[Translated article] Implementation of the standardized process of drug therapy evaluation in inpatients and outpatients.

OBJECTIVES: The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). METHODS: A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1781 patients was evaluated before and 2129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5209 and 2246. In the after-SPEP period were 6105 and 2641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8072 in the study period. CONCLUSIONS: This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Bamboo forage in Peruvian Amazon: a potential feed for cattle.

During the dry and rainy seasons of the Northeastern Zone of Peru, a chemical characterization of five species of bamboo prevalent in the area (Guadua lynnclarkiae, G. takahashiae, Bambusa vulgaris, G. weberbaueri, and Dendrocalamus asper) was conducted. Then, the effect of supplementing bamboo leaves (0, 20, and 40% inclusion of D. asper) on the intake and live weight gain of 18 Gyr × Holstein heifers was evaluated for 28 days. Among the species evaluated, D. asper has the greatest crude protein (CP) concentration (158-166 g/kg Dry matter- DM), post-ruminal CP supply (127 g/kg DM), and in vitro organic matter digestibility (444-456 g/kg DM) but similar concentrations of crude ash (124 g/kg DM), calcium (2.4-2.8 mg/g), phosphorus (0.7-2.1 mg/g), protein fractions A, B1, B2, B3, C (45, 5, 35, 56, and 17g/kg DM, respectively), rumen-undegraded CP (31% CP), neutral detergent fiber (NDF, 685g/kg DM), and acid detergent fiber (ADF, 357 g/kg DM) than the other species evaluated. Dry matter intake was higher in the control treatment and in the 20% bamboo leaf inclusion treatment than in the 40% bamboo inclusion treatment. Intake of CP and NDF decreased with the increase in bamboo inclusion. Despite the differences in DM, CP, and NDF intake, the live weight gain remained similar across treatments. However, there was a greater feed conversion in the 20% bamboo leaf inclusion treatment. During the dry season, bamboo leaves can be used as an alternative supplement at a maximum inclusion of 20% without affecting the live weight gain.

Ecotoxicidad aguda en semillas de Lactuca sativa L. de antibacterianos con riesgo ambiental / Acute ecotoxicity in seeds of Lactuca sativa L. Antibacterial with environmental risk

En los últimos años existe una creciente preocupación por los efectos que los desechos de los medicamentos producen en el medio ambiente. El objetivo de esta investigación fue evaluar la ecotoxicidad aguda de antibacterianos en Lactuca sativa que se vierten a uno de los dos ríos que atraviesan las zonas más urbanizadas de la ciudad de Santa Clara (Cuba). Para esto se realizó un estudio de consumo de los antibacterianos consumidos en el hospital durante un año, se predijo sus concentraciones ambientales mediante un modelo matemático y se determinó su riesgo ecotoxicológico. En el período de estudio se utilizaron 22 antibacterianos, el de mayor consumo fue la ceftriaxona y el de menor la doxiciclina. Todos constituyen un riesgo para el ambiente exceptuando doxiciclina y miconazol. Se observó inhibición de la germinación de Lactuca sativa L. en todos los antibacterianos resaltando el cotrimoxazol con 38.78% (CI50=0.52g/L) y vancomicina la de menor efecto en la inhibición de la germinación con un 8.56% (CI50=44,14g/L). En la mezcla solamente hubo inhibición de la geminación a la mayor concentración evaluada, mientras que en el resto de las concentraciones no se evidenciaron diferencias estadísticamente significativas con respecto al control. El tipo de interacción de la mezcla se clasifica como sinérgica. El vertimiento de residuos de antibacterianos puede ser causa de contaminación ambiental perjudicial

In recent years there is growing concern about the effects that drugs produce waste in the environment. The objective of this research was to evaluate the acute ecotoxicity of antibacterials in Lactuca sativa discharged into one of two rivers that cross the most urbanized areas of the city of Santa Clara (Cuba). For this, a consumer study of antibacterial consumed in the hospital for a year was made, its environmental concentrations predicted by a mathematical model and determined their ecotoxicological risk. In the study period 22 antibacterials were used, the highest consumption was lower ceftriaxone and doxycycline. All pose a risk to the environment except doxycycline and miconazole. inhibition of germination of Lactuca sativa L. was observed in all antibacterial highlighting cotrimoxazole with 38.78% (IC50 = 0.52g / L) and vancomycin the least effect on the inhibition of germination with 8.56% (IC50 = 44,14g / L). In the mixture there was only germination inhibition at the highest concentration tested, while in other concentrations no statistically significant differences were found with respect to control. The type of interaction is classified as synergistic mixture. Shedding of antibiotics residues can cause harmful environmental pollution. while in other concentrations were not statistically significantly different from control is evidenced. The type of interaction is classified as synergistic mixture. Shedding of antibiotics residues can cause harmful environmental pollution. while in other concentrations were not statistically significantly different from control is evidenced. The type of interaction is classified as synergistic mixture. Shedding of antibiotics residues can cause harmful environmental pollution

Intoxicaciones veterinarias en Chile reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Chile veterinary poisonings reported to the Poison Information Center at the Pontificia Universidad Catolica de Chile (CITUC)

Las intoxicaciones en animales son una problemática a nivel mundial, constituyen una causa habitual de consultas veterinarias y muertes. En Chile existe escasa información sobre el tema y se hace necesario investigar sobre agentes tóxicos involucrados y especies expuestas. En este estudio se describen las exposiciones a diferentes agentes potencialmente tóxicos por parte de animales registradas por el CITUC durante el período 2006-2013. Las variables analizadas fueron especie, agente, vía de exposición, interlocutor y lugar de procedencia del llamado de acuerdo al formato de la O.M.S. Se analizaron 3.261 llamados, predominando las exposiciones en perros (83,6%), siendo el principal interlocutor el dueño del animal (74,3%). El principal agente correspondió a plaguicidas (63,1%), destacándose entre ellos los rodenticidas (58,4%). Los llamados se realizaron principalmente desde el hogar (74,6%), seguido por clínicas veterinarias (22,8%). La probabilidad de exposición por plaguicidas en perros fue 1,3 veces superior que en otras especies de animales (IC95%: 1,1-1,6). Al analizar las intoxicaciones por rodenticidas se observó que el 91,8% de éstas se produjo en perros y que el riesgo de exposición en esta especie por esta familia de plaguicidas fue 2,3 veces superior (IC 95%: 1,4-3,7) con respecto a otros animales. En conclusión, la mayoría de estas exposiciones reportadas ocurrió en animales de compañía. El conocimiento sobre el peligro potencial de los tóxicos presentes en el hogar por parte de los responsables de la tenencia de mascotas, juega un papel fundamental en la prevención de intoxicaciones en especies animales (AU)

Poisonings in animals are a problem worldwide, are a common cause of veterinary visits and deaths. In Chile there is little information on the subject and we need to investigate toxic agents involved and exposed species. In this study different exposures to potentially toxic agents registered by the CITUC during the period 2006-2013 animals are described. The variables analyzed were kind, agent, route of exposure, interlocutor and place of origin of the call according to the format called WHO 3261 were analyzed, predominantly exhibits dogs (83.6%), the main contact the owner of animal (74.3%). The main agent corresponded to pesticides (63.1%), especially including rodenticides (58.4%). Calls were made mainly from home (74.6%), followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3.7) compared to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3.7) compared to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals

Cultura de seguridad del paciente por personal de enfermería en Bogotá, Colombia

La cultura de seguridad del paciente está relacionada con las creencias y actitudes que asumen las personas en su práctica para garantizar que no experimentará daño innecesario o potencial asociado a la atención en salud.Este estudio describe la percepción de dicha cultura referida por el personal de enfermería en instituciones prestadoras de servicios de salud del tercer nivel de complejidad que hacen parte del Sistema de Seguridad Social en Salud en Bogotá, Colombia. Método: Estudio descriptivo, transversal, exploratorio realizado durante el 2009. La muestra estuvo constituida por 201 profesionales y técnicos en enfermería que aceptaron participarvoluntariamente y cumplieron los requisitos de inclusión planteados. La medición se realizó con el instrumento Hospital Survey on Patient Safety Culture. El cuestionario fue autoadministrado después de informar el propósito y cumplir las consideraciones éticas. Resultados: La cultura de seguridad del paciente referida por el personal de enfermería se evidencia por resultados positivos en la coordinación y comunicación eficaz dentro de las unidades y la percepción generalizada de que la gerencia se interesa en la seguridad del paciente. En los aspectos a mejorar se destaca la percepción de personal insuficiente y el alto flujo de personal ocasional percibidos como riesgos en la atención que afecta la seguridad del paciente. Los participantes del estudio indican que al notificar eventos adversos se llevarán a cabo acciones punitivas en su contra. Conclusiones: Las institucionesprestadoras de servicios de salud y su personal son cada vez más conscientes de la importancia de mejorar la seguridad del paciente.

Evaluation of Tobacco Germplasm for Seedling Resistance to Stem Rot and Target Spot Caused by Thanatephorus cucumeris.

Stem rot and target spot of tobacco, caused by Rhizoctonia solani and its teleomorph Thanatephorus cucumeris, respectively, can cause serious problems in production of tobacco (Nicotiana tabacum) seedlings. Previous screens for genetic resistance in tobacco have been limited. The objective of this study was to evaluate 97 genotypes composing several classes of tobacco and related Nicotiana spp. for seedling resistance to stem rot and target spot. Significant differences in disease incidence initially were observed among the genotypes for both stem rot and target spot; however, resistance to target spot was not observed when disease pressure was high. Partial resistance to stem rot was observed in several genotypes in repeated tests. These accessions may be useful as a source of resistance to R. solani in future breeding efforts.

Defective running shoes as a contributing factor in plantar fasciitis in a triathlete.

STUDY DESIGN: Case study of a patient who developed plantar fasciitis after completing a triathlon. OBJECTIVES: To describe the factors contributing to the injury, describe the rehabilitation process, including the analysis of defective athletic shoe construction, and report the clinical outcome. BACKGROUND: Plantar fasciitis has been found to be a common overuse injury in runners. Studies that describe causative factors of this syndrome have not documented the possible influence of faulty athletic shoe construction on the symptoms of plantar fasciitis. METHODS AND MEASURES: The patient was a 40-year-old male triathlete who was followed up for an initial evaluation and at weekly intervals up to discharge 4 weeks after injury and at 1 month following discharge. Perceived heel pain, ankle strength, and range of motion were the primary outcome measures. Shoe construction was evaluated to assess the integrity of shoe manufacture and wear of materials by visual inspection of how shoe parts were glued together, if shoe parts were assembled with proper relationship to each other, if the shoe sole was level when resting on a level surface, and if the sole allowed unstable motion. RESULTS: The patient appeared to have a classic case of plantar fasciitis with a primary symptom of heel pain at the calcaneal origin of the plantar fascia. On initial evaluation, right heel pain was a 9 of 10, plantar flexion strength was a 3+/5, and ankle dorsiflexion motion was 10 degrees. One month after discharge, perceived heel pain was 0, plantar flexion strength was 5/5, and dorsiflexion motion was 15 degrees and equal to the uninvolved extremity. The right running shoe construction deficit was a heel counter that was glued into the shoe at an inward leaning angle, resulting in a greater medial tilt of the heel counter compared with the left shoe. The patient was taught how to examine the integrity of shoe manufacture and purchased a new pair of sound running shoes. CONCLUSIONS: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fasciitis. Assessing athletic shoe construction may prevent lower extremity overuse injuries.

Factors that Affect Development of Collar Rot on Tobacco Seedlings Grown in Greenhouses.

Collar rot, caused by Sclerotinia sclerotiorum, is an important disease of tobacco transplants produced under greenhouse conditions. Factors that affect the development of the disease were studied, including age of seedlings, presence of an external source of nutrients (leaf extract), clipping (leaf removal) practices, exposure to low temperature, and leaf injury caused by heat and a chemical. Flue-cured tobacco seedlings, cultivar K-326, were grown in polystyrene cell trays floating on a nutrient solution. Trays were maintained in a phytotron growth chamber with a 28/18°C day/night temperature regime. Seedlings were inoculated with ascospores of S. sclerotiorum at the desired stage of growth by placing mature apothecia in the growth chamber and inducing ascospore release and deposition. Disease incidence was determined by examining seedlings for the presence of stem lesions over the next 15 to 21days. Seedlings between 35 and 53 days old were more susceptible to collar rot than younger or older seedlings. Inoculum efficiency was highest and disease was most severe when an external source of nutrients was present on leaf surfaces. Clipping of leaf tips did not increase disease, but if the leaf pieces created by clipping were left on seedlings, collar rot development was enhanced compared with treatments where debris was removed. Heat and chemical injuries that resulted in necrotic tissue provided highly susceptible infection courts for ascospores of S. sclerotiorum, but exposure to low temperature, which caused no visible injury, did not enhance infection. Adoption of cultural practices that minimize accumulation of leaf debris and eliminate factors that cause necrotic injury on leaves should greatly reduce the severity of collar rot of tobacco seedlings.

Identification and Quantification of Ascospores as the Primary Inoculum for Collar Rot of Greenhouse-Produced Tobacco Seedlings.

Collar rot, caused by Sclerotinia sclerotiorum, is a severe disease of tobacco seedlings grown in greenhouses. A semiselective medium was adapted and used to detect the presence and quantity of ascospores in commercial greenhouses. Petri dishes of the semiselective medium were placed inside and outside of greenhouses in four counties during the transplant production period in 1995 and 1996. Ascospores were present throughout the production period each year (February to April) and were confirmed to be the primary inoculum for the disease. Significant differences were observed in the number of ascospores trapped within and between counties. Peak numbers of ascospores were trapped between 10 and 12 a.m., and higher numbers of ascospores were trapped outside than inside houses. In general, distribution of ascospores inside houses was uniform unless a high concentration of apothecia was present very close to one section of the greenhouse. The semiselective medium and trapping technique used in this study may allow development of a forecasting system for collar rot of tobacco based on the presence and level of pathogen inoculum.

Sources of Inoculum and Management for Rhizoctonia solani Damping-off on Tobacco Transplants under Greenhouse Conditions.

Damping-off and target spot are important diseases of tobacco transplants produced under greenhouse conditions. Identification of sources of inoculum for these diseases caused by Rhizoctonia solani is an important first step in disease management. Control strategies based on sanitation and the eradication of primary inoculum were studied. Potting mix and Styrofoam trays used in transplant production were assayed to determine if they were sources of primary inoculum. Eleven sources of potting mix were sampled over a 2-year period. None of the mixes contained viable inoculum of R. solani. R. solani was isolated from previously used trays after 1 year of storage by removing and plating pieces of Styrofoam from individual tray cells on alkaline water agar (AWA). Sclerotia and melanized hyphae of R. solani were observed in the cracks present in the cells of the trays. Dry heat (70 to 80°C for 2 h) and chemical (sodium hypochlorite and sodium chloride) treatments reduced the levels of inoculum on trays up to 45% compared to controls, but only methyl bromide and steam treatments (80°C for 0.5 to 2.0 h) eradicated inoculum of R. solani from trays. Elimination of primary inoculum from previously used trays effectively controlled target spot and stem rot diseases caused by R. solani.