Environmental pollution with psychiatric drugs.

Among all contaminants of emerging interest, drugs are the ones that give rise to the greatest concern. Any of the multiple stages of the drug's life cycle (production, consumption and waste management) is a possible entry point to the different environmental matrices. Psychiatric drugs have received special attention because of two reasons. First, their use is increasing. Second, many of them act on phylogenetically highly conserved neuroendocrine systems, so they have the potential to affect many non-target organisms. Currently, wastewater is considered the most important source of drugs to the environment. Furthermore, the currently available wastewater treatment plants are not specifically prepared to remove drugs, so they reach practically all environmental matrices, even tap water. As drugs are designed to produce pharmacological effects at low concentrations, they are capable of producing ecotoxicological effects on microorganisms, flora and fauna, even on human health. It has also been observed that certain antidepressants and antipsychotics can bioaccumulate along the food chain. Drug pollution is a complicated and diffuse problem characterized by scientific uncertainties, a large number of stakeholders with different values and interests, and enormous complexity. Possible solutions consist on acting at source, using medicines more rationally, eco-prescribing or prescribing greener drugs, designing pharmaceuticals that are more readily biodegraded, educating both health professionals and citizens, and improving coordination and collaboration between environmental and healthcare sciences. Besides, end of pipe measures like improving or developing new purification systems (biological, physical, chemical, combination) that eliminate these residues efficiently and at a sustainable cost should be a priority. Here, we describe and discuss the main aspects of drug pollution, highlighting the specific issues of psychiatric drugs.

Changes in the corneal thickness and limbus after 1 year of scleral contact lens use.

PURPOSE: To assess the physiological changes in the cornea over time in patients with irregular cornea fitted with Rose K2 XL gas-permeable scleral contact lenses. METHODS: Prospective study of 16 eyes of patients who did not tolerate gas-permeable corneal contact lenses and were fitted with Rose K2 XL scleral lenses. We assessed the central vault and the corneal thickness centrally and at peripheral regions (2 to 5 mm annulus). All these measures were obtained by anterior segment optical coherence tomography. The measurements were taken immediately after fitting the lenses and 1, 6 and 12 months later. Prior to the study and at 1 year, we performed an objective test for diagnosing limbal stem cell deficiency (Limbokit). RESULTS: The mean vault was 201.7 ± 82.3 µm 20 min after fitting the contact lens; 189.4 ± 94.0 µm at 1 month; 165.1 ± 75.9 µm at 6 months and 142.1 ± 76.8 µm at 1 year, the values at 6 and 12 months being significantly different to baseline. After 1 year, the central corneal thickness had increased by 2.3% (IQR = 5.6), but the changes were only significant for the superior thickness. There is no limbal stem cell deficiency after 1 year of scleral contact lens use. CONCLUSIONS: After use of Rose K2 XL scleral contact lenses, the corneal physiology of patients with an irregular cornea remains unchanged, as assessed by corneal thickness measurements and the Limbokit test. In all cases, however, the vault decreased over time.

Implementación de NeoKissEs en España: un sistema validado de vigilancia de la sepsis nosocomial en recién nacidos de muy bajo peso / mplementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants

Antecedentes: Las sepsis son las infecciones nosocomiales más frecuentes en las Unidades de Cuidados Intensivos Neonatales (UCIN), afectando especialmente a los recién nacidos de muy bajo peso al nacer (RNMBP, ≤ 1.500 g). Un sistema de vigilancia epidemiológica puede contribuir a su prevención mediante una evaluación continua de su frecuencia y factores de riesgo asociados. El objetivo de este artículo es describir la implementación del sistema de vigilancia de las sepsis nosocomiales en RNMBP (NeoKissEs) en un grupo de UCIN españolas. Métodos: Estudio de cohorte de RNMBP con < 28 días de edad ingresados en las UCIN participantes. Dos UCIN tradujeron y adaptaron materiales a partir del sistema original alemán NEO-KISS. Durante la implementación, se desarrollaron 8talleres formativos, con participación de 210 profesionales. Se creó un sistema web para la introducción de datos de pacientes y episodios de sepsis, su monitorización, análisis comparativo y retroalimentación a las unidades. En cada UCIN, un neonatólogo fue responsable de la implementación, recogiendo información sobre las dificultades percibidas durante el proceso. Resultados: De 50 unidades que aceptaron participar, 45 utilizaron NeoKissEs durante la fase de implementación, registrando 1.108 episodios de sepsis asociados a catéter vascular en 3.638 neonatos, con una tasa de 18,4 episodios por 1.000 pacientes-día con catéter (IC del 95%: 17,8-19,1). Conclusiones: El sistema de vigilancia epidemiológica NeoKissEs representa una fuente útil de información para la comparación estandarizada de la incidencia de sepsis de las UCIN, evaluar factores de riesgo y facilitar la evaluación del efecto de futuras intervenciones preventivas

Background: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500 g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. Methods: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. Results: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. Conclusions: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs

[Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]. / Implementación de NeoKissEs en España: un sistema validado de vigilancia de la sepsis nosocomial en recién nacidos de muy bajo peso.

BACKGROUND: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. METHODS: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. RESULTS: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. CONCLUSIONS: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.

Traducción y validación al español del cuestionario EMPATHIC-30 para medir la satisfacción de los padres en cuidados intensivos / Spanish translation and validation of the EMPATHIC-30 questionnaire to measure parental satisfaction in intensive care units

INTRODUCCIÓN: Existen pocas encuestas validadas para medir la satisfacción de los padres en las Unidades de Cuidados Intensivos Pediátricos (UCIP) y ninguna de ellas en idioma español. El objetivo de este estudio es traducir el cuestionario EMpowerment of PArents in THe Intensive Care (EMPATHIC), que mide la satisfacción y experiencias de los padres, a la lengua española y validarlo. MATERIAL Y MÉTODOS: Estudio prospectivo, realizado en la UCIP de un hospital terciario mediante encuestas a los familiares de pacientes ingresados (de entre 0 y 17 años). Los criterios de inclusión fueron una estancia mayor de 24 h y una buena comprensión del idioma de los padres/tutores. Los criterios de exclusión fueron los reingresos y los pacientes fallecidos. Se realizó la traducción del cuestionario mediante un procedimiento estandarizado. Tras la traducción, se hizo un estudio observacional transversal para confirmar su validez y consistencia. La fiabilidad se estimó mediante el alfa de Cronbach y la validez de contenido mediante el análisis de correlación de Spearman. RESULTADOS: Se reunieron 150 encuestas. El α de Cronbach por dominios se situó por encima de 0,7, lo que indica una alta consistencia interna del cuestionario. La validez fue medida correlacionando los 5 dominios con los 4 ítems de satisfacción general, lo que demostró una correlación adecuada (rs: 0,41-0,66; p < 0,05). CONCLUSIONES: Basados en estos resultados, la adaptación del EMPHATIC-30 a la cultura e idioma español es un instrumento válido, de fácil cumplimentación y adecuado para el entorno estudiado, capaz de medir la satisfacción de los padres y de servir como guía para mejorar la calidad de la atención en las UCIP españolas

INTRODUCTION: Few validated surveys measuring parental satisfaction in the Paediatric Intensive Care Unit (PICU) are available, and none of them in Spanish language. The aim of this study is to translate and validate the questionnaire EMpowerment of PArents in THe Intensive Care (EMPATHIC). This questionnaire measures parental perceptions of paediatric intensive care-related satisfaction items in the Spanish language. MATERIAL AND METHODS: A prospective cohort study was carried out using questionnaires completed by relatives of children (range 0-17 years old) admitted into a tertiary PICU. Inclusion criteria were a length of stay more than 24h, and a suitable understanding of Spanish language by parents or guardians. Exclusion criteria were re-admissions and deceased patients. The questionnaire was translated from English to Spanish language using a standardised procedure, after which it was used in a cross-sectional observational study was performed to confirm its validity and consistency. Reliability was estimated using Cronbach's α, and content validity using Spearman's correlation analysis. RESULTS: A total of 150 questionnaires were collected. A Cronbach's α was obtained for domains greater than 0.7, showing a high internal consistency from the questionnaire. Validity was measured by correlating 5 domains with 4 general satisfaction items, documenting an adequate correlation (Rs: 0.41-0.66, P < .05). CONCLUSIONS: The Spanish version of EMPHATIC 30 is a feasible, easy, and suitable tool in this specific environment, based on the results. EMPATHIC 30 is able to measure parental satisfaction, and may serve as a valid indicator to measure quality of care in Spanish PICUs

Evaluation of the Reliability and Repeatability of Scheimpflug System Measurement in Keratoconus.

PURPOSE: To assess the reliability and repeatability of the parameters obtained using a Scheimpflug system (Pentacam HR-high resolution) for monitoring progression in eyes with keratoconus. METHODS: A prospective study was conducted based on measurements taken with the Pentacam HR in 82 eyes with keratoconus. We calculated the intraclass correlation coefficient (ICC) and the repeatability limit for topographic and aberrometric parameters. RESULTS: All the parameters analyzed had excellent ICCs, above 0.95 in all cases, except for the measurement of the anterior best-fit sphere, for which the ICC was 0.873. The key repeatability limits for the parameters analyzed were as follows: 1.54 diopters (D) for the maximum keratometry in the central cornea, 1.08 D for maximum keratometry, 32.6 degrees for the axis of corneal astigmatism, 11.9 degrees for the coma axis, and 14.2 µm for thinnest corneal thickness. CONCLUSIONS: The level of repeatability of the measurements obtained with a Pentacam HR confirms the usefulness of this system for the diagnosis of keratoconus. Nevertheless, it has certain limitations for monitoring individual progression of keratoconus and planning intrastromal corneal ring segment insertion.

[Spanish translation and validation of the EMPATHIC-30 questionnaire to measure parental satisfaction in intensive care units]. / Traducción y validación al español del cuestionario EMPATHIC-30 para medir la satisfacción de los padres en cuidados intensivos.

INTRODUCTION: Few validated surveys measuring parental satisfaction in the Paediatric Intensive Care Unit (PICU) are available, and none of them in Spanish language. The aim of this study is to translate and validate the questionnaire EMpowerment of PArents in THe Intensive Care (EMPATHIC). This questionnaire measures parental perceptions of paediatric intensive care-related satisfaction items in the Spanish language. MATERIAL AND METHODS: A prospective cohort study was carried out using questionnaires completed by relatives of children (range 0-17 years old) admitted into a tertiary PICU. Inclusion criteria were a length of stay more than 24h, and a suitable understanding of Spanish language by parents or guardians. Exclusion criteria were re-admissions and deceased patients. The questionnaire was translated from English to Spanish language using a standardised procedure, after which it was used in a cross-sectional observational study was performed to confirm its validity and consistency. Reliability was estimated using Cronbach's α, and content validity using Spearman's correlation analysis. RESULTS: A total of 150 questionnaires were collected. A Cronbach's α was obtained for domains greater than 0.7, showing a high internal consistency from the questionnaire. Validity was measured by correlating 5 domains with 4 general satisfaction items, documenting an adequate correlation (Rs: 0.41-0.66, P<.05). CONCLUSIONS: The Spanish version of EMPHATIC 30 is a feasible, easy, and suitable tool in this specific environment, based on the results. EMPATHIC 30 is able to measure parental satisfaction, and may serve as a valid indicator to measure quality of care in Spanish PICUs.

Resultados de un programa educativo con refuerzo audiovisual durante la sesión, en pacientes en hemodiálisis / Results of an educational program with audio-visual reinforcement during the session in hemodialysis patients

Los medios audiovisuales son imprescindibles para reforzar la información del paciente. El objetivo del trabajo es describir la utilidad del uso de presentaciones educativas para los pacientes en hemodiálisis y los medios audiovisuales disponibles en la unidad. Se elaboraron tres presentaciones educativas en Microsoft Office Power Point y se pasaron una serie de cuestionarios con 13 preguntas que hacían referencia a aspectos fundamentales del cuidado tratados en las presentaciones, antes y después de éstas. Se realizó un análisis estadístico descriptivo con la distribución de frecuencias y porcentajes de las variables categóricas y con la media y la desviación típica de las variables cuantitativas. Para comprobar los resultados de las respuestas antes y después de las presentaciones/micropíldoras se ha utilizado la prueba de McNemar para dos muestras relacionadas con un nivel de significación estadística de p<0,05. El estudio consta de 45 pacientes, 73,3% varones con una edad media de 63,82 años. Se encontraron resultados estadísticamente significativos con p=0,031 y p=0,004, referentes a cuestiones sobre la desinfección de la fístula y el aporte proteico. El presente estudio ha servido para demostrar que la herramienta ha abierto nuevas posibilidades de formación a los pacientes (AU)

Audiovisual media are essential to reinforce patient information. The objective of this study is to describe the usefulness of educational presentations for hemodialysis patients and available audiovisual media in the unit. Three educational presentations were developed in Microsoft Office Power Point and questionnaires were used with 13 questions regarding fundamental aspects of care approached in the presentations, before and after these presentations. A descriptive statistical analysis was performed with the distribution of frequencies and percentages of the categorical variables and with the mean and standard deviation of the quantitative variables. To test the results of the responses before and after the presentations, the McNemar’s test was used for two related samples, with a statistical significance level of p<0.05. The study included 45 patients, 73.3% males with a mean age of 63.82 years. Statistically significant results were found with p=0.031 and p=0.004, concerning questions about fistula disinfection and protein intake (AU)