HT. CONCLUSIONES: La incidencia de EHI moderada-grave es homogénea entre CC. AA. Aunque se constata un importante progreso en la implementación de la HT, es preciso mejorar la disponibilidad de HT activa entre CC. AA., así como el diagnóstico precoz y el traslado con garantías desde los centros emisores

INTRODUCTION: There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS: This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS: All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS: The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres

Low-concentration distal nerve blocks with 0.125% levobupivacaine versus systemic analgesia for ambulatory trapeziectomy performed under axillary block: a randomized controlled trial.

BACKGROUND: Trapeziectomy is one of the most painful procedures in ambulatory surgery. This prospective randomized trial aimed to compare postoperative pain control using distal peripheral nerve blocks (dPNB) with a low concentration of a long-acting local anesthetic versus conventional systemic analgesia. METHODS: Fifty-two patients undergoing trapeziectomy were randomized to receive levobupivacaine 0.125% 5 mL on radial and median nerves at the elbow (dNB group), or not to receive these blocks (control group). In both groups, surgery was performed under axillary block (mepivacaine 1% 20 mL) and the same analgesic regimen was prescribed at discharge. The primary outcome was postoperative pain at 24 and 48 hours after surgery and maximum pain score on the first and second postoperative day. Secondary outcomes were duration of dPNB, rescue analgesia requirements, opioid-related side effects, consumption and effectiveness of antiemetic therapy, and upper limb motor block. RESULTS: Fifty patients were analyzed. Maximum pain intensity was moderate to severe (dPNB vs. control) in 33.3% vs. 92.3% (P=0.002) on the first day after surgery and 20.8% vs. 80.8% (P<0.001) on the second day. The average duration of analgesia after dPNB was 10 hours and no patient reported motor block. dPNB reduced rescue analgesia requirements and the incidence of postoperative nausea and vomiting (PONV). CONCLUSIONS: dPNB on target nerves provided better analgesia than systemic analgesia after trapeziectomy performed under axillary block. Opioid consumption and the incidence of PONV were lower in the dPNB group.

Valoración integral enfermera al paciente geriátrico con patología quirúrgica urológica / No disponible

Los tumores urológicos son los más habituales entre la población de mayores de 70 años. En el paciente geriátrico, la evaluación preoperatoria es fundamental, pero la clasificación de riesgo ASA no ha sido específicamente diseñada para evaluar pacientes de edad avanzada. La reserva funcional y los síndromes geriátricos son aspectos a valorar en el paciente que va a ser intervenido quirúrgicamente

Urological tumours are the most frequent among population over 70 years of age. Preoperative evaluation is of pivotal importance for elderly people, but ASA has not been specifically designed to evaluate elderly patients

[Incidence of hypoxic-ischaemic encephalopathy and use of therapeutic hypothermia in Spain]. / Incidencia de la encefalopatía hipóxico-isquémica e implementación de la hipotermia terapéutica por regiones en España.

INTRODUCTION: There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS: This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015. RESULTS: All (90) contacted hospitals participated. HIE incidence rate was 0.77/1000 live newborns (95% CI 0.72 - 0.83). During 2012-2013, 86% of the newborns diagnosed with moderate-severe HIE received TH (active or passive). Active TH was increasingly used, from 78% in 2012 to 85% in 2013 (P=.01). Of the 14% that did not receive TH, it was mainly due to a delay in the diagnosis or inter-hospital transfer, and to the fact that the treatment was not offered. More than half (57%) were born in hospitals where TH was not provided, and passive hypothermia was used for inter-hospital patient transfer, and in 39% of the cases by inappropriately trained personnel. By June 2015, 57 out of 90 centres had implemented TH, of which 54 performed whole-body TH (using servo-controlled devices). The geographical distribution of centres with active TH, and the number of newborn that received TH, was heterogeneous. CONCLUSIONS: The incidence of moderate-severe HIE is homogeneous across Spanish territory. Significant progress is being made in the implementation of TH, however it is necessary to increase the availability of active TH between Autonomous Communities, to improve early diagnosis, and to guarantee high quality patient transfer to referral centres.

Population-Based Study of the National Implementation of Therapeutic Hypothermia in Infants with Hypoxic-Ischemic Encephalopathy.

Data on the incidence of hypoxic-ischemic encephalopathy (HIE) in the first 6 hours of life together with the implementation of therapeutic hypothermia (TH) are relevant to delineate actions to achieve the lowest rates of neonatal mortality, morbidity, and long-term impact on health associated with HIE. This is population-based national survey study, including newborns ≥35 weeks of gestation with moderate-to-severe HIE from all level III neonatal care units, to provide the incidence of HIE for the period 2012-2013, and the implementation of TH up to June 2015 in Spain. Incidence rate was 0.77 per 1000 live births (95% confidence interval 0.72-0.83). By June 2015, 63% (57/90) of the units had implemented TH; 95% of them performed servo-controlled whole-body TH. For the 2-year period, 86% of the newborns diagnosed with moderate-to-severe HIE received TH. Active TH increased in use from 78% in 2012 to 85% in 2013 (p = 0.01). The main reasons for not cooling were a delay in the diagnosis (31/682) and the fact that the treatment was not offered (20/682). Interhospital patient transfer was performed using passive hypothermia, by appropriately trained personnel in 61% of centers. Eighteen percent of newborns with moderate or severe HIE died, without significant differences between the 2 years. Up-to-date knowledge of the national coverage of neonatal care of infants with HIE in developed countries is a prerequisite to reducing the load of HIE in this area and to facilitating coordinated, eliminate investigation.

Epidemiological comparison between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®).

BACKGROUND: International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain. METHODS: Data collected, from 2010 to 2013, in the Navarra Major Trauma Registry (NMTR) and the TraumaRegister DGU® (TR-DGU) were compared. Both registries followed the Utstein Trauma Template (European Core Dataset) for documentation of trauma patients. Adult patients (≥ 16 years) with New Injury Severity Score (NISS) being >15 points were included in this study. Patients who had been admitted to the hospital later than 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Demographic data, injury data, prehospital data, hospital treatment data, time intervals, and outcome were compared. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). RESULTS: A total of 646 and 43,110 patients were included in the outcome analysis from NMTR and TR-DGU, respectively. The difference between observed and expected mortality was -0.4% (standardized mortality ratio [SMR] 0.97; 95% CI 0.93-1.04) in Germany and 1.6% (SMR 1.08; 95% CI: 1.02-1.14) in Navarra. Differences in the characteristics of trauma patients and trauma systems between the regions were noted. CONCLUSION: The higher observed mortality in Navarra is consistent with the epidemiological characteristics of its population. However, to improve the quality of trauma care in the Navarra trauma system, certain improvements are necessary. There were less young adults with severe injuries in Navarra than in Germany. It is possible to compare data of severely injured patients from different countries if standardized registries are used.

[More than three hours, less than three years. Safety of anesthetic procedures in children under three years, subject to surgeries of more than three hours]. / Más de tres horas y menos de tres años. Seguridad de procedimientos anestésicos en niños menores de tres años, sometidos a cirugías de más de tres horas.

The Food and Drug Administration (USA) warning (December 2016) on the safety of general anesthesia and sedation in patients younger that 3 years and pregnant women has raised many questions about the attitude that should be taken by professionals involved in the treatment of these patients. In view of this situation, the following Medical Scientific Societies: SEDAR, SECP, SECIP and SENeo have constituted a working group to analyze and clarify the safety of these techniques. In the present article, we conclude that at present both general anesthesia and deep sedation should continue to be considered safe techniques because there is no sufficient opposing evidence in clinical studies with humans. Despite this, we should not ignore the problem which must be followed carefully mainly in patients under three years of age undergoing anesthetic procedures longer than three hours or prolonged sedation in Neonatal or Pediatric Intensive Care Units.

La alerta de la FDA de diciembre 2016, sobre la seguridad de la anestesia general y las sedaciones en pacientes menores de 3 años y en mujeres embarazadas, ha suscitado numerosas dudas sobre la actitud que deben tomar los profesionales implicados en el tratamiento de estos pacientes. Ante esta situación, las siguientes Sociedades Científicas Médicas: SEDAR (Sociedad Española de Anestesia y Reanimación), SECP (Sociedad Española de Cirugía Pediátrica), SECIP (Sociedad Española de Cuidados Intensivos Pediátricos) y SENeo (Sociedad Española de Neonatología), han constituido un grupo de trabajo para analizar y clarificar la seguridad de estas técnicas. En este artículo concluimos que en el momento actual tanto la anestesia general como la sedación profunda deben seguir siendo consideradas como técnicas seguras, porque no existen evidencias de lo contrario en estudios con seres humanos. Esta seguridad no nos permite ignorar el problema, que debe ser seguido con atención, fundamentalmente en pacientes de menos de tres años, sometidos a procedimientos anestésicos de más de tres horas o a sedaciones prolongadas en las Unidades de Cuidados Intensivos Neonatales o Pediátricos.

Angiogenesis is VEGF-independent in the aged striatum of male rats exposed to acute hypoxia.

Brain hypoxia is involved in many diseases. The activation of angiogenesis is one of the major adaptive mechanisms to counteract the adverse effects of hypoxia. In a previous work, we have shown that the adult rat striatum promotes angiogenesis in response to hypoxia via upregulation of the most important proangiogenic factor, the vascular endothelial growth factor (VEGF). However, the effects of hypoxia on angiogenesis in the aged striatum remain unknown and constitute our aim. Here we show the upregulation of hypoxia-inducible factor-1α in the striatum of aged (24-25 months old) Wistar rats exposed to acute hypoxia and analysed during a reoxygenation period ranging from 0 h to 5 days. While the mRNA expression of the proangiogenic factors VEGF, transforming growth factor-ß1 (TGF-ß1), and adrenomedullin dropped at 0 h post-hypoxia compared to normoxic control, no changes were detected at the protein level, showing an impaired response of these proangiogenic factors to hypoxia in the aged striatum. However, the striatal blood vessel network increased at 24 h of reoxygenation, suggesting that mechanisms independent from these proangiogenic factors may be involved in hypoxia-induced angiogenesis in the striatum of aged rats. A thorough understanding of the factors involved in the response to hypoxia is essential to guide the design of therapies for hypoxia-related diseases in the aged brain.

Escalas para predicción de resultados tras traumatismo grave / Scales for predicting outcome after severe trauma

En este artículo se ha hecho una revisión sobre el desarrollo de las escalas más utilizadas en los pacientes con traumatismo grave desde hace 40 años. Es sabido que, las escalas anatómicas son eficaces, tanto para medir la severidad de las lesiones, como para predecir resultados. Las escalas fisiológicas miden el componente dinámico tras el trauma, con gran influencia en el pronóstico de los traumatizados. Los índices metabólicos, tanto lactato como el déficit de base, son reflejo de un estado de hipoperfusión tisular, y por tanto de shock. Las escalas combinadas sirven para la predicción y comparación evaluativa de los resultados. La incorporación de factores que influyen en el pronóstico de los traumatizados ha conllevado al desarrollo de nuevas escalas. Sin embargo, carecen de estudios de validación externa para su uso generalizado. Hasta que estos estudios se lleven a cabo, estas escalas deben usarse con precaución (AU)

In this article we review the development of the most-used scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scales (AU)

[Scales for predicting outcome after severe trauma]. / Escalas para predicción de resultados tras traumatismo grave.

In this article we review the development of the most-used scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scales.

La Unidad de Neonatología del Hospital Universitario Miguel Servet en la actualidad. Nuevos retos / Neonatology Unit of the Hospital Universitario Miguel Servet at present: new challenges

La presente revisión resume las características de la actual Unidad de Neonatología del Hospital Universitario Miguel Servet en Zaragoza. La Unidad de Neonatología es una unidad de nivel IIIB de acuerdo con la clasificación del Comité de Estandares y la Junta Directiva de la Sociedad Espñola de Neonatología de 2013, siendo la unidad neonatal de referencia de la Cornunidad Autónoma de Aragón. En una primera aproximación, se describen la misión, visión y valores, seguido de una resña estructural y de la cartera de servicios de la Unidad de Neonatología. La actividad asistencia de la Unidad de Neonatología se presenta teniendo en cuenta tanto la hospitalización neonatal como el seguimiento ambulatorio en el área de consultas externas. La actividad docente e investigadora son otros aspectos importantes a considerar en la actual Unidad de Neonatología. Finalmente se revisan los retos de la Unidad de Neonatología para los proximos afios (AU)

This review summarizes the characteristics of the current Neonatology Unit of the Universitary Hospital Miguel Servet in Zaragoza. The Neonatology Unit is a type IIIB unit according to the classification of the Standards Committee and the Board of the Spanish Society of Neonatology in 2013, being the reference neonatal unit for the Autonomous Community of Aragon. In a first approximation, the mission, vision and values are described, followed by a structural review and all the services that de Neonatology Unit provides. The health care activity of the Neonatology Unit is presented taking care of neonatal hospitalization and its subsequent follow-up out patient clinic. The teaching and investigation activity is another important aspect to consider in the current Neonatology Unit. Finally, the challenges of the Neonatology Unit for the next years are been reviewed (AU)

Theoretical rationalization of the singlet-triplet gap in OLEDs materials: impact of charge-transfer character.

New materials for OLED applications with low singlet-triplet energy splitting have been recently synthesized in order to allow for the conversion of triplet into singlet excitons (emitting light) via a Thermally Activated Delayed Fluorescence (TADF) process, which involves excited-states with a non-negligible amount of Charge-Transfer (CT). The accurate modeling of these states with Time-Dependent Density Functional Theory (TD-DFT), the most used method so far because of the favorable trade-off between accuracy and computational cost, is however particularly challenging. We carefully address this issue here by considering materials with small (high) singlet-triplet gap acting as emitter (host) in OLEDs and by comparing the accuracy of TD-DFT and the corresponding Tamm-Dancoff Approximation (TDA), which is found to greatly reduce error bars with respect to experiments thanks to better estimates for the lowest singlet-triplet transition. Finally, we quantitatively correlate the singlet-triplet splitting values with the extent of CT, using for it a simple metric extracted from calculations with double-hybrid functionals, that might be applied in further molecular engineering studies.

Cost-Effective Force Field Tailored for Solid-Phase Simulations of OLED Materials.

A united atom force field is empirically derived by minimizing the difference between experimental and simulated crystal cells and melting temperatures for eight compounds representative of organic electronic materials used in OLEDs and other devices: biphenyl, carbazole, fluorene, 9,9'-(1,3-phenylene)bis(9H-carbazole)-1,3-bis(N-carbazolyl)benzene (mCP), 4,4'-bis(N-carbazolyl)-1,1'-biphenyl (pCBP), phenazine, phenylcarbazole, and triphenylamine. The force field is verified against dispersion-corrected DFT calculations and shown to also successfully reproduce the crystal structure for two larger compounds employed as hosts in phosphorescent and thermally activated delayed fluorescence OLEDs: N,N'-di(1-naphthyl)-N,N'-diphenyl-(1,1'-biphenyl)-4,4'-diamine (NPD), and 1,3,5-tri(1-phenyl-1H-benzo[d]imidazol-2-yl)phenyl (TPBI). The good performances of the force field coupled to the large computational savings granted by the united atom approximation make it an ideal choice for the simulation of the morphology of emissive layers for OLED materials in crystalline or glassy phases.