Detection and reduction of errors in parenteral nutrition compounding through gravimetric and product control. / [Artículo traducido] Detección y reducción de errores en la elaboración de la nutrición parenteral mediante control gravimétrico y de producto.

OBJECTIVE: To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control. METHODS: All errors detected through quality control in the compounding of pediatric and adult parenteral nutrition between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018. RESULTS: A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (p < 0.05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (p < 0.05). CONCLUSIONS: Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count.

Detection and reduction of errors in parenteral nutrition compounding through gravimetric and product control.

OBJECTIVE: To analyze the errors in the preparation of parenteral nutrition in a Pharmacy Service, detected through an already consolidated gravimetric and product quality control, and compare them with those detected during the initial years of implementing this quality control. METHODS: All errors detected through quality control in the compounding of pediatric and adult parenteral nutritions between 2019 and 2021 were prospectively analyzed. This quality control consisted of 3 sequential processes: a visual check, a gravimetric control, and a product control. Errors were classified as gravimetric, when the nutrition had a deviation of more than 5% from the theoretical weight, or as product errors when a qualitative or quantitative error was detected upon reviewing the remainder of the components used. These errors were analyzed in terms of type and the component involved. A comparison was made with the errors detected during the implementation phase of this quality control from 2016 to 2018. RESULTS: A total of 41,809 parenteral nutritions were reviewed, and 345 errors were detected (0.83% of the preparations); of these, 59 errors were found in pediatric nutritions (0.68% of them), and 286 in adult nutritions (0.86% of them). Among these errors, 193 were of gravimetric nature, while 152 were detected through product control. The main components involved in product errors were electrolytes, primarily due to the addition of excessive volumes and the use of incorrect components. A significant absolute reduction of 0.71% (P < .05) in the total number of errors was observed when compared to the implementation phase. This reduction was consistent in both gravimetric errors (-0.59%) and product-related errors (-0.12%) (P < .05). CONCLUSIONS: Comprehensive quality control of parenteral nutrition preparation is an easily implementable tool that effectively detected and prevented significant errors. Furthermore, its widespread adoption contributed to a reduction in the overall error count.

Cost-Effectiveness Analysis of Abrocitinib Compared with Other Systemic Treatments for Severe Atopic Dermatitis in Spain.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itchy, painful, and dry skin. Despite the great number of available therapies, economic evaluations are still needed to provide evidence on their cost efficiency. This research aimed to evaluate the cost effectiveness of the Janus kinase (JAK) inhibitor abrocitinib (200 mg) compared with dupilumab (300 mg), tralokinumab (300 mg), baricitinib (2 and 4 mg), and upadacitinib (15 and 30 mg) for the treatment of patients with severe AD from the Spanish National Health System (NHS) perspective. METHODS: A hybrid model consisting of a decision tree linked to a Markov model was developed to estimate costs, quality-adjusted life-years (QALYs), total years in response and incremental cost-per-QALY gained (willingness-to-pay [WTP] threshold: €25,000/QALY). Adults with severe AD entered the decision tree and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) was considered at 16 and 52 weeks. After this time, patients entered the Markov model (remainder of the 10-year time horizon), which consisted of three health states: maintenance with active therapy, subsequent treatment, or death. All costs were presented in 2022 euros (€). Additionally, cost per number-needed-to-treat (NNT) was calculated for abrocitinib and dupilumab based on a head-to-head post-hoc analysis. RESULTS: Abrocitinib 200 mg was dominant (i.e., lower incremental costs and higher incremental benefit) compared with all studied alternatives (dupilumab 300 mg, tralokinumab 300 mg, baricitinib 2 and 4 mg, upadacitinib 15 and 30 mg) with a QALYs gain of 0.49, 0.60, 0.64, 0.43, 0.45, and 0.08, respectively, and per-person costs savings of €22,097, €24,140, €14,825, €7,116, €12,805, and €45,189, respectively. Considering the WTP threshold, abrocitinib was dominant or cost effective compared with all alternatives for most simulations. Additionally, abrocitinib was dominant compared with all alternatives when evaluating the cost effectiveness over a 5-year time horizon. NNT showed that abrocitinib was dominant versus dupilumab. CONCLUSIONS: The results of the study show that abrocitinib is a cost-effective therapy compared with other JAK inhibitors and biological therapies from the Spanish NHS perspective.

Suicide Risk among University Students in Spain: Implications for Social Work.

Suicide is a phenomenon that affects university students all over the world, and although vulnerability has been revealed in universities, there are still few studies that include large populations, a large number of universities and students pursuing different degrees. The study presented here aims to detect the risk of suicide in Spanish university students pursuing different areas of study. A total of 2,025 students from 16 Spanish universities and 17 degree programs completed an online questionnaire assessing support and suicide risk factors. The results indicate that 29.2 percent of the university students had experienced suicidal ideation in their lifetime. Logistic regression analysis showed that this risk was associated with depressive symptomatology and having suffered sexual violence. In contrast, self-esteem, life satisfaction, and perceived support were shown to be protective factors. Suicide risk affects one in three students. The present study includes particular implications for decision makers in the university community and other related governmental bodies, as well as for social work.

Implementation of a parenteral nutrition home care programme in a tertiary hospital / Implementación de un programa de atención domiciliaria de nutrición parenteral en un hospital de tercer nivel

Aim: the objective of this study was to describe the results of the implementation of a home parenteral nutrition (HPN) care programme (Nutrihome©) in a cohort of patients treated at a tertiary hospital. Methods: retrospective study of the patients included in Nutrihome© at Hospital General Universitario Gregorio Marañón, Madrid, Spain. Nutrihome consists of different modules including pre-discharge nursing hospital visits and nursing home visits, deliveries of the infusion pump, consumables and parenteral nutrition bags, patient training, weekly scheduled nursing home visits, scheduled nursing phone calls, stock control phone calls and 24-hour on-call line manned by the nurses. Results: the study included 8 (75 % women) and 10 (70 % women) patients in the Nutrihome© pilot and Nutrihome© programme, respectively. A total 37 adverse events were reported during Nutrihome© pilot, 26 of which were technical, 9 clinical, 1 was catheter-related and 1 other event. Nutrihome© programme registered a total of 107 adverse events reported, 57 of which were technical, 21 clinical, 16 were catheter-related and 13 were other events. A total of 99 % of these events were solved by Nutrihome© via phone calls or home visits. Conclusions: Nutrihome© programme has been extremely useful during this pandemic, facilitaing both the start of HPN and training at the patient home without the need for hospitalisation. Additionally, the adverse events reported and solved by Nutrihome© not only reduced the physicians’ burden during those tough times and the patients´ stress of being hospitalised during a pandemic, but supported the entire healthcare system. (AU)

Objetivo: el objetivo de este estudio fue describir los resultados de la implementación de un programa de cuidados de nutrición parenteral domiciliaria (NPD) (Nutrihome©) en una cohorte de pacientes atendidos en un hospital terciario. Métodos: estudio retrospectivo de los pacientes incluidos en Nutrihome© en el Hospital General Universitario Gregorio Marañón de Madrid (España). Nutrihome consta de diferentes módulos que incluyen visitas de enfermería previas al alta y visitas al domicilio, entregas de la bomba de infusión, consumibles y bolsas de nutrición parenteral, formación del paciente, visitas semanales al domicilio programadas, llamadas telefónicas de enfermería programadas, llamadas telefónicas de control de existencias y atención telefónica de enfermería las 24 horas al día. Resultados: el estudio incluyó a 8 (75 % mujeres) y 10 (70 % mujeres) pacientes en el piloto Nutrihome© y en el programa Nutrihome©, respectivamente. Durante el piloto, se registraron un total de 37 eventos adversos, de los cuales 26 fueron técnicos, 9 clínicos, 1 relacionado con el catéter y 1 otro evento. Durante el programa Nutrihome©, se registró un total de 107 eventos adversos, de los cuales 57 fueron técnicos, 21 clínicos, 16 relacionados con el catéter y 13 otros eventos. El 99 % de estos eventos fueron resueltos por Nutrihome© por teléfono o mediante visitas a domicilio. Conclusiones: el programa Nutrihome© ha sido de gran utilidad durante esta pandemia, posibilitando tanto el inicio de la NPD como la formación en el domicilio del paciente sin necesidad de hospitalización. Además, los eventos adversos descritos y resueltos por Nutrihome© no solo redujeron la carga de los médicos durante esos tiempos difíciles y el estrés de los pacientes derivado de estar hospitalizados durante la pandemia, sino que fue un apoyo para todo el sistema de salud. (AU)

Implementation of a parenteral nutrition home care programme in a tertiary hospital.

Introduction: Aim: the objective of this study was to describe the results of the implementation of a home parenteral nutrition (HPN) care programme (Nutrihome©) in a cohort of patients treated at a tertiary hospital. Methods: retrospective study of the patients included in Nutrihome© at Hospital General Universitario Gregorio Marañón, Madrid, Spain. Nutrihome consists of different modules including pre-discharge nursing hospital visits and nursing home visits, deliveries of the infusion pump, consumables and parenteral nutrition bags, patient training, weekly scheduled nursing home visits, scheduled nursing phone calls, stock control phone calls and 24-hour on-call line manned by the nurses. Results: the study included 8 (75 % women) and 10 (70 % women) patients in the Nutrihome© pilot and Nutrihome© programme, respectively. A total 37 adverse events were reported during Nutrihome© pilot, 26 of which were technical, 9 clinical, 1 was catheter-related and 1 other event. Nutrihome© programme registered a total of 107 adverse events reported, 57 of which were technical, 21 clinical, 16 were catheter-related and 13 were other events. A total of 99 % of these events were solved by Nutrihome© via phone calls or home visits. Conclusions: Nutrihome© programme has been extremely useful during this pandemic, facilitaing both the start of HPN and training at the patient home without the need for hospitalisation. Additionally, the adverse events reported and solved by Nutrihome© not only reduced the physicians' burden during those tough times and the patients´ stress of being hospitalised during a pandemic, but supported the entire healthcare system.

Introducción: Objetivo: el objetivo de este estudio fue describir los resultados de la implementación de un programa de cuidados de nutrición parenteral domiciliaria (NPD) (Nutrihome©) en una cohorte de pacientes atendidos en un hospital terciario. Métodos: estudio retrospectivo de los pacientes incluidos en Nutrihome© en el Hospital General Universitario Gregorio Marañón de Madrid (España). Nutrihome consta de diferentes módulos que incluyen visitas de enfermería previas al alta y visitas al domicilio, entregas de la bomba de infusión, consumibles y bolsas de nutrición parenteral, formación del paciente, visitas semanales al domicilio programadas, llamadas telefónicas de enfermería programadas, llamadas telefónicas de control de existencias y atención telefónica de enfermería las 24 horas al día. Resultados: el estudio incluyó a 8 (75 % mujeres) y 10 (70 % mujeres) pacientes en el piloto Nutrihome© y en el programa Nutrihome©, respectivamente. Durante el piloto, se registraron un total de 37 eventos adversos, de los cuales 26 fueron técnicos, 9 clínicos, 1 relacionado con el catéter y 1 otro evento. Durante el programa Nutrihome©, se registró un total de 107 eventos adversos, de los cuales 57 fueron técnicos, 21 clínicos, 16 relacionados con el catéter y 13 otros eventos. El 99 % de estos eventos fueron resueltos por Nutrihome© por teléfono o mediante visitas a domicilio. Conclusiones: el programa Nutrihome© ha sido de gran utilidad durante esta pandemia, posibilitando tanto el inicio de la NPD como la formación en el domicilio del paciente sin necesidad de hospitalización. Además, los eventos adversos descritos y resueltos por Nutrihome© no solo redujeron la carga de los médicos durante esos tiempos difíciles y el estrés de los pacientes derivado de estar hospitalizados durante la pandemia, sino que fue un apoyo para todo el sistema de salud.

Stress, subjective wellbeing and self-knowledge in higher education teachers: A pilot study through bodyfulness approaches.

Work-related stress is a major cause of health problems worldwide. Faculty in educational institutions, including universities, also face high levels of stress, which undoubtedly affects their performance, level of personal satisfaction and wellbeing, and the relationship with students. Training interventions based on embodied learning can promote self-knowledge, emotional regulation and stress reduction, thereby increasing levels of psychological well-being. The present pilot study analyzed the impact of body awareness training in 31 university teachers using a controlled, randomized pre-post experimental design, with two experimental groups and a control group (n = 10). The two interventions were: Hatha Yoga (n = 11) and Dance Movement Therapy/Body Mind Centering (n = 10), which we have termed Body Movement Awareness. Variables related to body awareness, mindfulness, wellbeing, life satisfaction and stress were measured using self-perception tests. Cortisol levels, heart rate variability and sleep quality were also analyzed. Finally, participants' reflections were analyzed according to a qualitative approach. The results showed significant differences between the control group and the Hatha Yoga group in terms of stress reduction and wellbeing. The Body Movement Awareness group exhibited evidence of contributions on self-knowledge, communication and kinesthetic empathy, key elements in the educational field. Despite the inherent limitations of the study, the conclusions are encouraging and open new lines of research from embodied approaches that introduce creative movement and group experience as part of the process of emotional regulation and self-knowledge.

From the inside: Dancing between burnout and engagement in a prison.

OBJECTIVES: Professionals who work in prisons present high levels of chronic stress that affect their daily performance and health. The incorporation of training workshops on emotional regulation and stress coping strategies from a psycho-body approach could have a positive impact on their well-being. This article presents an exploratory study that analyzes chronic stress, emotional repertoire and body awareness, of a sample of 15 professionals from a prison, together with the effect produced by an intervention through training workshops with Dance Movement Therapy. MATERIAL AND METHOD: A mixed methodology with a pretest-posttest design was used. The variables of burnout, engagement, emotional repertoire and body awareness were measured. With the information obtained from a participatory focus group, a six-hour body awareness program was designed and implemented, during which participants completed reflective diaries for subsequent analysis. RESULTS: High levels of stress and low body awareness were found. Qualitative analysis generated evidence for improvements in body awareness and the incorporation of coping strategies based on listening to body sensations and emotional regulation. Pre-post test analysis for a subsample (n = 4) of the total showed improvements in different subscales, not statistically significant, but with medium effect sizes. DISCUSSION: Despite the limitations of the study, the results are promising. The participants value the workshop very positively and consider having incorporated tools to cope with work stress.

[Recommendations for using oral antineoplastic and immunomodulating agents in oncohematology by enteral tube administration]. / Recomendaciones para la administración de antineoplásicos e inmunomoduladores orales por sonda enteral en oncohematología.

INTRODUCTION: Introduction and objective: in recent years, the number of oral antineoplastic and immunomodulating drugs in oncohematology has increased enormously. Often, these drugs must be administered to patients with enteral tube feeding or swallowing disorders, which causes safety problems when handling these drugs (many of them are classified as hazardous drugs). In addition, it is important to note that the administration of these drugs can also interact with enteral nutrition (EN). The objective of this study was to review and update the recommendations for the administration and handling of oral antineoplastic and immunomodulating drugs. Methods: a Working Group made up of pharmacists from the Pharmacy Group of The Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Clinical Nutrition Group of The Spanish Society of Hospital Pharmacy (SEFH) was created. A bibliographic review was carried out between 2015 and 2020 on the administration and handling of oral antineoplastic and immunomodulating drugs in oncohematology. The information about pharmaceutical specialties, dosage, presentation, brand names, instructions for oral or enteral tube administration, interactions with EN, precautions, and remarks for handling and administration was analyzed. Results: a total of 77 active principles and 84 pharmaceutical forms were included. Recommendations and instructions for oral, nasogastric tube, and gastrostomy administration, handling of the antineoplastic and immunomodulating drugs, and interactions with EN were described. Conclusions: the handling and administration information about the oral antineoplastic and immunomodulating drugs currently used in oncohematology for people with enteral accesses or swallowing disorders is limited. It is important to perform post-marketing studies to ensure a safe and effective administration of these drugs.

INTRODUCCIÓN: Introducción y objetivo: en los últimos años, el número de fármacos antineoplásicos e inmunomoduladores orales (ANIO) ha crecido enormemente. Con frecuencia, estos fármacos deben administrarse por sonda enteral (SE) o a pacientes con problemas de deglución, planteando un problema respecto a su manipulación (muchos pertenecen al grupo de medicamentos peligrosos). Además, también pueden presentar interacciones cuando se administran con la nutrición enteral (NE). El objetivo ha sido analizar y actualizar las recomendaciones de administración y manipulación de los ANIO. Métodos: se creó un Grupo de Trabajo formado por farmacéuticos del Grupo de Farmacia de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y del Grupo de Nutrición Clínica de la Sociedad Española de Farmacia Hospitalaria (SEFH). Se realizó una revisión bibliográfica entre 2015 y 2020 de las condiciones de manipulación y administración de los ANIO en oncohematología, elaborando una tabla que recoge especialidades farmacéuticas, dosis, presentación, nombre comercial, instrucciones para la administración oral y por SE, interacciones con la NE, precauciones y observaciones para su manipulación y administración. Resultados: se elaboró una tabla con 77 principios activos y 84 formas farmacéuticas, recogiendo recomendaciones e instrucciones para su administración por vía oral, sonda nasogástrica y gastrostomía, para la correcta manipulación y para la administración junto a la NE. Conclusiones: la información sobre cómo administrar y manipular los ANIO en personas con accesos enterales o problemas de deglución es escasa. Consideramos importante incluir en los estudios poscomercialización una investigación dirigida a responder a estas cuestiones para garantizar una administración segura y eficaz de los medicamentos a estos pacientes.

Desde dentro: bailando entre el burnout y el engagement en un centro penitenciario / From the inside: Dancing between burnout and engagement in a prison

Objetivos: Los profesionales que trabajan en centros penitenciarios, presentan altos niveles de estrés crónico que afectan a su desempeño diario y a su salud. La incorporación de talleres de regulación emocional y estrategias de afrontamiento del estrés, desdeun enfoque psicocorporal, podrían tener un impacto positivo en su bienestar. Este estudio exploratorio pretende analizar el estréscrónico, el repertorio emocional y la consciencia corporal, de una muestra inicial de 15 profesionales de un centro penitenciario,así como los efectos producidos por una intervención a través de talleres formativos con danza movimiento terapia (DMT).Material y método: Se utilizó una metodología mixta con diseño pre-post test, midiendo las variables burnout, engagement, repertorioemocional y consciencia corporal (CC). Con la información obtenida de un focus group (FG) participativo, se diseñó e implementó unprograma de CC de seis horas de duración, durante el cual los participantes cumplimentaron diarios reflexivos para su posterior análisis.Resultados: Se encontraron altos niveles de estrés y baja CC. El análisis cualitativo generó evidencias en cuanto a mejoras de laCC y la incorporación de estrategias de afrontamiento basadas en la escucha de las sensaciones corporales y la regulación emocional. El análisis pre-post test para una submuestra (n = 4) del total mostró mejoras en distintas subescalas, no estadísticamentesignificativas, pero con tamaños de efecto medios.Discusión: A pesar de las limitaciones del estudio, los resultados son prometedores. Los participantes valoran de modo muypositivo el taller realizado y consideran haber incorporado herramientas para afrontar el estrés laboral. (AU)

Objectives: Professionals who work in prisons present high levels of chronic stress that affect their daily performance andhealth. The incorporation of training workshops on emotional regulation and stress coping strategies from a psycho-bodyapproach could have a positive impact on their well-being. This article presents an exploratory study that analyzes chronicstress, emotional repertoire and body awareness, of a sample of 15 professionals from a prison, together with the effect produced by an intervention through training workshops with Dance Movement Therapy.Material and method: A mixed methodology with a pretest-posttest design was used. The variables of burnout, engagement, emotional repertoire and body awareness were measured. With the information obtained from a participatory focus group, a six-hour bodyawareness program was designed and implemented, during which participants completed reflective diaries for subsequent analysis.Results: High levels of stress and low body awareness were found. Qualitative analysis generated evidence for improvements inbody awareness and the incorporation of coping strategies based on listening to body sensations and emotional regulation. Prepost test analysis for a subsample (n = 4) of the total showed improvements in different subscales, not statistically significant,but with medium effect sizes.Discussion: Despite the limitations of the study, the results are promising. The participants value the workshop very positivelyand consider having incorporated tools to cope with work stress. (AU)

[Quality control of parenteral nutrition compounding: gravimetric and component verification control]. / Control de calidad de la elaboración de nutriciones parenterales: control gravimétrico y de productos utilizados.

INTRODUCTION: Introduction: parenteral nutrition (PN) compounding is a process with a high probability of errors. Objective: to analyze PN compounding errors detected using a gravimetric control (GC) and a component verification control (CVC). Methods: a prospective analysis was carried out during a three-year period (January 2016 to December 2018). The MedicalOne Parenteral® software program was used to calculate the theoretical weight of each PN based on density and volume. Each elaborated PN was weighed to obtain the real weight. Gravimetric error (%) ((real weight - theoretical weight) x 100 / theoretical weight) was considered correct if within the ± 5 % interval. The CVC consisted of checking that the correct ingredients and volumes were added according to the PN order. Results: during the study period a total number of 28,761 PNs were checked out; 20,612 adult PNs (APN) were weighed and 124 were considered incorrect (0.60 %). Of the 1,203 non-neonatal pediatric PNs (NPPN), 15 (1.25 %) were incorrect, and of the 6,946 neonatal PNs (NPN), 164 (2.96 %) were incorrect. Regarding the CVC, 71 errors were detected in the APN (0.70 %), 6 (1.34 %) in the NPPN, and 5 (0.21 %) in the NPN group. The total number of errors included: adding more volume of one component [38 (46.34 %)], adding a wrong component [27 (32.93 %)], and absent volume of one component [17 (20.73 %)]. Conclusions: the quality control carried out allowed to detect errors during the preparation of PNs and prevented them from reaching the patient. More incorrect NPNs were detected through GC. The main error detected with CVC was adding more volume of a component.

INTRODUCCIÓN: Introducción: la elaboración de nutriciones parenterales (NP) es un proceso complejo y con alta probabilidad de aparición de errores. Objetivo: analizar los errores detectados en el control gravimétrico (CG) y de productos (CP) utilizados realizado en las NP elaboradas. Métodos: se realizó un análisis prospectivo en el que durante tres años (enero de 2016 a diciembre de 2018) se pesaron las NP elaboradas. Se utilizó el programa informático MedicalOne Parenteral®, que calcula el peso teórico teniendo en cuenta la densidad y el volumen. Cada NP elaborada se pesaba para obtener el peso real. El error gravimétrico (%) (EG = (peso real - peso teórico) x 100 / peso teórico) se consideró correcto dentro del intervalo de ± 5 %. El CP consistía en la comprobación de los productos y los volúmenes utilizados con la hoja de elaboración. Resultados: se realizó el control de 28.761 NP. Se pesaron 20.612 NP de adultos (NPA), siendo incorrectas 124 (0,6 %). De las 1203 NP de pacientes pediátricos no neonatos (NPP), 15 (1,25 %) fueron incorrectas, y de las 6946 de neonatos (NPN), 164 (2,96 %). Respecto al CP se detectaron 71 errores en las NPA (0,70 %), 6 (1,34 %) en las NPP y 5 (0,21 %) en las NPN. Los errores fueron: añadir más volumen de un componente [38 (46,34 %)], añadir menos volumen [17(20,73 %)] y producto erróneo [27 (32,93 %)]. Conclusiones: el control de calidad realizado permitió detectar errores producidos durante la elaboración y evitó que llegaran al paciente. Se detectaron en el CG más NP incorrectas entre las NPN. Con el CP, el error mayoritario fue añadir más volumen de un componente.

Re-inhabiting one's body: A pilot study on the effects of dance movement therapy on body image and alexithymia in eating disorders.

BACKGROUND: Body image disturbance and alexithymia are two core aspects of Eating Disorders (EDs). However, standard treatments for EDs do not include specific techniques to approach these issues on a bodily level. This pilot study evaluated the effects of a Dance Movement Therapy (DMT) intervention on body image and alexithymia in patients with EDs, and also explored their experience of the therapeutic process. METHOD: 14 patients with EDs were recruited from a private clinic. Seven were assigned via quasi-randomization to the DMT group and the others (n = 5) continued their treatment as usual. The length of the intervention was 14 weeks. All participants completed the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Toronto Alexithymia Scale (TAS-20) at the beginning and at the end of the intervention. Additionally, the DMT group wrote reflective diaries about their experience at the end of each session, which were analyzed using qualitative methods. RESULTS: Between the pre- and post-intervention, the participants of the DMT group significantly improved in Body Areas Satisfaction (effect size: 0.95) and Appearance Evaluation (effect size: 1.10), and they decreased significantly in Appearance Orientation (effect size: 1.30). A decrease in Overweight Preoccupation was observed (effect size: 0.75), however this was not statistically significant. The control group did not show significant changes in any of the MBSRQ subscales. Neither the DMT group nor the control group improved significantly in the alexithymia scores. The qualitative analysis revealed valuable insights into the participants' processes throughout the sessions. In general, participants received the DMT intervention positively. They reported improvements in their mood states and an increase in their self-awareness. They also appreciated the relationship with the group and the therapist. CONCLUSION: These results indicate that DMT might be a complementary treatment option for EDs, as it may be able to address body image issues more effectively than verbal therapies. More studies with larger samples are needed to confirm these promising preliminary results.

Agenesia renal bilateral / Bilateral renal agenesis

Gestante de 23 años de edad, primigesta, sin antecedentes patológicos personales ni familiares de interés, remitida con 22,6 semanas de amenorrea al Servicio Provincial de Genética Médica de Cienfuegos. En la exploración ecográfica se observó un feto único acorde a su edad gestacional, poca cantidad de líquido amniótico, placenta insertada en la cara posterior, y ausencia de ambos riñones y vejiga urinaria. Las glándulas suprarrenales se encontraban elongadas (signo de la suprarrenal acostada), y ocupaban ambos espacios renales. En la exploración ultrasonográfica del corazón se observó un defecto en el tabique interatrial. El diagnóstico planteado por el Servicio de Genética Médica fue: agenesia renal bilateral, agenesia vesical, comunicación interatrial y oligohidramnios. Se le brindó asesoramiento genético a la pareja, que decidió la interrupción del embarazo con una edad gestacional de 23,2 semanas. Se obtuvo un feto femenino, de piel blanca, al que se le realizó necropsia clínica. Durante la exploración del hábito interno se observó ausencia de vejiga urinaria, genitales internos, ambos uréteres y riñones. Su lugar anatómico estaba ocupado por ambas suprarrenales de características macroscópicas y microscópicas normales (paneles A y B)(AU)

Copolymer-1 enhances cognitive performance in young adult rats.

Cognitive impairment is a dysfunction observed as a sequel of various neurodegenerative diseases, as well as a concomitant element in the elderly stages of life. In clinical settings, this malfunction is identified as mild cognitive impairment. Previous studies have suggested that cognitive impairment could be the result of a reduction in the expression of brain-derived neurotrophic factor (BDNF) and/or immune dysfunction. Copolymer-1 (Cop-1) is an FDA-approved synthetic peptide capable of inducing the activation of Th2/3 cells, which are able to release BDNF, as well as to migrate and accumulate in the brain. In this study, we evaluated the effect of Cop-1 immunization on improvement of cognition in adult rats. For this purpose, we performed four experiments. We evaluated the effect of Cop-1 immunization on learning/memory using the Morris water maze for spatial memory and autoshaping for associative memory in 3- or 6-month-old rats. BDNF concentrations at the hippocampus were determined by ELISA. Cop-1 immunization induced a significant improvement of spatial memory and associative memory in 6-month-old rats. Likewise, Cop-1 improved spatial memory and associative memory when animals were immunized at 3 months and evaluated at 6 months old. Additionally, Cop-1 induced a significant increase in BDNF levels at the hippocampus. To our knowledge, the present investigation reports the first instance of Cop-1 treatment enhancing cognitive function in normal young adult rats, suggesting that Cop-1 may be a practical therapeutic strategy potentially useful for age- or disease-related cognitive impairment.

Reconocimiento de la medicación y cumplimiento terapéutico en pacientes usuarios de medicamentos genéricos / Recognition of medication and adherence to medical prescriptions in patients using generic drugs

Fundamentos. La prescripción por principio activo ha fomentado el auge de medicamentos genéricos y el aumento de la variedad de presentaciones, lo que puede causar confusión, errores y favorecer el incumplimiento terapéutico. La población mayor puede presentar mayor riesgo por sus comorbilidades y polimedicación asociadas. Objetivos. Valorar el reconocimiento de medicación y adherencia al tratamiento en pacientes mayores con cambios en la isoapariencia de su medicación. Metodología. Estudio descriptivo transversal en muestra por reclutamiento en Atención Primaria. Se realizó entrevista estructurada a 96 pacientes mayores de 65 años evaluando su adherencia al tratamiento farmacológico, mediante test de Morisky-Green y reconocimiento de medicación mediante test de discriminación de diferentes cajas de fármacos. Resultados. El 99 % de los pacientes (IC95% 94.3-99.8 %) refiere no equivocarse nunca al tomar su medicación. El 84.4 % (IC95% 75.8-90 %) reconoce su medicación sin errores, el 67.7 % (IC95% 57.8-76.2 %) reconoce el principio activo y el 56.2 % (IC95% 46.3-65.7 %) la cantidad correcta de principio activo. Las mujeres, los pacientes con mayor nivel educativo y los no polimedicados presentan mayor nivel de reconocimiento (p < 0.05). La mitad de los pacientes (51 %; IC95% 41.2-60.8 %) muestran adherencia al tratamiento, sin encontrarse diferencias significativas con variables sociodemográficas y grado de reconocimiento de medicación. Conclusiones. Elevada tasa de falta de adherencia al tratamiento farmacológico, pero similar a otras publicaciones. El nivel educativo influye a favor en el reconocimiento de la medicación, mientras que la polifarmacia influye de forma negativa. La creencia de los pacientes de tomar adecuadamente su medicación contrasta con los datos obtenidos, y debe tenerse en cuenta (AU)

Bases. The prescription based on the active ingredients has fostered the rise of generic drugs, increasing the variety of presentations, which can cause confusion, mistakes and encourage the medication nonadherence. The elderly may be at higher risk due to associated comorbidities and polymedication. Objectives. To assess recognition of the medication and adherence to medical prescription in elderly patients with changes in their medication appearance. Methodology. Descriptive cross-sectional study of a sample made by recruitment in Primary Health Care. We performed structured interviews to 96 patients over 65 years: we evaluated the adherence to medical prescription through the Morisky- Green test and we assessed the ability to recognize the medication by a discrimination test using drug boxes. Results. 99 % of the patients (CI95% 94.3- 99.8 %) reported never to fail in taking their medication. 84.4 % (CI95% 75.8-90 %) recognized their medication without errors, 67.7 % (CI95% 57.8-76.2 %) recognized the correct active ingredient and 56.2 % (CI95% 46.3-65.7 %) the right amount of active ingredient. A higher level of recognition was found in women, patients with a superior education level and those without polymedication (p < 0.05). Half of the patients (51 %; CI95% 41.2-60.8 %) showed adherence to medical prescription, but we found no significant relationship with the socio-demographic variables or the degree of recognition of the medication. Conclusions. High rate of lack of adherence to drug therapy, but similar to other publications. The education level influences the recognition of the medication, while polymedication has a negative effect. The wrong appreciation by patients considering that they take appropriately their medication contrasts with the real data, and should be taken into consideration (AU)

Effectiveness and Safety of Ombitasvir-Paritaprevir/Ritonavir and Dasabuvir With or Without Ribavirin for HCV Genotype 1 Infection for 12 Weeks Under Routine Clinical Practice.

BACKGROUND: No previous studies exist examining the effectiveness and safety in real clinical practice of the combination of ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV). OBJECTIVE: To evaluate the effectiveness and safety in real clinical practice of the combination of OBV/PTV/r+DSV with or without ribavirin for 12 weeks in treatment-naïve and previously treated adult patients with chronic hepatitis C virus (HCV) genotype 1 infection. METHODS: This was an observational study of a prospective cohort of treatment-naïve and pretreated adult patients who received 12 weeks of OBV/PTV/r (25/150/100 mg once daily) and DSV (250 mg twice daily) with or without ribavirin. The primary effectiveness outcome was sustained virological response 12 weeks after the end of treatment (SVR12). Safety outcomes were presented by the incidence of adverse events. RESULTS: A total of 116 of 121 patients achieved a SVR12 (95.9%, 95% CI = 90.6-98.6). The SVR12 rate was 93.8% (95% CI = 86.0-97.9) in cirrhotic patients and 100% (95% CI = 91.4-100.0) in noncirrhotic patients. Adverse events occurred in 91.7% of patients, of which 81.8% were grade 1/2, and none led to premature discontinuation. Grade 3 adverse events were reported in 9.9% of patients. The most frequent adverse event was anemia (52.1%), although only 1.6% had a hemoglobin level below 8 g/dL. The incidence of any adverse event was higher in the group of patients who received ribavirin (96.5% vs 80.0%, P = 0.002). CONCLUSIONS: The combination of OBV/PTV/r+DSV with or without ribavirin for 12-week settings achieved a high rate of SVR12, with an acceptable safety profile in routine clinical care.

Guiding pharmacist clinical interviews: a safety tool to support the education of patients treated with oral antineoplastic agents.

OBJECTIVE: Oral antineoplastic agents (OAA) lead to new challenges in patient education, monitoring, medication errors, drug interactions, adverse events management, and adherence. The aim is to develop a structured guide supporting pharmacist interviews and onco-hematologic outpatients' education process and to identify the key points that a pharmacist should address in order to increase OAA safety and efficacy. METHODS: A literature review was performed and the recommended standards associated with OAA approved by ASCO and MASCC were analyzed. Additionally, a multidisciplinary team was formed to address the key points associated with OAA in clinical practice and to create a useful clinical guide. RESULTS: The multidisciplinary team defined the safety and efficacy key points during patient education and issued recommendations regarding the following items: dose, drug administration, interactions, adverse events, adherence, literacy, quality of life, storage, and handling. A guide was created as a check-list in support of the pharmacist clinical interview. Implications for clinical practice, including adverse events management, drug interactions management, and interventions on adherence were added. CONCLUSION: This article provides a consensus set of safety recommendations regarding OAA in clinical practice and a well-researched easily implementable support guide to standardize and guarantee quality pharmaceutical care of onco-hematologic outpatients.

Efficiency of biological therapies in patients with moderate to severe psoriasis: impact of a pharmacotherapeutic protocol.

BACKGROUND: It is not clear how to best use biologics in the treatment of psoriasis. Our objective was to assess use of a protocol for biological therapies (BT) in psoriasis. METHODS: A consensus protocol was established that included the indications for BT and dose optimization. Patient's characteristics, effectiveness, and cost of BT were analyzed before and after the implementation with two cross-sectional studies to assess its impact. RESULTS: About 106 were treated before the protocol and 118 patients were treated after. After implementing the protocol, the dose was reduced in 43.4% of the patients receiving adalimumab, in 37.5% for etanercept, in 28.6% for infliximab, and in 14.7% for ustekinumab. No statistically significant differences were found in PASI score after the implementation of the protocol, except for the percentage of patients that achieved PASI 75 with ustekinumab, which was slightly higher. The global yearly savings achieved with the protocol implementation were 115,969 €. CONCLUSIONS: The protocol helped to increase the efficiency of BT, with decreasing doses of BT without affecting treatment effectiveness.

Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction.

BACKGROUND: Self-administration of oral chemotherapy regimens in the home setting leading to new challenges in the health system. OBJECTIVE: To develop and evaluate a comprehensive pharmaceutical care program for cancer outpatients treated with oral antineoplastic agents. SETTING: A Spanish tertiary hospital. METHODS: During 2012, a comprehensive pharmaceutical care program was elaborated following the standards recommended by ASCO. It comprised a standard procedure focusing on: drug indication, dosing regimen, required laboratory tests, route of administration, interactions with other current medications and adverse events; a checklist and informational brochures. A pharmaceutical follow up was defined and structured into three clinical interviews over 6 months which focused on safety and efficiency outcomes. Patients starting treatment with oral antineoplastic agents during 2011 (control group) without pharmacist monitoring were compared to patients beginning treatment at some point in 2013 who were prospectively monitored by a pharmacist (intervention group). Statistical analysis was performed by the statistical program SPSS, 21.0 and p < 0.05 was considered significant. MAIN OUTCOME MEASURES: Patient demographics and clinical data were recorded. The primary endpoint was safety outcomes: detection of drug related problems, drug interactions, and adverse events. Adherence, permanence and patient satisfaction were also collected. RESULTS: A total of 249 patients were enrolled in the study. Two hundred and seventy-five medication errors were recorded [106 in the control group and 169 in the intervention group (p = 0.008)]. The pharmacist intervened in 362 occasions being accepted 88.8 % of the time, mainly to reinforce patient education and literacy and giving information on co-administration with other drugs and herbal medicines. Adherent patients increased at the 6th month of treatment in the intervention group by 20 % (p < 0.001). High satisfaction was reported. CONCLUSION: The program has been implemented and evaluated successfully. It ensures a high quality and standard of pharmaceutical care with high patient satisfaction rate and the key points to prioritize for improvement in terms of safety (interactions and administration errors) and efficiency (adherence and permanence) of oral antineoplastic agents.

[Recognition of Medication and Adherence to Medical Prescriptions in Patients Using Generic Drugs]. / Reconocimiento de la medicación y Cumplimiento Terapéutico en Pacientes Usuarios de Medicamentos Genéricos.

Bases: The prescription based on the active ingredients has fostered the rise of generic drugs, increasing the variety of presentations, which can cause confusion, mistakes and encourage the medication nonadherence. The elderly may be at higher risk due to associated comorbidities and polymedication. Objectives: To assess recognition of the medication and adherence to medical prescription in elderly patients with changes in their medication appearance. Methodology: Descriptive cross-sectional study of a sample made by recruitment in Primary Health Care. We performed structured interviews to 96 patients over 65 years: we evaluated the adherence to medical prescription through the Morisky-Green test and we assessed the ability to recognize the medication by a discrimination test using drug boxes. Results: 99% of the patients (CI95% 94.3-99.8%) reported never to fail in taking their medication. 84.4% (CI95% 75.8-90%) recognized their medication without errors, 67.7% (CI95% 57.8-76.2% recognized the correct active ingredient and 56.2% (CI95% 46.3-65.7%) the right amount of active ingredient. A higher level of recognition was found in women, patients with a superior education level and those without polymedication (p < 0.05). Half of the patients (51%; CI95% 41.2-60.8%) showed adherence to medical prescription, but we found no significant relationship with the socio-demographic variables or the degree of recognition of the medication. Conclusions: High rate of lack of adherence to drug therapy, but similar to other publications. The education level influences the recognition of the medication, while polymedication has a negative effect. The wrong appreciation by patients considering that they take appropriately their medication contrasts with the real data, and should be taken into consideration.