Significado del alta precoz en pacientes quirúrgicos / Meaning of premature discharge in surgical patients

En los últimos años se han producido en nuestra sociedad cambios relacionados con la organización del sistema sanitario para optimizar los recursos y atender a la población. A causa del envejecimiento progresivo de la misma y el aumento de pluripatologías crónicas, existe un aumento de la demanda asistencial, que conlleva a la implantación de las nuevas tecnologías y cirugías mínimamente invasivas, ayudando a la rápida reinserción del paciente en su actividad habitual. No existe una definición consensuada de alta precoz, pero se puede definir como que el paciente recibe el alta médica antes de lo indicado por los estándares, siempre que la condición médica, personal, social y familiar lo permita. El objetivo de nuestro trabajo es conocer en profundidad el significado de la experiencia vivida por los pacientes, en relación al alta precoz y los cuidados asociados al domicilio, así como conocer las carencias y necesidades percibidas por los pacientes durante la recuperación en su medio.Esto nos permitirá tener una visión realista y humanista que nos ayudará a comprender y mejorar los procesos de atención, de planificación y evaluación de las diferentes situaciones complejas en salud (AU)

In the last years, there have been some changes in our society related to the organization of the health system to optimize resources and serve the population. Because of the gradual aging of the population and increasing chronic pluripathologies, there is an increased health care demand, leading to the introduction of new technologies and minimally invasive surgery, helping quick reintegration of the patient in their daily activity. There is no agreed definition of early discharge but the patient is discharged from hospital sooner than indicated by the standards, provided that the medical condition, personal, social and family allows. The aim of our work is to know in depth the meaning of the experience of patients in relation to early discharge and home care associated and, knowing the deficiencies and needs perceived by patients during recovery in their midst. This will allow us to have a realistic and humanist view that will help us understand and improve the processes of care, planning and evaluation of different health complex situations (AU)

Highly functionalized 1,2-diamino compounds through reductive amination of amino acid-derived ß-keto esters.

1,2-Diamine derivatives are valuable building blocks to heterocyclic compounds and important precursors of biologically relevant compounds. In this respect, amino acid-derived ß-keto esters are a suitable starting point for the synthesis of ß,γ-diamino ester derivatives through a two-step reductive amination procedure with either simple amines or α-amino esters. AcOH and NaBH(3)CN are the additive and reducing agents of choice. The stereoselectivity of the reaction is still an issue, due to the slow imine-enamine equilibria through which the reaction occurs, affording mixtures of diastereoisomers that can be chromatographically separated. Transformation of the ß,γ-diamino esters into pyrrolidinone derivatives allows the configuration assignment of the linear compounds, and constitutes an example of their potential application in the generation of molecular diversity.

[Meaning of premature discharge in surgical patients]. / Significado del alta precoz en pacientes quirúrgicos.

In the last years, there have been some changes in our society related to the organization of the health system to optimize resources and serve the population. Because of the gradual aging of the population and increasing chronic pluripathologies, there is an increased health care demand, leading to the introduction of new technologies and minimally invasive surgery, helping quick reintegration of the patient in their daily activity. There is no agreed definition of early discharge but the patient is discharged from hospital sooner than indicated by the standards, provided that the medical condition, personal, social and family allows. The aim of our work is to know in depth the meaning of the experience of patients in relation to early discharge and home care associated and, knowing the deficiencies and needs perceived by patients during recovery in their midst. This will allow us to have a realistic and humanist view that will help us understand and improve the processes of care, planning and evaluation of different health complex situations.

Optically active 1,3,4,4-tetrasubstituted ß-lactams: synthesis and evaluation as tumor cell growth inhibitors.

The in vitro cytotoxicity assays of several enantiopure (3S,4S)- and (3R,4R)-1,3,4,4-tetrasubstituted ß-lactams derived from amino acids have shown that the (3S,4S)-4-benzyl-1-p-methoxybenzyl-3-methyl-4-methoxycarbonyl derivative 2a, obtained from Phe, displays significant activity, which is comparable to that of the anticancer drug Doxorubicin against HT29 cell lines. Modifications at positions 1 and 4 of the ß-lactam ring led to identify the Tyr(2,6-ClBz) analogu 26d with similar activity data to those of 2a. The synthesis and SAR of all these tetrasubstituted ß-lactams are reported here.

Synthesis and SAR studies on azetidine-containing dipeptides as HCMV inhibitors.

SAR studies on an azetidine-containing dipeptide prototype inhibitor of HCMV are described. Three series of structurally modified analogues, involving substitutions at the N- and C-terminus, and at the C-terminal side-chain were synthesized and evaluated for antiviral activity. Aliphatic or no substituents at the C-carboxamide group, an aliphatic C-terminal side-chain, as well as a benzyloxycarbonyl moiety at the N-terminus were absolute requirements for anti-HCMV activity. The conformational restriction induced by the 2-azetidine residue into the dipeptide derivatives, identified by (1)H NMR as a γ-type reverse turn, seems to have influence on the activity of these molecules.

Highly stereoselective vinylogous Pummerer reaction mediated by Me3SiX.

A highly stereoselective vinylogous Pummerer rearrangement involving 1,4-migration of the sulfinyl oxygen atom occurs when ortho-sulfinyl benzyl carbanions are treated with trimethylsilyl halides. The reaction proceeds in good yield and affords optically pure benzyl alcohols with extremely high enantioselectivity (ee > 98%).

A general and expeditious one-pot synthesis of sulfoxides in high optical purity from norephedrine-derived sulfamidites.

A general and simple procedure for preparing any kind of enantiomerically enriched sulfoxide starting from norephedrine-derived N-benzyloxycarbonylsulfamidite 3a is reported. After one-pot reaction of 3a with RMgX, HBF(4), and R'MgX, a variety of sulfoxides 6 are obtained in ee usually higher than 93% and isolated yields ranging between 50 and 78%. The obtained configuration is tunable by simply electing the order of the addition of the reagents. [reaction--see text]