[Assessment of adherence to antibiotic treatment in Primary Care by determining levels of the drug using a liquid chromatography technique]. / Valoración de la adherencia al tratamiento antibiótico en Atención Primaria mediante la determinación de niveles del fármaco utilizando una técnica de cromatografía líquida.

OBJECTIVE: The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sani-tary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. METHODS: Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. RESULTS: A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. CONCLUSIONS: Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance.

[Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain]. / Coste-efectividad a largo plazo de ticagrelor frente a clopidogrel en síndrome coronario agudo en España.

OBJECTIVE: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. METHODS: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of life-adjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus) or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental cost-effectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. RESULTS: Treatment with Ticagrelor was associated to an incremental cost of 1,228 Euros per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 Euros and the cost per one gained life year of 7,435 . The sensitivity analysis showed consistent results. CONCLUSIONS: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.

OBJETIVO: Evaluar la relación coste-efectividad de ticagrelor frente a clopidogrel en el tratamiento del síndrome coronario agudo en España. MÉTODOS: Para el cálculo de la tasa de eventos y la calidad de vida relacionada con la salud para ticagrelor y clopidogrel durante los doce primeros meses se utilizaron los datos del estudio PLATO, mientras que los costes se obtuvieron de fuentes españolas. La supervivencia ajustada por calidad de vida y los costes se estimaron en función de que los pacientes no sufrieran ningún evento trombótico (infarto de miocardio o ictus) o éste fuese no mortal. El coste a lo largo de toda la vida, los años de vida ganados y la supervivencia por calidad de vida se estimaron para ambos brazos de tratamiento. Los ratios de coste-efectividad incremental se presentaron desde la perspectiva del sistema sanitario español en 2013, empleando una estrategia de macrocostes basada en la bibliografía publicada y utilizando las tablas de supervivencia de la población española. RESULTADOS: El tratamiento con ticagrelor se asoció con un coste incremental de 1.228 anuales, un aumento de 0,1652 años de vida ganados y 0,1365 años de vida ajustados por calidad comparado con clopidogrel. Se obtuvo un coste por año de vida ajustado por calidad de 8.997y un coste por año de vida ganado de 7.435 . El análisis de sensibilidad mostró resultados consistentes. CONCLUSIONES: El tratamiento durante 12 meses del síndrome coronario agudo con ticagrelor se asoció a un coste por año de vida ajustado por calidad por debajo de los límites de costeefectividad generalmente aceptados en España.

Coste-efectividad a largo plazo de ticagrelor frente a clopidogrel en síndrome coronario agudo en España / Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain

Objetivo: Evaluar la relación coste-efectividad de ticagrelor frente a clopidogrel en el tratamiento del síndrome coronario agudo en España. Métodos: Para el cálculo de la tasa de eventos y la calidad de vida relacionada con la salud para ticagrelor y clopidogrel durante los doce primeros meses se utilizaron los datos del estudio PLATO, mientras que los costes se obtuvieron de fuentes españolas. La supervivencia ajustada por calidad de vida y los costes se estimaron en función de que los pacientes no sufrieran ningún evento trombótico (infarto de miocardio o ictus) o éste fuese no mortal. El coste a lo largo de toda la vida, los años de vida ganados y la supervivencia por calidad de vida se estimaron para ambos brazos de tratamiento. Los ratios de coste-efectividad incremental se presentaron desde la perspectiva del sistema sanitario español en 2013, empleando una estrategia de macrocostes basada en la bibliografía publicada y utilizando las tablas de supervivencia de la población española. Resultados: El tratamiento con ticagrelor se asoció con un coste incremental de 1.228 euros anuales, un aumento de 0,1652 años de vida ganados y 0,1365 años de vida ajustados por calidad comparado con clopidogrel. Se obtuvo un coste por año de vida ajustado por calidad de 8.997 euros y un coste por año de vida ganado de 7.435 euros. El análisis de sensibilidad mostró resultados consistentes. Conclusiones: El tratamiento durante 12 meses del síndrome coronario agudo con ticagrelor se asoció a un coste por año de vida ajustado por calidad por debajo de los límites de coste-efectividad generalmente aceptados en España (AU)

Objective: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. Methods: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of life-adjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus) or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental cost-effectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macrocosts strategy based on published literature and the survival tables for the Spanish population. Results: Treatment with Ticagrelor was associated to an incremental cost of 1,228 euros per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 euros and the cost per one gained life year of 7,435 euros. The sensitivity analysis showed consistent results. Conclusions: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain (AU)

[Nutritional assessment in a Moroccan university population during Ramadan]. / Evaluación nutricional de una población universitaria Marroquí en el tiempo de Ramadán.

The aim of this work was to assess nutritional status in Muslim population, bigger and bigger in our universities, in a period during which its dietary habits change considerably. The study has been performed in a population of Muslim students from the University of Granada, and has been compared to a non-Muslim population within the same setting. Study subjects undertook a questionnaire in which they reported the diet consumed each day during the Ramadan period. Macronutrient analysis for such diet was performed with Dietsource software. On the other hand, anthropometrical parameters were taken before and after the study period to observe their change and obtain conclusions on nutritional status. It has been observed that lipid intake of Muslims during the Ramadan period was excessive (48% of total energy), by decreasing hydrocarbons and particularly proteins. This is highlighted by means of the anthropometrical study, observing a decrease in measurements such as muscular area of the arm, the arm area, the muscle perimeter of the arm, and weight, with an increase in arm fat, perimeter of the arm, leg and mid-ieg circumference in the Muslim group, which are in contrast with parameters in the non-Muslim group. From our results, we may stress that during the Ramadan period macronutrient intake values are not appropriate as compared to standard recommendations in Spain. Besides, it is striking to observe how anthropometrical measurements related to fat increase whereas those related to muscular mass decrease.

[Nutritional assessment of a university population]. / Evaluación nutricional de una población universitaria.

In this work, we have planned to perform a nutritional assessment of a group of 50 students from the University of Granada, to which questionnaires have been administered relating to 24-hour remembrance of type and frequency of food consumption, for 30 days. In order to know macro- and micronutrients intake, the results have been analyzed with DietSource software. At the same time, anthropometrical measurements have been taken to verify their possible change during the study period. We have been able to observe a protein intake slightly higher than the recommended intake, similarly to what occurs with lipids. The studied group positively values menus with high content in meat, whereas deficiencies in fruit and vegetable intake are observed. In addition, there is a variation of anthropometrical measurements of these individuals during the study period. We also noticed a deficiency in some micronutrients such as iron, zinc, calcium, iodine, cupper, selenium, vitamin E, and folic acid in all the studied population. However, vitamin C and thiamine levels in both groups and riboflavin levels in women may be considered adequate. From these results, we may highlight a nutrition unbalance in this population group since we have observed some deficiencies in the intake of important micronutrients for health maintenance and promotion, and macronutrient consumption that diverges from the established recommendations.

Evaluación nutricional de una población universitaria marroquí en el tiempo de Ramadán / Nutritional assessment in a moroccan university population during ramadan

En este trabajo se pretende evaluar el estado nutricional de una población musulmana, cada vez más numerosa en nuestras universidades, en un período en el que varían de forma considerable sus hábitos alimenticios. El estudio se ha realizado en una población de estudiantes musulmanes de la Universidad de Granada, comparándola con un grupo de población no musulmán del mismo ámbito. A los sujetos de estudio, se les realizó una encuesta en la que reflejaban la dieta de cada día durante el período del Ramadán. Se realizó el análisis de macronutrientes de dicha dieta mediante el programa Dietsource. De otra parte, se tomaron medidas antropométricas antes y después del período de estudio para así observar la variación de las medidas realizadas y obtener las conclusiones del estudio nutricional. Se ha observado que el aporte de lípidos de los musulmanes en el tiempo del Ramadán era excesivo (48% del total de la energía), a expensas de disminuir el aporte de hidratos de carbono y aún más el de proteínas. Esto se pone de manifiesto en el estudio antropométrico, observándose una disminución de medidas como área muscular del brazo, área del brazo, perímetro muscular del brazo y peso frente a un aumento del área grasa del brazo, perímetro del brazo, circunferencia de pierna y pierna media en el grupo musulmán, medidas que contrastan con las del grupo no musulmán. A la vista de los resultados cabe destacar que durante el tiempo de Ramadán los valores de ingesta de macronutrientes no son adecuados si se comparan con las recomendaciones de referencia en España. Asimismo, llama la atención cómo aumentan las medidas antropométricas que hacen referencia a la grasa a la vez que disminuyen aquéllas que miden la masa muscular (AU)

The aim of this work was to assess nutritional status in Muslim population, bigger and bigger in our universities, in a period during which its dietary habits change considerably.The study has been performed in a population of Muslim students from the University of Granada, and has been compared to a non-Muslim population within the same setting. Study subjects undertook a questionnaire in which they reported the diet consumed each day during the Ramadan period. Macronutrient analysis for such diet was performed with Diet source software. On the other hand, anthropometrical parameters were taken before and after the study period to observe their change and obtain conclusions on nutritional status. It has been observed that lipid intake of Muslims during the Ramadan period was excessive (48% of total energy), by decreasing hydrocarbons and particularly proteins. This is highlighted by means of the anthropometrical study, observing a decrease in measurements such as muscular area of the arm, the arm area, the muscle perimeter of the arm, and weight, with an increase in arm fat, perimeter of the arm, leg and mid-ieg circumference in the Muslim group, which are in contrast with parameters in the non-Muslim group. From our results, we may stress that during the Ramadan period macronutrient intake values are not appropriate as compared to standard recommendations in Spain. Besides, it is striking to observe how anthropometrical measurements related to fat increase whereas those related to muscular mass decrease (AU)

Automatización de la elaboración de nutrición parenteral: adecuación a la legislación actual / Automation of parenteral nutrition elaboration: adaptation to in force legislation

Introducción: Los criterios de calidad y eficiencia de las prestaciones asociadas a los procedimientos tecnológicos se está desarrollando en un entorno de exigencia de calidad,y a raíz de ello se ha desarrollado el RD 175/2001 por el que se regulan las normas de correcta elaboración y control de calidad de fórmulas magistrales y preparados oficinales. La nutrición parenteral (NP) es una fórmula magistral y como tal su elaboración y control se deben ajustar a la normativa vigente. Con esta finalidad, en el Hospital Universitario de Bellvitge hemos desarrollado un proyecto de automatización de la elaboración de mezclas de NP con la Bomba Micro-Macro® 23 Baxa Compounder . Objetivos: Evaluar el impacto de la implantación de un sistema automatizado de control volumétrico en la elaboración de NP. Material y métodos: El desarrollo del proyecto se puede dividir en dos aspectos diferenciados. El primero, consistió en la implantación y optimización del SACV (sistema automatizado de control volumétrico).Un segundo aspecto abarca el control comparativo realizado entre el nuevo sistema y el anterior que consistía en un sistema gravimétrico de control visual. Para ello se recogieron los pesos reales y se calcularon los pesos teóricos y se recogió el tiempo de elaboración por bolsa de preparaciones realizadas antes y en 2 periodos después de la implantación del sistema automatizado; un primer periodo justo tras la implantación del sistema automatizado y otro al año. Resultados Para el estudio comparativo entre los 2 sistemas utilizados se analizaron un total de 141 preparaciones correspondientes a NP individualizadas: 47 elaboradas con el sistema gravimétrico (SG), 47 con el SACV en el peutiliriodo de implantación (NP SACV periodo 1) y 47 NP realizada con el SACV al año de su implantación (NP SACV periodo 2).La media de variación del peso real respecto al teórico en los tres periodos (pre-SACV, NP SACV periodo 1, NP SACV periodo 2) fue de 2,41%, 1,35% y 1,25% respectivamente (tabla I). Esta disminución fue significativa (p=0,014). Al analizar el porcentaje de preparaciones fuera del límite de variación del 3% se observó una reducción significativa (p=0,00001) al comparar los 3 periodos (tabla II). El tiempo medio de elaboración con el SACV aumentó aproximadamente 4 minutos por bolsa (3min58s) en el primer periodo estudiado y 3min10s al comparar las NP elaboradas con el SACV durante el segundo periodo de estudio con el SG. Conclusiones: El nuevo sistema de llenado de bolsas mediante control volumétrico supone un aumento en el control de la exactitud y una disminución del riesgo de superar los límites considerados aceptables. La puesta en marcha de un proceso tecnológico es una tarea difícil que implica el cambio en muchos aspectos de la actividad diaria y que hace necesario un cambio "cultural" en la Unidad de NP con el fin de optimizar todo el proceso. Sin embargo, estos aspectos permiten una adecuación a los requisitos legales existentes en cuanto a normas de correcta elaboración y control de calidad de fórmulas magistrales así como una mejora en la calidad asistencial integral (AU)

Introduction: Quality and efficiency criteria of allowances associated to technological procedures are developing in a setting that values quality, and from there the Real Decree RD175/2001 has been issued by which the rules of correct elaboration and quality control of formulations and pharmacy preparations. Parenteral nutrition (PN) is a formulation and, as such, its elaboration and control have to agree with the in force regulations.With this aim, at the Bellvitge University Hospital we have developed a project for automation of elaboration of PN mixtures with the MicroMacro Pump 23 Baxa Compounder®. Objectives: To assess the impact of implementing an automated system of volumetric control in PN elaboration. Material and methods: The project development may be divided into two differentiated aspects. The first one consisted in the implementation and optimization of the automated system of volumetric control (ASVC). The second aspect comprehends the comparative control performed between the new system and the previous one, and which consisted of a gravimetric system with visual control. For that, real weights were gathered and were compared to predicted weights, and the time of elaboration per bag before and at two times after the implementation of the automated system was registered; the first time just after implementation of the system, and the second time within one year. Results: For the comparison study between both systems used, 141 preparations in total, corresponding to individualized PN, were analyzed: 47 elaborated by means of the gravimetric system (GS), 47 with the ASVC during the implementation period (PN ASVC period 1), 7 PN elaborated with the ASVC within one year of implementation (PN ASVC period 2).The average variation between real weight and predicted weight at the three periods (pre-ASVC, NP ASVC period 1, NP ASVC period 2) was 2.41%, 1.35% and 1.25% respectively (table I). This decrease was statistically significant (p = 0.014). When analyzing the percentage of preparations out of the 3% variation range, we observed a significant reduction (p = 0.00001) by comparing he three periods (Table II). The average elaboration time with the ASVC increased approximately in 4 minutes by bag (3 min 58 sec) during the first studied period, and 3 min 10 sec during the second period, as compared with the study period with the GS. Conclusions: The new bag-filling system by means of volumetric control represents an improvement in accuracy control and a decrease in the risk for surpassing the acceptable limits.The implementation of a new technological procedure is a difficult task that implies the change of many aspects of the daily practice and that requires a "cultural" change in the PN Unit with the aim of optimizing the process.However, these issues allow for an adaptation to legal requisites in force regarding the regulations of proper elaboration and quality control of formulations as well as an improvement in the integral quality of care (AU)

Evaluación nutricional de una población universitaria / Nutritional assessment of a university population

En este trabajo se ha planteado realizar la evaluación nutricional de un grupo de 50 alumnos de la universidad de Granada, a los que se les han realizado cuestionarios de recuerdo de 24 horas y de frecuencia de consumo de alimentos, durante un período de treinta días. Al objeto de conocer la ingesta de macro y micronutrientes, los resultados se han analizado por medio del programa Dietsource. Paralelamente, se les han realizado también medidas antropométricas para comprobar la posible variación de las mismas durante el período de estudio. Se ha podido observar un consumo proteico ligeramente superior a las ingestas recomendadas, al igual que ocurre con los lípidos. El grupo estudiado valora positivamente los menús con un elevado contenido en carne mientras que se observan deficiencias en el consumo de frutas y verduras. Asimismo, se observa una variación de las medidas antropométricas de dichos individuos durante el tiempo de estudio. También hay que destacar la deficiencia de algunos micronutrientes tales como hierro, zinc, calcio, yodo, cobre, selenio, vitamina E y ácido fólico para toda la población de estudio. Sin embargo, los valores de vitamina C y tiamina en ambos grupos y de riboflavina en mujeres se pueden considerar adecuados. A la vista de los resultados se pone de manifiesto que existen desequilibrios en la alimentación de este grupo de población, ya que se han observado deficiencias en el consumo de micronutrientes importantes para el mantenimiento y promoción de la salud, así como un consumo de macronutrientes que se aleja de las recomendaciones establecidas (AU)

In this work, we have planned to perform a nutritional assessment of a group of 50 students from the University of Granada, to which questionnaires have been administered relating to 24-hour remembrance of type and frequency of food consumption, for 30 days. In order to know macro- and micronutrients intake, the results have been analyzed with DietSource software. At the same time, anthropometrical measurements have been taken to verify their possible change during the study period. We have been able to observe a protein intake slightly higher than the recommended intake, similarly to what occurs with lipids. The studied group positively values menus with high content in meat, whereas deficiencies in fruit and vegetable intake are observed. In addition, there is a variation of anthropometrical measurements of these individuals during the study period. We also noticed a deficiency in some micronutrients such as iron, zinc, calcium, iodine, cupper, selenium, vitamin E, and folic acid in all the studied population. However, vitamin C and thiamine levels in both groups and riboflavin levels in women may be considered adequate. From these results, we may highlight a nutrition unbalance in this population group since we have observed some deficiencies in the intake of important micronutrients for health maintenance and promotion, and macronutrient consumption that diverges from the established recommendations (AU)