ABSTRACT
RESUMEN Objetivo Establecer el estado de situación de los laboratorios analíticos que cuantifican inmunosupresores en pacientes con trasplantes que se encuentran bajo monitoreo terapéutico de drogas (TDM) de estos fármacos en Argentina, para establecer potenciales áreas de actuación perfectibles. Métodos Se realizó una encuesta en centros clínicos y analíticos de TDM de Argentina, coordinada por la Unidad de Farmacocinética Clínica del Hospital Garrahan y el Instituto Nacional Central Único Coordinador de Ablación e Implante, desde setiembre de 2013 hasta noviembre de 2014. Resultados Se incluyeron 27 centros clínicos y analíticos (muestra representativa nacional). El 45% fueron hospitales públicos. La mayoría (95%) monitorizan ciclosporina y tacrolimús; en menor medida, sirolimús y everolimús, y muy pocos el ácido micofenólico. La cantidad (mediana, rango) de muestras analizadas por mes para estos cinco fármacos fue de 251 (10 - 2024). Casi 60% de las muestras se analizaron en instituciones privadas. Solo cuatro (17%) de los encuestados informan valores del margen terapéutico. El 92% usa inmunoensayos como metodología analítica. El 68% de los encuestados que contaban con instalaciones bioanalíticas propias informaron poseer algún programa de garantía de calidad. Conclusiones El TDM de inmunosupresores es una práctica recomendada para pacientes con trasplante en Argentina. Se requiere generar iniciativas nacionales que desarrollen guías armonizadas para laboratorios analíticos que incluyan procesos de garantía de calidad con alcance regulatorio relacionados con el TDM. Por otra parte, también es necesario capacitar al personal técnico y profesional, e invitar a participar a organizaciones públicas y privadas del ámbito regulatorio, sanitario y de la investigación.
ABSTRACT Objective Determine the status of analytical laboratories that quantify immunosuppressants in transplant patients who are under therapeutic drug monitoring (TDM) for these drugs in Argentina in order to identify potential perfectible areas for action. Methods A survey of the clinical and analytical TDM centers in Argentina was conducted between September 2013 and November 2014 under the direction of the Garrahan Hospital Clinical Pharmacokinetics Unit and the National Unified Central Institute for Ablation and Implant Coordination. Results A nationally representative sample of 27 clinical and analytical centers was identified, of which 45% were public hospitals. Most of these centers (95%) monitor ciclosporin and tacrolimus, and to a lesser extent, sirolimus and everolimus; a small number of them also monitor mycophenolic acid. The median number of samples of these five drugs analyzed per month was 251 (range: 10-2024). Nearly 60% of the samples were analyzed in private institutions. Only four of the respondents (17%) reported values within the therapeutic margin. Of all the centers, 92% use immunoassay as the analytical methodology. Of the bioanalytical installations that have their own facilities, 68% reported that they also have their own quality assurance program. Conclusions TDM of immunosuppressants is a recommended practice for transplant patients in Argentina. Initiatives need to be taken at the national level to develop uniform guidelines for analytical laboratories that include TDM-related quality assurance processes with regulatory force. There is also a need to train technical and professional personnel and to invite the participation of public and private organizations in the regulatory, public health, and research areas.
Subject(s)
Quality Control , Pharmacokinetics , ArgentinaABSTRACT
O xadrez vem sendo utilizado como um recurso pedagógico para potencializar habilidades cognitivas de escolares. Dentre estas habilidades,destaca-se a tomada de decisão, fundamental em diversas atividades acadêmicas, contudo ainda são poucos os estudos que mostram os efeitos da prática do xadrez na eficiência e eficácia da tomada de decisão. Assim, o objetivo deste estudo foi verificar o efeito da prática do xadrez na habilidade cognitiva de tomada de decisão em escolares do ensino fundamental. Para tanto, 44 escolares de 7 a 12 anos de idade foram distribuídos em dois grupos (22 escolares sem contato com o xadrez e 22 escolares praticantes de xadrez na escola). Todos os escolares foram avaliados pelo Software Stroop Task v.1.0, através do qual o tempo de reação de escolha e a qualidade da escolha (relação erro/acerto) foram contabilizados. Os resultados mostraram que os escolares praticantes de xadrez na escola tomam decisões em menor tempo (t =2,3068; p < 0.05) e menor número de erros (X² = 112,061; p < 0.001) que escolares que nunca tiveram contato com o xadrez. Futuros estudos necessitam investigar o impacto destas capacidades nas atividades acadêmicas, ampliando o entendimento sobre os processos envolvidos na cognição e ação
Chess has been used as a teaching resource to enhance cognitive skills of students. Among these skills highlights the decision making, critical in various academic activities. However, there arefew studies that show the effects of the practice of chess in the efficiency and effectiveness of decision making. The objective of this study was to investigate the effect of the practice of chess in the cognitive ability of decision making in primary schools. To this end, 44 students aged 7 to 12 years old were divided into two groups (22 students without contact with chess and 22 school practitioner's chess in school). All students were assessed by the Stroop Task Software v.1.0 where the reaction time of choice and the quality of choice (correct/incorrect choice) were recorded. Results showed that practicing school chess in school make decisions in less time (t= 2,3068; p< 0.05) and fewer errors (X²= 112,061; p < 0.001) than students who never had contact with chess.Futures studies need to investigate what impact these skills in academic activities, expanding the understanding of the processes involved in cognition and action.
Subject(s)
Humans , Child , Play and Playthings/psychology , LearningABSTRACT
En este trabajo se plantea la importancia de la descentralizacion porque favorece la eficacia de la administracion y permite la participacion directa en la toma de decisiones por parte de sus destinatarios. La profundizacion del proceso de descentralizacion debera fortalecer el federalismo para devolver a las provincias el ejercicio efectivo de sus poderes. Este trabajo presenta la metodologia y accion a llevar a cabo para conseguir este objetivo