[Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital]. / Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital.

OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. METHODS: Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015. RESULTS: During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05). CONCLUSIONS: This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

[The neurobiology of sleep: Cajal and present-day neuroscience]. / Neurobiología del sueño: Ramón y Cajal y la neurociencia actual.

AIMS: We briefly describe the most significant findings obtained recently concerning the sleep-waking cycle in comparison to the studies conducted by Cajal on the same subject. DEVELOPMENT: This paper includes a short biographical sketch of Santiago Ramón y Cajal, with special emphasis on his importance within the framework of neuroscience. Cajal represents the decisive turning point in neurobiological studies, with the discovery of the synapse and his law of dynamic polarization. We conduct a short survey of the current knowledge about the phases of sleep and oneiric phenomena, based on their anatomo-physiological foundations. We present a summary of the history of the subject and analyze the contributions made by Cajal to this field, i.e. his study of the associative cortices, which are essential in memory processes and related to the mechanisms governing the sleep-waking cycle. For Cajal the fine anatomy of the thalamus must be considered in relation to the specificity of its connections an idea that is still completely valid today. He did not observe any projections of the thalamic reticular nucleus towards the cerebral cortex, a fact that has been corroborated using modern-day techniques. He spoke of the involvement of neuroglia in the attentional and sleep processes, which is so, although not quite in the way Cajal thought. He considered the production of dreams to be based on intimate neural mechanisms, which is still so. He also studied other brain structures related with the regulation of the sleep waking cycle, although avoiding any specific mention of the mechanisms controlling such a cycle. Furthermore, he conducted self-observation studies with a high degree of insight. CONCLUSIONS: Cajal studied the phenomena of attention and sleep in an objective manner and contributed a number of significant interpretations, some of which are now somewhat outdated while others are still wholly valid today.