[Evaluation of the collaboration between Primary and Hospital Care in order to improve inappropriate prescription]. / Evaluación de la colaboración entre atención primaria y hospitalaria para mejorar la polimedicación inapropiada.

INTRODUCTION AND OBJECTIVES: To evaluate the implementation of a collaborative experience between Primary (PC) and Hospital Care (HC) aimed at reducing potentially inappropriate prescribing (PIP) in patients with polypharmacy. MATERIALS AND METHODS: Collaborative experience including a controlled before-after intervention study, carried out in the Donostialdea Integrated Health Organization (IHO), with Bilbao Basurto IHO as control group, Osakidetza, Basque Health Service. Participant were 227 PC physicians and physicians from 7 hospital services, and patients with 5 or more drugs meeting at least one PIP criteria. The intervention consisted of communication and knowledge between professionals, PC-HC consensus, training, identification of patients at risk, medication review, evaluation and feed-back. The collaboration process (agreements, consensus documents, training activities) and the change in the prevalence of PIP in polymedicated patients (using computerised health records) were evaluated. RESULTS: A total of 21 PIP criteria and 6 recommendation documents were agreed. An analysis was performed on 15,570 PIP from OSI Donostialdea and 24,866 from the control group. The prevalence of PIP in polymedicated patients was reduced by -4.53% (95% CI: -4.71 to -4.36, P< .0001) in comparison with the control group. The before-after differences were statistically significant across the 7 services. CONCLUSIONS: PC-HC collaboration is feasible and, along with other intervention components, reduces inappropriate polypharmacy in the context of a recently integrated healthcare organisation. The collaboration process is complex and requires continuous monitoring, policy involvement, leadership that encourages health professional participation, and intensive use of information systems.

Effect of the change of the ancillary carboxylate bridging ligand on the SMM and luminescence properties of a series of carboxylate-diphenoxido triply bridged dinuclear ZnLn and tetranuclear Zn2Ln2 complexes (Ln = Dy, Er).

Eleven new dinuclear and tetranuclear compounds of general formulae [Zn(µ-L)(µ-X)Ln(NO3)2]·nS, [Zn2Dy2(µ3-L')2(µ-sal)2(NO3)(CH3OH)](NO3)·5CH3OH and [Zn2Er2(µ3-L')2(µ-sal)2(CH3OH)2](NO3)2·4CH3OH (X = benzoate, anthracenate, diclofenac, salicylate, 2,6-dihydroxybenzoate; Ln = Dy, Er; S = water, acetonitrile, methanol) were prepared from the N,N'-dimethyl-N,N'-bis(2-hydroxy-3-formyl-5-bromobenzyl)ethylenediamine compartmental ligand (H2L). Complexes 1-6 and 9-11 consist of diphenoxido-carboxylate triply bridged compounds, which differ mainly in the carboxylate bridging ligand. It should be noted that the acidic character of the salicylic acid promotes, in the presence of methanol, the methoxylation of the H2L ligand thereby yielding a hemiacetal H3L', which is able to connect the Ln(iii) ions of two ZnLn dinuclear units forming the Zn2Ln2 tetranuclear complexes 7 and 8. All compounds display SMM behaviour in the presence of an external field with effective energy barriers (Ueff) as high as 61 K. Magneto-structural data for these complexes reveal that their SMM behaviour is not only significantly affected by the type of Ln(iii) ion but also by the carboxylate bridging ligand connecting the Zn(ii) and Ln(iii) ions. Photoluminescence properties have also been accomplished, showing that the ligands are able to sensitize lanthanide centred emissions in the visible and near-infrared regions with variable capacity. Moreover, the analysis of the luminescence decay curves reveals emission lifetimes in the range of few microsecond or hundreds of nanoseconds for Dy(iii)-based or Er(iii)-based luminophores, respectively.

Technique for precaval and laterocaval nodes excision at extraperitoneal paraaortic lymphadenectomy.

STUDY OBJECTIVE: To describe our technique for excision of the pre-caval and laterocaval nodes using an extraperitoneal approach. This technique was developed to make the dissection and excision of the less accessible nodes in an easier and safer way by minimizing the risk of great vessels injury and bleeding. DESIGN: Step-by-step description of the surgical procedure using video (Canadian Task Force classification III). SETTING: The procedure was performed at a teaching hospital, Hospital Universitario Donostia (Spain). PATIENTS: A 52-year-old woman with a body mass index of 33 underwent endoscopic extraperitoneal paraaortic lymphadenectomy for advanced high grade cervical adenocarcinoma FIGO IIB. INTERVENTIONS: The patient underwent an endoscopic extraperitoneal para-aortic lymphadenectomy. An anatomical dissection is being performed being the upper limit of the dissection the left renal vein. Focus of the video involves the challenging dissection of the right nodes. MEASUREMENTS AND MAIN RESULTS: Firstly we complete a dissection of all the anatomical aortic limits until the renal vein and exeresis of aortic nodes. A plane just above the cava vein is carefully developed by pushing all the lymph nodes to the roof of the dissection. Special care must be taken close to the aortic bifurcation due to the perforating vessels that can be found more frequently in this location. Once all this space is dissected, nodes attached to the roof are easily pushed down. It is useful to use a clip in the upper part, close to the renal vein, to prevent lymphorrhea. Nodes are excised in four blocks, supramesenteric and inframesenteric aortic and precaval nodes. The proximity to the peritoneal roof and the chance for a peritoneal hole and loss of pneumoperitoneum can be less problematic if the right dissection is performed at the end of the procedure. CONCLUSION: A complete para-aortic retroperitoneal dissection can be achieved with this extraperitoneal approach. Benefits of this technique are based on the absence of the bowel or other intraperitoneal structures invading the operative field given the barrier-free nature of the retroperitoneal space. Despite the challenge of the access to the right nodes in a retroperitoneal paraaortic lymphadenectomy they can be successfully excised reaching the renal vein including obese patients.

Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes.

OBJECTIVE: To evaluate uterine artery (UtA) Doppler over the course of pregnancy in low-risk nulliparous women and to analyze whether an abnormal uterine artery pulsatility index (UtA-PI) at a 32-34 week' scan implies poorer perinatal outcomes. METHODS: An observational prospective study was carried out including 616 low-risk nulliparous women. Women with any of the following were excluded: fetal abnormalities, multiple pregnancy, and heparin, metformin or hypotensive treatment. Maternal characteristics, mean arterial pressure measurements and UtA Doppler findings were recorded longitudinally. RESULTS: Complete pregnancy data were available for 489/616 women (79.3%). Of these, 385 women had a normal UtA-PI throughout pregnancy (Group 0), while 50 (10.1%) had an UtA-PI > 95th percentile in the first or the second trimester that normalized in the third trimester (Group 1), and 56 (11.4%) had an abnormal UtA-PI in the third trimester (Group 2). We found that the rate of pre-eclampsia (PE) was higher in Group 2 (7/56 versus 4/435, p = 0.003) as was the rate of intrauterine growth restriction (IUGR) (6/56 versus 14/435, p = 0.02). CONCLUSIONS: Low-risk nulliparous women with abnormal UtA Doppler findings in the third trimester are at a higher risk of developing PE and having a baby with IUGR.

Ion beam induced 18F-radiofluorination: straightforward synthesis of gaseous radiotracers for the assessment of regional lung ventilation using positron emission tomography.

A simple, straightforward and efficient method for the synthesis of [18F]CF4 and [18F]SF6 based on an ion beam-induced isotopic exchange reaction is presented. Positron emission tomography ventilation studies in rodents using [18F]CF4 showed a uniform distribution of the radiofluorinated gas within the lungs and rapid elimination after discontinuation of the administration.

The effect of cattle slurry electroflotation products as fertilizers on gaseous emissions and grassland yield.

The climatic conditions of the Basque Country (northern Spain) provide the favorable conditions for the growth of grasslands and the development of livestock enterprises. The intensification of the farms is leading to serious environmental risks due to the great generation of manures and slurries and their subsequent inefficient management. Their application involves N losses that can be pollutant. The environmental company ADE BIOTEC S.L. is developing the process called "electroflotation" with the aim of reducing the volume of slurries from intensive livestock farms. The process consists basically of an electrolysis of the slurry catalyzed by iron which leads to the flocculation of the solid particles, giving as a final result a solid and a liquid fraction. The objective of this work was to assess the usefulness of these two fractions as fertilizers. With this aim, the environmental risk of their application was determined regarding gaseous emissions to the atmosphere (i.e., of NO, NH(3), N(2)O, and CO(2)) and their fertilizer capacity was investigated by determining their effects on grassland yield and N uptake in comparison to the untreated slurry. The untreated slurry and the solid and the liquid fractions were all applied at a rate of 70 kg NH(4)(+)-N ha(-1). The application of the products of electroflotation did not affect N(2)O and CO(2) losses, being of the same magnitude as those caused by the application of the original slurry. However, after their application, a reduction in NH(3) volatilization losses was induced in the short term and a reduction in NO losses was caused in the long term. The solid and liquid fractions both increased biomass yield with respect to the untreated slurry. The solid fraction even induced a higher N uptake than the liquid fraction and the untreated slurry.

Cómo buscar (y encontrar) la mejor evidencia científica disponible de manera rápida y sencilla / How to search for (and find) the best scientific evidence available rapidly and easily

La Medicina Basada en la Evidencia (MBE) es un pujante movimiento desarrollado durante la última década que intenta integrar la experiencia clínica y las circunstancias individuales del paciente con la mejor evidencia científica existente. Dentro del enfoque propuesto por la MBE, las revisiones sistemáticas constituyen el tipo de estudio más adecuado (en cuanto a nivel de evidencia y grado de recomendación de una decisión clínica) cuando lo que se evalúa es la efectividad de un tratamiento o actuación preventiva. Existen fuentes de información que seleccionan y actualizan de manera continuada la evidencia científica a las que se puede acceder de manera rápida y sencilla. El objetivo general de este trabajo es explicar cómo buscar la mejor evidencia disponible de una manera sencilla. Los objetivos específicos son: dar a conocer los principios de la MBE; dar a conocer las revisiones sistemáticas y su importancia; presentar y facilitar el acceso a varias fuentes de información de elevada calidad y estimular la profundización en los temas relacionados con la MBE (AU)