Optimización de los tratamientos de la insuficiencia cardiaca con fracción de eyección reducida en la práctica diaria: propuesta de un grupo de expertos / Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts

El tratamiento de los pacientes con insuficiencia cardiaca con fracción de eyección reducida (IC-FEr) con una combinación de 4 clases de fármacos se recomienda en las principales guías de práctica clínica internacionales. Sin embargo, no especifican cómo deben introducirse y ajustarse estos tratamientos. En consecuencia, muchos pacientes con IC-FEr no pasan a un régimen de tratamiento optimizado. El objetivo de esta revisión es proponer un algoritmo pragmático para optimizar el tratamiento, diseñado para que sea lo más fácil posible de aplicar en la práctica diaria. El primer objetivo es garantizar que las 4 clases de medicación recomendadas se inicien cuanto antes para establecer una terapia eficaz, incluso a dosis bajas. Esto se considera preferible a iniciar menos medicamentos a una dosis máxima. El segundo objetivo es garantizar que los intervalos entre la introducción de los medicamentos y entre los distintos pasos de titulación sean lo más breves posible, por la seguridad del paciente. Se hacen propuestas específicas para los pacientes de edad avanzada (> 75 años) frágiles, y para aquellos con trastornos del ritmo cardiaco. La aplicación de este algoritmo debería permitir alcanzar un protocolo de tratamiento óptimo en un plazo de 2 meses para la mayoría de los pacientes. Este debe ser nuestro objetivo en el tratamiento de la IC-FEr. (AU)

Major international practice guidelines recommend the use of a combination of 4 medication classes in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) but do not specify how these treatments should be introduced and up-titrated. Consequently, many patients with HFrEF do not receive an optimized treatment regimen. This review proposes a pragmatic algorithm for treatment optimization designed to be easily applied in routine practice. The first goal is to ensure that all 4 recommended medication classes are initiated as early as possible to establish effective therapy, even at a low dose. This is considered preferable to starting fewer medications at a maximum dose. The second goal is to ensure that the intervals between the introduction of different medications and between different titration steps are as short as possible to ensure patient safety. Specific proposals are made for older patients (> 75 years) who are frail, and for those with cardiac rhythm disorders. Application of this algorithm should allow an optimal treatment protocol to be achieved within 2-months in most patients, which should the treatment goal in HFrEF. (AU)

Optimization of energy consumption per kg of pure meat by electrical and thermal systems in broiler chicken farms / [Otimização do consumo de energia por kg de carne pura por meio de sistemas térmicos em granjas de frangos de corte]

The present study was conducted to investigate the effect of electrical and thermal systems optimization on energy consumption in broiler farms. Experiments were conducted in 4 different climates (cold, hot, dry, and temperate) with four treatments (4 broiler farms in each region) and 5 iterations (5 rearing periods per farm) on the Ross 308 strain of broiler chicken in a completely randomized basic design. The results showed that the solutions applied in cold and dry climates had a significant effect on reducing energy consumption (P<0.05). In the hot climate, although the reduction in energy consumption was observed after the application of the solutions, the difference was not statistically significant (P>0.05). Also, the application of solutions in temperate climates created a significant difference in the specific amount of thermal energy consumption per kilo of meat and total energy (P<0.05). Overall, the results of the present experiment showed that optimizing the electrical and thermal systems of broiler houses could reduce energy consumption in all climates.(AU)

O presente estudo foi realizado para investigar o efeito da otimização de sistemas elétricos e térmicos no consumo de energia em fazendas de frangos de corte. Foram realizadas experiências em 4 climas diferentes (frio, quente, seco e temperado) com quatro tratamentos (4 granjas de frangos de corte em cada região) e 5 iterações (5 períodos de criação por granja) na cepa Ross 308 de frangos de corte em um projeto básico completamente aleatório. Os resultados mostraram que as soluções aplicadas em climas frios e secos tiveram um efeito significativo na redução do consumo de energia (P<0,05). No clima quente, embora a redução no consumo de energia tenha sido observada após a aplicação das soluções, a diferença não foi estatisticamente significativa (P>0,05). Além disso, a aplicação de soluções em climas temperados criou uma diferença significativa na quantidade específica de consumo de energia térmica por quilo de carne e energia total (P<0,05). Em geral, os resultados do presente experimento mostraram que a otimização dos sistemas elétricos e térmicos das casas de frangos de corte poderia reduzir o consumo de energia em todos os climas.(AU)

Módulo Cartas Avales para el Sistema Informático Colpadi de la Unidad Central de Cooperación Médica. Cuba / Module Letters Guarantees for the Colpadi Computer System of the Central Unit for Medical Cooperation. Cuba

La Unidad Central de Cooperación Médica (UCCM) es un centro de excelencia del Ministerio de Salud Pública (MINSAP). Este centro se encarga de garantizar el cumplimiento de los compromisos internacionales contraídos por el MINSAP y el Gobierno de la República de Cuba, en el área de la cooperación médica a través de la asistencia técnica y docente. El objetivo de este desarrollo es implementar un módulo para el Sistema Integral para la Gestión de Información en la Colaboración Médica Cubana (Colpadi), que optimice el proceso de gestión de cartas avales que se generan en la UCCM. El trabajo que se desarrolla contribuye de forma positiva al concepto de excelencia de la institución. El proyecto tiene un enfoque cualitativo, con alcance descriptivo, de tipo retrospectivo y diseño no experimental, de corte transversal. Se emplean los métodos científicos de observación y análisis documental. Además, la implementación utilizando el Lenguaje Unificado de Modelado (UML) y la metodología RUP de desarrollo de software. Como resultado se obtiene un módulo, como parte del sistema informático Colpadi, que optimiza el proceso de gestión de cartas avales. Las cartas avales se entregan a los cooperantes internacionalistas del MINSAP en sus vacaciones y al finalizar su misión en el exterior. Con la implementación de la aplicación informática se obtienen varias ventajas como la automatización de los vuelos de entrada, las solicitudes automáticas para el procesamiento de las cartas avales, los reportes estadísticos y el tratamiento de la información(AU)

Central Unit for Medical Cooperation (UCCM) is a center of excellence of the Ministry of Public Health (MINSAP). This center is in charge for guaranteeing compliance with the international commitments made by MINSAP and the Government of the Republic of Cuba, in the area of ​​medical cooperation through technical and educational assistance. This research contributes positively to the institution's concept of excellence. Its objective is to implement a module for the Colpadi computer system, which it optimizes the process for managing the guarantee letters generated at the UCCM. The research has a qualitative approach, with a descriptive scope, of a retrospective type and a non-experimental, cross-sectional design. Scientific observation and documentary analysis methods are used; as well as UML, and RUP software development methodology in its implementation. As a result, a module is obtained, as part of the Colpadi computer system, which it optimizes the guarantee letter management process. The letters of guarantee are delivered to the internationalist aid workers of the MINSAP, on their vacations and at the end of their mission abroad. With the implementation of the computer application, several advantages are obtained, such as the automation of the incoming flights, the automatic requests for the processing of the letters of guarantee, the statistical reports and the treatment of the information(AU)

Manual para otimização da aquisição de medicamentos no âmbito hospitalar / Manual for optimizing the acquisition of medicines in the hospital environment

Introdução: a falta de um medicamento durante a internação hospitalar, põe em risco o correto cumprimento dos planos terapêuticos traçados para os pacientes, o que pode vir a gerar a recidiva de um quadro clínico, o prolongamento do tempo de internação e o consequente aumento de custos para a instituição, seja ela pública ou privada. Dentro da cadeia logística do medicamento, diversas são as etapas que podem contribuir para o desabastecimento. No âmbito hospitalar essa logística se dá por meio do ciclo da assistência farmacêutica que compreende as etapas de seleção, programação, aquisição, armazenamento, distribuição e dispensação de medicamentos. Os estoques da farmácia hospitalar são caracterizados por ciclos de demandas e de ressuprimentos, com flutuações significativas, o que dificulta a disponibilidade na mesma proporção da utilização do medicamento. Tendo em vista esta complexidade torna-se necessário o uso de indicadores, que avaliem os processos de trabalho. Objetivos: o objetivo deste estudo foi identificar as principais causas de desabastecimento de medicamentos em uma unidade de saúde e desenvolver um manual para otimização da aquisição de medicamentos. Materiais e método: Inicialmente foi realizado um mapeamento do fluxo de valor a fim de compreender a movimentação de materiais e informações envolvidos no processo de aquisição de medicamentos. Posteriormente, confeccionou-se uma planilha para registrar o fluxo logístico dos produtos, que resultou na obtenção dos pontos críticos do processo. A coleta dos dados de aquisição de medicamentos foi realizada durante o ano de 2019. Os critérios avaliados foram definidos com base nas ocorrências que mais contribuíram para o desabastecimento, seja pela relevância, ou pela frequência. Por fim foi elaborado um manual contendo critérios, normas, e procedimentos, a serem seguidos a fim de se evitar o desabastecimento. Resultados: Elaboração de um manual para otimização da aquisição de medicamentos composto por: mapa do fluxo de valor logístico de medicamentos, planilha para registro da logística de aquisição de medicamentos, procedimentos operacionais padrão para a gestão da aquisição de medicamentos. Conclusão: com o manual espera-se otimizar a gestão logística de medicamentos e reduzir a incidência de problemas com desabastecimento, gerando um impacto positivo na assistência ao paciente

Introduction: the lack of a drug during hospitalization puts at risk the correct compliance with the therapeutic plans outlined for the patients, which can lead to the recurrence of a clinical condition, the extension of the hospital stay and the consequent increase in costs for the institution, whether public or private. Within the drug's logistics chain, there are several steps that can contribute to shortages. In the hospital context, this logistics takes place through the pharmaceutical care cycle, which comprises the stages of selection, programming, acquisition, storage, distribution and dispensing of medicines. Hospital pharmacy stocks are characterized by cycles of demand and resupply, with significant fluctuations, which makes availability in the same proportion as the use of the medication difficult. Due to this complexity, it is necessary to use indicators that assess work processes. Objectives: The aim of this study was to identify the main causes of drug shortages in a health unit and to develop a manual for optimizing drug acquisition. Materials and method: Initially, a mapping of the value stream was carried out in order to understand the flow of materials and information involved in the drug procurement process. Subsequently, a spreadsheet was made to record the logistical flow of the products, which resulted in the critical points of the process being obtained. Logistic data for drug acquisition during 2019 were collected and the criteria evaluated were defined based on the occurrences that most contributed to the shortage, either by relevance or by the frequency with which they occurred. Finally, a manual was created containing criteria, norms, and procedures to be followed in order to avoid shortages. Results: Preparation of a manual for optimizing drug procurement, comprising: a map of the logistical value flow of drugs, a spreadsheet for recording the logistics of drug procurement, standard operating procedures for managing drug procurement. Conclusion: the manual is expected to optimize the logistical management of medicines and reduce the incidence of problems with shortages, generating a positive impact on patient care

Optimization of cosmetic formulations development using Box-Behnken design with response surface methodology: physical, sensory and moisturizing properties

Considering the importance of an adequate composition of the formulation in the development of stable, safe and effective cosmetic products, experimental design techniques are tools that can optimize the formulation development process. The objective of this study was to develop topical formulations using the Box-Behnken design with response surface methodology and evaluate its physical, sensory and moisturizing properties. The experimental design used in the first step allowed to identify and to quantify the influence of raw materials, as well as the interaction between them. In the second step, the analysis identified the influence of soy lecithin, the phytantriol and capric acid triglyceride and caprylic on the consistency index, stickiness and greasiness and skin hydration. Cetearyl alcohol, dicetyl phosphate and cetyl phosphate 10EO and acrylates/C10-30 alkylacrylate crosspolymer showed effects in rheological parameters. The addition of soy lecithin had significant effects in terms of consistency index, stickiness, oiliness and immediate moisturizing effects. Phytantriol showed effects on increasing consistency index and oiliness sensation. Thus, the experimental design was shown to be an effective tool for research and development of cosmetics, since it allowed the assessment of the individual and interaction effects of raw materials in the responses: rheological parameters, sensory and clinical efficacy.

Desenvolvimento e otimização de sistemas conservantes empregando os conceitos de Qualidade por Design (QbD) e Tecnologia Analítica de Processos (PAT) / Development and optimization of preservative systems using Quality by Design (QbD) and Process Analytical Technology (PAT) concepts

Recentemente, produtos farmacêuticos e cosméticos com concentrações mínimas de parabenos e outros conservantes ganharam e apelo comercial e de segurança, devido à controvérsia sobre a segurança dos conservantes. No entanto, o uso de conservantes é essencial para garantir a conservação microbiana de produtos cosméticos e farmacêuticos durante o seu uso. Neste trabalho, desenvolveu-se um método quimiométrico de espectroscopia no infravermelho com Fourier transform near-infrared (FTIR) para prever a eficácia de sistemas conservantes em produtos farmacêuticos e cosméticos tópicos usando os conceitos de Quality by design (QbD) e Process Analytical Technology (PAT). A abordagem de QbD foi usada para determinar a eficácia antimicrobiana frente aos microrganismos: Candida albicans (ATCC 10231), Escherichia coli (ATCC 8739) e Staphylococcus aureus (ATCC 6538), em funções das concentrações de parabenos, e determinar a região de Design Space, empregando o delineamento de compóstio central (CCD) Todas as 15 formulações preparadas foram analisadas utilizando um espectrofotômetro (FTIR) equipado com aparato de Attenuated Total Reflectance (ATR). Os modelos de regressão por Partial Least Squares (PLS) para predição dos "slopes" das curvas de morte microbiana em função dos espectros ATR/FTIR foram bem ajustados, com R2 e R2-predição de 0,9937 e 0,8921, 0,9947 e 0,8783, e 0,9957 e 0,9222 para Candida albicans (ATCC 10231), Escherichia coli (ATCC 8739) e Staphylococcus aureus (ATCC 6538), respectivamente. O método FTIR proposto aplicado em uma abordagem de PAT foi capaz de prever a eficácia do sistema conservante em tempo reduzido. Este método de predição de silício permitirá um controle lote-a-lote da eficácia do sistema conservante de produtos farmacêuticos e cosméticos

Recently, pharmaceuticals and cosmetics with minimal concentrations of parabens and other preservatives have gained and commercial and safety appeal due to controversy over the safety of preservatives. However, the use of preservatives is essential to ensure the microbial conservation of cosmetic and pharmaceutical products during use. In this work, a chemometric method of infrared spectroscopy with Fourier transform (FTIR) was developed to predict the effectiveness of preservative systems in pharmaceutical products and topical cosmetics using the concepts of Quality by design (QbD) and Process Analytical Technology (PAT). The QbD approach was used to determine antimicrobial efficacy against candida albicans (ATCC 10231), Escherichia coli (ATCC 8739) and Staphylococcus aureus (ATCC) microorganisms 6538), in functions of paraben concentrations, and determine the Design Space region, employing the design of central composite (CCD). All 15 prepared formulations were analyzed using a spectrophotometer (FTIR) equipped with Attenuated Total Reflectance (ATR). The Partial Least Squares (PLS) regression models for the prediction of the slopes of microbial death curves as a function of ATR /FTIR spectra were well adjusted, with R2 and R2-prediction 0.9937 and 0.8921, 0.9947 and 0.8783, and 0.9957 and 0.9222 for Candida albicans (ATCC 10231), Escherichia coli (ATCC 8739) and Staphylococcus aureus (ATCC 6538)respectively. The proposed FTIR method applied in a PAT approach was able to predict the effectiveness of the preservative system in reduced time. This method in silico prediction will allow a batch-to-lot control of the effectiveness of the preservative system of pharmaceuticals and cosmetics

Differences in the need for adalimumab dose optimization between Crohn's disease and ulcerative colitis

Aim: to compare the need for and time to adalimumab dose escalation and de-escalation between patients with Crohn's disease (CD) and ulcerative colitis (UC). Methods: this observational cohort study included patients with luminal CD or patients with UC treated with adalimumab. Adalimumab dose optimization was decided based on the Harvey-Bradshaw index (CD) or the partial Mayo score (UC). The co-primary endpoints were the differences in the rate of dose escalation and the cumulative probability of escalation-free survival between cohorts. We also evaluated the rates of de-escalation and predictors of adalimumab dose escalation and de-escalation. Results: twenty-four of 43 CD patients (56%) and 28 of 43 UC patients (65%) required adalimumab dose escalation. UC patients had a higher adjusted rate of dose escalation (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.19-4.56; p = 0.013) than CD patients. The median time to dose escalation was significantly shorter for UC than CD patients (3.2 months, interquartile range [IQR]: 2.0-10.3 vs 12.2 months, IQR: 6.1-35.7; p = 0.001). Survival curves showed that UC patients had an increased probability of dose escalation (p < 0.001). Prior anti-TNF therapy was associated with dose escalation (HR 2.13, 95% CI 1.05-4.34; p = 0.037). Adalimumab dose de-escalation was attempted in 32% of UC patients and 50% of CD patients. Survival curves showed that CD patients had an increased probability of dose de-escalation (p = 0.030). Conclusion: UC patients more frequently required adalimumab dose escalation than CD patients. UC patients required optimization earlier than CD patients. More CD patients than UC patients can be dose de-escalated later on during treatment

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Optimización de la gestión del dolor postoperatorio basado en una nueva herramienta tecnológica. Mapa del dolor / Optimization of postoperative pain management based on a new technological tool. Pain map

Introducción: En el año 2005 el Ministerio de Sanidad, Servicios Sociales e Igualdad (MSSSI) impulsó y promovió la Estrategia de Seguridad del Paciente del Sistema Nacional de Salud (SNS), en colaboración con las comunidades autónomas, que integraba las aportaciones de los profesionales sanitarios y de los pacientes a través de sus organizaciones. Uno de los objetivos de las prácticas seguras era la necesidad de prevención y control del dolor en el adulto y en el niño, incluyéndose la gestión de este en los estándares de calidad. En el Hospital Universitario Germans Trias i Pujol (HUGTIP), en el año 2016 se inició la elaboración de los indicadores que se querían evaluar para una mejor detección y eficiencia terapéutica del dolor agudo intrahospitalario de cualquier área y que finalizó con el diseño y creación de lo que denominamos "Mapa del dolor". El objetivo fue diseñar una herramienta que, a través de la variable clínica dolor, permitiera mejorar la visualización de esta y extraer los datos estadísticos de los indicadores defi nidos para una óptima gestión del dolor dentro de un hospital universitario de tercer nivel. Material y método: Análisis descriptivo de la herramienta que denominamos "Mapa del dolor" en el Hospital Universitario Germans Trias i Pujol (HUGTiP) durante el año 2016. Se incluyeron todos los pacientes ingresados en los que el registro de dolor se realizó a través de la historia clínica informatizada GacelaCare(R). Considerando el dolor como 5.ª constante, la variable principal fue el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) en cada turno de enfermería. El procedimiento de creación de la herramienta para la elaboración del denominado "Mapa del dolor" se realizó con la colaboración del Departamento de Sistemas de Información del HUGTiP, junto con miembros de la Unidad del Dolor. Resultados: El "Mapa del dolor" se fundamenta en el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) por turno de enfermería, acción previa imprescindible por parte de enfermería. Permite visualizar en la pantalla los registros de la intensidad del dolor de todos los pacientes hospitalizados de manera simultánea y en tiempo real. El "Mapa del dolor" identifi ca los registros con distintos colores a modo de semáforo del dolor, en color verde marca los valores de EVN entre 1-3 (dolor leve), en color naranja EVN entre 4-6 (dolor moderado) y en color rojo EVN entre 7-10 (dolor intenso); asimismo señala con una franja de color morado aquellos pacientes operados el día anterior, facilitando el control del dolor durante las primeras 24 horas postoperatorias. La explotación estadística de los registros informatizados de dolor permite obtener resultados de los indicadores relacionados con su gestión, previamente defi nidos por nuestro hospital. Discusión: El "Mapa del dolor" es una herramienta innovadora que permite desarrollar con garantías la efi ciencia de las unidades de dolor agudo de bajo coste

Introduction: In 2005, the Ministry of Health, Social Services and Equality (MSSSI) promoted the Patient Safety Strategy of the National Health System (SNS), in collaboration with the Autonomous Communities, which integrated the contributions of health professionals and patients through their organizations. One of the objectives of safe practices was the need for prevention and control of pain in adults and children, including management of the same in quality standards. At the Germans Trias and Pujol University Hospital (HUGTIP) in 2016, the development of the indicators that were intended to be evaluated for better detection and therapeutic effi ciency of acute in-hospital pain in any area ended with the design and creation of what we call as "pain map". The objective was to design a tool that, through the clinical pain variable, could improve the visualization of pain and extract statistical data from the defi ned indicators for optimal pain management in a university hospital of the third level. Material and method: Descriptive analysis of the tool we call pain map at the Germans Trias and Pujol University Hospital during 2016. The population was all patients admitted to hospital units where the pain registry was made through the GacelaCare(R) computerized medical record. The main variable was the recording of pain intensity using the Visual Analogue Scale (VAS) or Numeric Verbal Scale (NVA) by nursing shift considering pain as the 5th constant. The tool creation procedure was carried out with the collaboration of the hospital information systems department together with members of the Pain Unit for the elaboration of the so-called pain map. Results: The pain map is based on the previous action required by nursing which is the recording of the intensity of pain using the Visual Analogue Scale (VAS) or Numerical Verbal Scale (NVA) in turn considering pain as the 5th constant. The map allows to visualize on the screen the registers of the pain intensity of all hospitalized patients simultaneously and in real time. The pain map identifi es with different colors as a traffi c light of pain. In green color, the EVN values are between 0-3 (mild pain), orange EVN between 4 and 6 (moderate pain) and red color between 7 and 10 (intense pain). Likewise, it indicates with a purple band those patients operated on the previous day, facilitating pain control during the fi rst 24 postoperative hours. The statistical exploitation of computerized pain registers allows obtaining results of the quality indicators related to pain management defi ned by our hospital. Discussion: The pain map is an innovative tool that allows the development of low-cost Acute Pain Units to be guaranteed with effi ciency

Claves para optimizar la eficiencia de un bloque quirúrgico / Keys to optimizing operating room efficiency

La asistencia sanitaria está en constante transformación. Los sistemas de salud deben centrarse en mejorar la eficiencia para satisfacer la creciente demanda de atención de salud de alta calidad y bajo coste. El quirófano es una de las mayores fuentes de ingresos y una de las mayores áreas de gasto. Por lo tanto, la gestión del bloque quirúrgico es una clave fundamental para el éxito. El objetivo de este artículo es analizar los principios actuales de organización, optimización y gestión clínica del bloque quirúrgico y su impacto en la calidad y en la seguridad asistenciales

Healthcare is in constant transformation. Health systems should focus on improving efficiency to meet a growing demand for high-quality, low-cost health care. The operating room is one of the biggest sources of revenue and one of the largest areas of expense. Therefore, operating room management is a critical key to success. The aim of this article is to analyze the current principles of organization, optimization and clinical management of the operating room and its impact on the quality and safety of care

Application of quality by design approach in RP-HPLC method development for simultaneous estimation of saxagliptin and dapagliflozin in tablet dosage form

A simple, sensitive, precise, accurate and robust high performance liquid chromatographic method has been developed for simultaneous estimation of saxagliptin (SAXA) and dapagliflozin (DAPA) in pharmaceutical formulation. Design of experiments (DoE) was applied for multivariate optimization of the experimental conditions of RP-HPLC method. Risk assessment was performed to identify the critical method parameters. Three independent factors; mobile phase composition, flow rate and column temperature were used to design mathematical models. Central composite design (CCD) was used to study the response surface methodology and to study in depth the effects of these independent factors. Desirability function was used to simultaneously optimize the retention time and resolution of SAXA and DAPA. The optimized and predicted data from contour diagram consisted of acetonitrile and ortho phosphoric acid (0.1%) in the ratio of 50:50 respectively, at a flow rate of 0.98 ml/min and column temperature 31.4 °C. Using these optimum conditions baseline separation of both drugs with good resolution and run time of less than 6 min were achieved. The optimized assay conditions were validated according to ICH guidelines. Hence, the results clearly showed that Quality by design approach could be successfully applied to optimize RP-HPLC method for simultaneous estimation of SAXA and DAPA.

Enhance Sport Performance of Elite Athletes: The Mindfulness-Based Interventions / Optimización del Rendimiento Deportivo en los Atletas de Elite: Las Intervenciones Basadas en la Atención Plena / Otimização da Performance em Atletas de Elite: As Intervenções Baseadas no Mindfulness

The purpose of this review is to summarize the empirical findings on the effectiveness of mindfulness-based programs to enhance elite athletes sport performance. A literature research was undertaken using Medline, Psych info, Web of Science, Cochrane, Ebscohost, Isi Web of Knowledge databases and references of retrieved articles. The search included original articles published from 1985 to March 2017. The main search terms were mindfulness programs, sport performance, elite athletes, in different combinations as needed. All articles were coded for their design, type of control, study population, and outcome measures. Search returned 26 articles, and set out 2 main mindfulness-based interventions on the field of elite sport performance. Despite methodological limitations in the research design, the results show MAC and MSPE programs as effective on enhancing elite athlete’s sports performance. To confirm these preliminary results, further research, with improved experimental designs, is recommended. Findings yielded mindfulness programs as an important factor on elite sport performance

El propósito de esta revisión es resumir los resultados empíricos sobre la efectividad de los programas basados en la atención plena para mejorar el desempeño deportivo de los atletas de elite. Se realizó una investigación bibliográfica utilizando las bases de datos Medline, Psych info, Web of Science, Cochrane, Ebscohost, Isi Web of Knowledge. La búsqueda incluyó artículos originales publicados entre 1985 y Marzo de 2017. Los principales términos de búsqueda fueron programas de atención plena, rendimiento deportivo, atletas de élite, en diferentes combinaciones según sea necesario. Todos los artículos fueron codificados para su diseño, tipo de control, población de estudio y medidas de resultado. La búsqueda devolvió 26 artículos, y fijó 2 intervenciones principales basadas en la atención plena en el campo del deporte de élite. A pesar de las limitaciones metodológicas en el diseño de la investigación, los resultados muestran que los programas de MAC y MSPE son eficaces para mejorar el rendimiento deportivo de los deportistas de élite. Para confirmar estos resultados preliminares, se recomienda realizar más investigaciones, con diseños experimentales mejorados. Los resultados arrojaron programas de atención plena como un factor importante en el desempeño del deporte de élite

O objetivo desta revisão é sintetizar os resultados empíricos que retratam a eficácia dos programas baseados no mindfulness na optimização da performance em atletas de elite. Para a realizacão deste estudo, efetuou-se uma pesquisa bibliográfica de artigos originais publicados com fator de impacto entre 1985 e Março de 2017, recorrendo às bases de dados Medline, Psych info, Web of Science, Cochrane, Ebscohost, Isi Web of Knowledge. A pesquisa focou-se nas intervenções baseadas no mindfulness, performance desportiva, atletas de elite e, por último, nas diferentes combinações de conceitos. Todos os artigos foram reunidos tendo em conta o design, tipo de controlo, população, instrumentos e resultados. No total, foram selecionados 26 artigos condicentes com os critérios metodológicos do presente estudo, verificando-se maioritariamente a implementação dos programas MSPE e MAC no campo da Psicologia da performance desportiva. Apesar das limitações do presente estudo, os resultados evidenciam que os programas MAC e MSPE são eficazes na otimização do desempenho desportivo de elite. Com efeito, e para confirmar os resultados preliminares, recomenda-se investigação adicional, com desenho experimental e controlo rigoroso. Conclui-se que, os programas baseados no mindfulness são um fator importante na otimização da performance em alta competição

Control del formaldehído, xileno y compuestos orgánicos volátiles mediante el sistema integral de friocongelación y fotocatalización / Prevention and control of formaldehyde, xylene and volatile organic compounds by photocatalysis and freezing integral system mileida

Antecedentes: En anatomía patológica, existen variedad de agentes químicos que deben ser controlados. Por su potencial cancerígeno destacan el Formaldehído (CH2 O), Xileno y los Compuestos Orgánicos Volátiles (COVs). Objetivo: Valorar la eficacia del uso de purificadores mediante la fotocatalización y los sistemas de friocongelación, para el control de los niveles de exposición a CH2 O, Xileno y COVs. Objetivo Secundario: Comparar mediciones de Formaldehído con otros 3 hospitales de la Comunidad de Madrid. Metodología: Se realizaron 26 mediciones ambientales en Anatomía Patológica del Hospital Universitario de Fuenlabrada (HUF), en febrero del año 2017 y en marzo del mismo año, posterior a la instalación de los purificadores y sistemas de friocongelación, en las áreas de laboratorio y sala de tallado. Se valora Xileno y COVs con el método PID (detector de fotoionización, PID por sus siglas en inglés, PhotoIonization Detector) y de CH2 O a través de un Sistema de Detección de Gas. Como criterio para valorar la exposición a COVs se tomó como gas de referencia el isobutileno con un VLA-EC de 100 ppm. Para el Xileno se compararon los resultados con el VLA-EC 100 ppm y para el CH2 O con el VLA-EC de 0,3 ppm, establecidos en la guía de «Límites de Exposición Profesional para Agentes Químicos» del Instituto Nacional de Seguridad e Higiene en el Trabajo. Resultados: Los niveles de exposición previos no superaban los valores límites. Se observó que tras la implantación de las medidas preventivas colectivas estos valores disminuyeron, obteniéndose resultados estadísticamente significativos: COVs (p= 0.0002; IC 95% 2.393- 5.506), Xileno (p= 0.0002; IC 95% 1.021- 2.359) y CH2 O (p= 0.0004; IC 95% 0.210-0.350). Conclusiones: El sistema integral de friocongelación y purificación mediante fotocatalización optimizan el control de la exposición a dichos agentes químicos, anulando las fuentes de emisión

Background: In anatomical pathology, there are a variety of chemical agents that must be controlled due to their carcinogenic potential, such as formaldehyde (CH2 O), Xylene and Volatile Organic Compounds (VOCs). Objective: To evaluate the effectiveness use of purifiers by photocatalysis and freezing systems for the control of exposure levels to CH2 O, Xylene and VOCs. Secondary Objective: To compare the Formaldehyde measurements among other 3 hospitals in the Community of Madrid. Methodology: 26 environmental assessments were performed in the Anatomical Pathology Department at the Hospital Universitario de Fuenlabrada (HUF, Madrid), in February 2017 and in March of the same year, after installing the purifiers and the freezing systems in the laboratory and room carved areas. Xylene and VOCs are evaluated using the PID method (Photo-Ionization Detector) and CH2 O through a Gas Detection System. As a criterion for assessing exposure to VOCs, isobutylene was used as a reference gas with a VLA-EC of 100 ppm. For Xylene the results were compared with the VLA-EC 100 ppm and for the CH2 O with the VLA-EC of 0.3 ppm, established in the guide of "Occupational Exposure Limits for Chemical Agents" from the National Institute of Occupational Safety and Health. Results: Previous exposure levels did not exceed the limit values. It was observed that these values decreased after the implementation of collective preventive measures, obtaining statistically significant results: VOCs (p = 0,0002, 95% CI 2,393-5,506), Xylene (P = 0,0002, 95% CI 1,021-2,359) and CH2 O (p = 0,0004, 95% CI 0,210-0,350). Conclusions: The integrated system of freeze-thawing and photocatalytic purification optimize the exposure control to these chemical agents, canceling emission sources

Optimizing antimicrobial prescribing: a practical decalogue / Optimización del uso de antibióticos: decálogo práctico

Increasing antibiotic resistance is one of the leading problems in the Public Agenda worldwide. In the last 20 years, the pace of antimicrobial drug development has markedly slowed leading to a dramatic world situation. Infections with antibiotic-resistant microorganisms have been associated with increased length of stay, mortality and costs. Improving antimicrobial prescribing is one of the tools in our hands to optimize the outcomes of patients with moderate to severe infections and control the emerging of resistance. Several clues to improve antimicrobial prescribing are provided as a key-messages decalogue (AU)

El incremento de resistencias antibióticas es uno de los problemas fundamentales al que nos enfrentamos en el manejo de infecciones en la actualidad. En los últimos 20 años, el desarrollo de nuevos fármacos se ha reducido de manera considerable conduciendo a una dramática situación mundial. Las infecciones por microorganismos multirresistentes se han asociado con un aumento de la estancia hospitalaria, de la mortalidad y de los costes. Para intentar cambiar esta situación, una de las estrategias que disponemos es mejorar el uso de antimicrobianos para disminuir la aparición de resistencias. En el texto se articulan en forma de decálogo mensajes claves para la optimización del uso de antibióticos (AU)

Detección de efecto adverso a benzodiacepinas de vida media larga en paciente anciano, optimización de la farmacoterapia desde la farmacia comunitaria / Detection of adverse effects in the medium and long-term benzodiazepines in elderly patients, optimization of pharmacotherapy from community pharmacy

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'International Centres of Excellence in Hospital Pharmacy'; a SEFH new initiative; the role of the clinical pharmacist in the hospital antibiotic stewardship in Northern Ireland / 'Centros de Excelencia Internacionales en Farmacia Hospitalaria'; una nueva iniciativa de la SEFH; el papel del farmacéutico clínico en la optimización de los antimicrobianos en Irlanda del Norte

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Evaluación del consumo de antimicrobianos mediante DDD/100 estancias versus DDD/100 altas en la implantación de un Programa de Optimización del Uso de Antimicrobianos / Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program

Introducción. La monitorización del consumo de antimicrobianos en los hospitales es una medida necesaria. Los indicadores habituales no reflejan claramente la presión del antimicrobiano sobre el paciente. El objetivo es evaluar dos métodos de consumo basados en las DDD, por estancia y por alta, antes y después de un Programa de Optimización de Antimicrobianos (PROA). Material y métodos. Estudio comparativo del consumo de antimicrobianos en seguimiento por un PROA utilizando las DDD/100 estancias y altas. Resultados. Las estancias se mantuvieron estables y las altas incrementaron ligeramente. El consumo de los antibacterianos disminuyó por estancias y por altas: 2,5% versus 3,8%. El consumo de antifúngicos disminuyó más del 50%. Conclusiones. En un contexto de reducción de estancia media, la disminución del consumo de antimicrobianos en seguimiento por un PROA se produce a expensas de disminuir los pacientes en tratamiento, mientras que aquellos que se incrementan se producen a expensas de una mayor duración (AU)

Introduction. Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program. Material and methods. Comparative pre-post study of antimicrobial consumption with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators. Results. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%. Conclusions. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment (AU)

Optimización en la recuperación del estreptococo del grupo B en el cribado de mujeres embarazadas / Enhanced recovery of group B Streptoccocus in pregnant women screening

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Training should be the first step toward an antifungal stewardship program

The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA).The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16 ± 1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved

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El derecho del paciente a decidir sobre su tratamiento: caso clínico de optimización de la farmacoterapia / The patient's right to decide on their treatment: a clinical report of medicines optimisation

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Optimización del tratamiento insulínico en la diabetes mellitus tipo 1 del niño / No disponible

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