ABSTRACT
La actitud de los profesionales sobre el testamento vital no es homogénea y varía en función de la especialidad, la experiencia y de las propias creencias; todavía muchos médicos siguen teniendo miedo de incomodar a los pacientes. No es igual la situación que se plantea para el profesional en un hospital de agudos con un paciente relativamente desconocido que lo que pueda surgir en una unidad de cuidados paliativos o en la consulta del médico de familia que es el que atiende de forma integral al paciente. En atención primaria se dispone de una situación privilegiada para acercarnos a la vida y los valores de nuestros pacientes y sus familiares y no solo a la enfermedad, lo que hace que sea el lugar adecuado para orientar y asesorar al paciente sobre la preparación y registro del documento de últimas voluntades (AU)
The attitude of professionals about living wills (advance directives) is not homogenous and varies depending on the specialty, experience and beliefs. Many doctors are still afraid of inconveniencing patients. The situation confronting the professional in an acute care hospital with a relatively unknown patient in a palliative care unit is not the same as consulting a family doctor who is caring for the patient holistically. Primary care has a unique position to approach the life and values of our patients and their families and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills (AU)
Subject(s)
Humans , Advance Directives/ethics , Advance Directive Adherence/ethics , Primary Health Care/statistics & numerical data , Physicians, Family , Clinical Record , Physician-Patient Relations , Professional-Family RelationsABSTRACT
The attitude of professionals about living wills (advance directives) is not homogenous and varies depending on the specialty, experience and beliefs. Many doctors are still afraid of inconveniencing patients. The situation confronting the professional in an acute care hospital with a relatively unknown patient in a palliative care unit is not the same as consulting a family doctor who is caring for the patient holistically. Primary care has a unique position to approach the life and values of our patients and their families and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.
Subject(s)
Advance Directives , Attitude of Health Personnel , Physicians, Family/organization & administration , Humans , Living Wills , Physician's Role , Primary Health Care/organization & administrationABSTRACT
OBJECTIVE: To investigate the prevalence of low-molecular-weight heparin (LMWH) prescription in venous thromboembolism prophylaxis in a general hospital and the suitability of the recommendations from the clinical practice guidelines. METHOD: A descriptive, observational and cross-sectional study of the indication-prescription type, carried out on patients admitted to medical departments and for surgery. RESULTS: 345 patients were included. The prevalence of HBPM use was 44.6% (95% CI, 39.3-50.1). Depending on the risk of thromboembolism, the decision to treat prophylactically (or not) was appropriate in 261 cases (75.7%; 95% CI, 70.7-80.1), and the action guidelines were not suitable for the remainder of patients. 55 patients (15.9%; 95% CI, 12.2-20.2) presented a high risk and were not prescribed prophylactically (underuse); and 29 patients (8.4%; 95% CI, 5.7-11.8) at low risk were treated prophylactically (overuse). There was a relationship between the appropriateness of the prescription and the type of patient (p<0.01). In the group of medical patients the prevalence of prescription was 22.6% (95% CI, 16.9-29.1) and only 33.3% of patients with a high to moderate risk of thromboembolism received prophylaxis. The prevalence of prescription in general surgery was 84.2% and 91.3% in traumatology. CONCLUSIONS: The degree of prophylaxis is adequate in surgical patients, but there was a significant percentage of medical patients with a high to moderate risk who did not receive suitable prophylaxis (underuse), despite recommendations with scientific and professional backing.
Subject(s)
Anticoagulants/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Venous Thromboembolism/prevention & control , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , RecordsABSTRACT
Human immunodeficiency virus type 1 (HIV-1) protease was expressed in Escherichia coli as a fusion protein with the N-terminal sequence of IGF-2. The protein accumulated in inclusion bodies as a 40:60 mixture of unprocessed fusion protein and processed protein. A simple purification procedure was developed that yielded 30-40 mg of active protease per liter of fermentation broth with a recovery of 30-40%. The purification process involved the selective extraction of HIV-1 protease from E. coli inclusion bodies with 50% acetic acid and fractional diafiltration to remove impurities and low-molecular-weight protease-related fragments. No chromatographic steps were employed, yet the HIV-1 protease produced by this procedure was greater than 95% pure by SDS-PAGE, reverse-phase HPLC, and N-terminal sequence analysis.
Subject(s)
Escherichia coli/genetics , HIV Protease/genetics , HIV Protease/isolation & purification , Acetates , Acetic Acid , Amino Acid Sequence , Chemical Fractionation , Fermentation , Genetic Vectors , Inclusion Bodies/enzymology , Intracellular Membranes/enzymology , Molecular Sequence Data , Plasmids , Recombinant Fusion Proteins/genetics , Recombinant Fusion Proteins/isolation & purificationABSTRACT
T4 RNA ligase catalyzes the ATP-dependent addition of a single 2'-deoxyribonucleoside 3',5'-bisphosphate to the 3'-hydroxyl of an oligodeoxyribonucleotide. The bisphosphate is joined to the deoxyoligomer by a 3' leads to 5' phosphodiester bond and the product, which is terminated by a 3'-phosphate, is one nucleotide longer than the substrate. Bisphosphates of dAdo, dCyd, dGuo, dThd, and dUrd are donors and oligodeoxyribonucleotides with dA, dC, dG, dT, or dU 3' termini act as acceptors. The preferred residue for both donor and acceptor is dCyd. Deoxyoligomers from 3 to 12 residues in length are active as acceptors. To obtain good yields, high concentration of enzyme, long incubation time at low temperature, and manganous rather than Mg(II) ion are required. Under optimal conditions, yields calculated with respect to deoxyoligomer converted to product vary from 40 to greater than 95%. The turnover number of the enzyme for DNA joining is extremely low but, because the preparation is nearly free of DNases, there is less than 3% degradation of substrate or product after 6 days of reaction. We anticipate that this reaction will serve as the basis for a method for the stepwise enzymatic synthesis of DNA of defined sequence.
