Pharmacist care in hospital emergency departments: a consensus paper from the Spanish hospital pharmacy and emergency medicine associations. / Atención farmacéutica en los servicios de urgencias: documento de posicionamiento de la Sociedad Española de Farmacia Hospitalaria (SEFH) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES).

OBJECTIVES: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. MATERIAL AND METHODS: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. RESULTS: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. CONCLUSION: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.

OBJETIVO: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarios mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. METODO: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. RESULTADOS: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. CONCLUSIONES: El desarrollo del conjunto de actividades e indicadores de atención farmacéutica en urgencias, priorizados por grado de relevancia para la unidad, es la base para el desarrollo de esta cartera de servicios en los hospitales españoles, y sirve como guía tanto para farmacéuticos como para gestores, médicos y enfermeros de la unidad a fin de mejorar la farmacoterapia los pacientes atendidos en los servicios de urgencias.

Integrating terrestrial and aquatic ecosystems to constrain estimates of land-atmosphere carbon exchange.

In this Perspective, we put forward an integrative framework to improve estimates of land-atmosphere carbon exchange based on the accumulation of carbon in the landscape as constrained by its lateral export through rivers. The framework uses the watershed as the fundamental spatial unit and integrates all terrestrial and aquatic ecosystems as well as their hydrologic carbon exchanges. Application of the framework should help bridge the existing gap between land and atmosphere-based approaches and offers a platform to increase communication and synergy among the terrestrial, aquatic, and atmospheric research communities that is paramount to advance landscape carbon budget assessments.

The impact of Body Mass Index on functional rehabilitation outcomes of working-age inpatients with stroke.

BACKGROUND: Stroke is the most relevant cause of acquired persistent disability in adulthood. The relationship between patient's weight during rehabilitation and stroke functional outcome is controversial, previous research reported positive, negative and no effects, with scarce studies specifically addressing working-age patients. AIM: To evaluate the association between Body Mass Index (BMI) and the functional progress of adult (<65 years) patients with stroke admitted to a rehabilitation hospital. DESIGN: Retrospective observational cohort study. SETTING: Inpatient rehabilitation center. POPULATION: 178 stroke patients (ischemic or hemorrhagic). METHODS: Point-biserial and Spearman's correlations, multivariate linear regressions and analysis of covariance were used to describe differences in functional outcomes after adjusting for age, sex, severity, dysphagia, depression and BMI category. Functional Independence Measure (FIM), FIM gain, efficiency and effectiveness were assessed. RESULTS: Participants were separated in 3 BMI categories: normal weight (47%), overweight (33%) and obese (20%). There were no significant differences between BMI categories in any functional outcome (total FIM [T-FIM], cognitive [C-FIM]), motor [M-FIM]) at discharge, admission, gain, efficiency or effectiveness. In regression models BMI (as continuous variable) was not significant predictor of T-FIM at discharge after adjusting for age, sex, severity, dysphagia, depression and ataxia (R2=0.4813), significant predictors were T-FIM at admission (ß=0.528) and NIHSS (ß=-0.208). M-FIM efficiency did not significantly differ by BMI subgroups, neither did C-FIM efficiency. Length of stay (LOS) and T-FIM effectiveness were associated for normal (r=0.33) and overweight (r=0.43), but not for obese. LOS and T-FIM efficiency were strongly negatively associated only for obese (r=-0.50). CONCLUSIONS: FIM outcomes were not associated to BMI, nevertheless each BMI category when individually considered (normal weight, overweight or obese) was characterized by different associations involving FIM outcomes and clinical factors. CLINICAL REHABILITATION IMPACT: In subacute post-stroke working-age patients undergoing rehabilitation, BMI was not associated to FIM outcomes (no obesity paradox was reported in this sample). Distinctive significant associations emerged within each BMI category, (supporting their characterization) such as length of stay and T-FIM effectiveness were associated for normal weight and overweight, but not for obese. Length of stay and T-FIM efficiency were strongly negatively associated only for obese.

Magnitude and drivers of integrated fluvial network greenhouse gas emissions across the boreal landscape in Québec.

Streams and rivers are now recognized to be sites of intense carbon (C) emissions, yet the lack of C emission estimates that integrate beyond individual river systems has slowed their inclusion in landscape C budgets. Here we apply empirical models of CO2 and CH4 concentrations and gas exchange continuously along entire fluvial networks to derive the total fluvial CO2 and CH4 emissions in large (3000 to 30,000 km2) watersheds located across the boreal biome of Québec (Canada). We assess how total fluvial network C emissions vary with landscape and climate properties, and compare their magnitude to other components of the landscape C budget. The total fluvial network emissions expressed as per unit watershed area ranged from 0.7 to 29.2 g C m-2 yr-1 for CO2, and 4-1780 mg C m-2 yr-1 for CH4, and neither was related to watershed area or drainage density. Rather, watershed slope and terrestrial net productivity were major drivers of the integrated network fluvial emissions. We also show that steeper watersheds had a greater proportion of emissions relative to downstream export of C from the watershed. Integrated fluvial emissions are of the same magnitude as the terrestrial C sink, yet these two fundamental components of the boreal landscape C budget are not tightly coupled.

The interplay between total mercury, methylmercury and dissolved organic matter in fluvial systems: A latitudinal study across Europe.

Large-scale studies are needed to identify the drivers of total mercury (THg) and monomethyl-mercury (MeHg) concentrations in aquatic ecosystems. Studies attempting to link dissolved organic matter (DOM) to levels of THg or MeHg are few and geographically constrained. Additionally, stream and river systems have been understudied as compared to lakes. Hence, the aim of this study was to examine the influence of DOM concentration and composition, morphological descriptors, land uses and water chemistry on THg and MeHg concentrations and the percentage of THg as MeHg (%MeHg) in 29 streams across Europe spanning from 41°N to 64 °N. THg concentrations (0.06-2.78 ng L-1) were highest in streams characterized by DOM with a high terrestrial soil signature and low nutrient content. MeHg concentrations (7.8-159 pg L-1) varied non-systematically across systems. Relationships between DOM bulk characteristics and THg and MeHg suggest that while soil derived DOM inputs control THg concentrations, autochthonous DOM (aquatically produced) and the availability of electron acceptors for Hg methylating microorganisms (e.g. sulfate) drive %MeHg and potentially MeHg concentration. Overall, these results highlight the large spatial variability in THg and MeHg concentrations at the European scale, and underscore the importance of DOM composition on mercury cycling in fluvial systems.

Expert consensus on the use of liraglutide in the treatment of diabetes in internal medicine.

BACKGROUND: Type 2 diabetes mellitus (DM2) is a disease of epidemic proportions. In the adult Spanish population, prevalence of DM2 is nearly 14%, which makes its monitoring and treatment imperative. Liraglutide has achieved relevance due to its efficacy and safety in DM treatment. The aim of this study is to gather expert opinion on diabetes to assess the current role of liraglutide in DM2. MATERIALS/METHODS: The survey was performed by 57 internal medicine specialists using the Delphi method. The questionnaire had 56 items regarding liraglutide in DM treatment. RESULTS: Consensus was reached in 71.4% of items. Panelists stated agreement regarding liraglutide suitability in the treatment of patients with DM2, high cardiovascular risk, and with pathologies related to obesity, highlighting its role in weight loss, low risk of hypoglycemia, and improvement of vascular risks. Moreover, consensus was not reached regarding the suitability of liraglutide in patients with special situations, mainly due to minimal experience caused by the small number of patients. CONCLUSIONS: Due to its safety and hypoglycemic efficacy, liraglutide is an excellent choice for DM treatment in combination with other drugs. Its effects on the reduction of weight and other cardiovascular risk factors, make it an optimal treatment, especially in overweight or obese patients.

Sediment size distribution and composition in a reservoir affected by severe water level fluctuations.

The reservoir sediments are important sinks for organic carbon (OC), the OC burial being dependent on two opposite processes, deposition and mineralization. Hence factors such as severe water level fluctuations are expected to influence the rate of OC accumulation as they may affect both deposition and mineralization. The Barasona Reservoir has been historically threatened by siltation, whilst the use of water for irrigation involves a drastic decrease of the water level. In this context, we have studied the physical and chemical characteristics (grain size, major and minor elemental compositions, organic and inorganic carbon, and nitrogen) of the recent sediments of the Barasona Reservoir and the relationships among them in order to: a) elucidate the main processes governing OC accumulation, b) evaluate the rate of OC mineralization and c) approach the effect of drought on the sediment characteristics in this system. Our results indicated that Barasona sediments were dominated by fine silts (>60%) and clays (>20%), the mean particle size decreasing from tail to dam. Desiccation increased particle sorting and size distribution became bimodal, but no effect on average size was observed. Attending to the composition, Barasona sediments were very homogeneous with low concentrations of nitrogen (TN) and phosphorus (<1.2 g kg(-1) dw and <0.6 g kg(-1) dw, respectively) and high concentration of OC (≈36 g kg(-1) dw). TN was negatively related to dry weight. Sediment mixing due to drastic changes in water level may have favoured the observed homogeneity of Barasona sediments affecting carbon, major ions and grain size. The high amount of OC deposited in Barasona sediment suggested that the adsorption of OC onto fine particles was more important than in boreal lakes. The rate of oxygen consumption by wet sediment ranged from 2.26 to 3.15 mg O2 m(-2) day(-1), values close to those compiled for Mediterranean running waters.

Estatinas y autoinmunidad / Statins and autoimmunity

Las estatinas son los fármacos más utilizados en la prevención tanto primaria como secundaria de enfermedades cardiovasculares y asociadas a aterosclerosis. Alrededor de 25 millones de personas están en tratamiento con estatinas en el mundo. A pesar de que son bien toleradas por la mayoría de los pacientes y de tener un perfil muy seguro, algunos pacientes presentan alteraciones, especialmente a nivel muscular. Los efectos biológicos asociados a estos fármacos son conocidos como pleiotrópicos; son de tal interés y diversidad que explican, en parte, algunas de las acciones de las estatinas, especialmente en relación con la inflamación y el sistema inmunitario. Algunos pacientes presentan ciertas alteraciones inmunológicas que puede transformarse luego en expresión clínica no deseable. Estudios recientes han mostrado que pueden desencadenar fenómenos autoinmunitarios. Han sido descritas enfermedades en las que actúan como desencadenantes, como la miopatía necrosante inmunomediada, o indirectamente en dermatomiositis o hepatitis autoinmunitaria, entre otras. Es así por lo que dado el elevado número de personas en tratamiento con estatinas, creemos que se trata de un problema clínicamente relevante y, por tanto, merecedor de estudio (AU)

Statins are the most widely used drugs for both primary and secondary prevention of cardiovascular diseases and those associated with atherosclerosis. About 25 million people are on statin therapy in the world. Although they are well tolerated by most patients and have a safety profile, some patients have muscle level alterations. The biological effects associated with these drugs are known as pleiotropic; they are of such interest and diversity that explains, in part, some of the actions of statins, especially in relation to inflammation and the immune system. Some patients have certain immune disorders that can turn into an undesirable clinical expression. Recent studies have shown that they can trigger autoimmune phenomena. Pathologies have been described in which these agents act as triggers such as immune-mediated necrotizing myopathy or indirectly in dermatomyositis or autoimmune hepatitis, among others. Given the high number of people being treated with statins, we believe that this is a clinically relevant problem and therefore worthy of study (AU)

[Statins and autoimmunity]. / Estatinas y autoinmunidad.

Statins are the most widely used drugs for both primary and secondary prevention of cardiovascular diseases and those associated with atherosclerosis. About 25 million people are on statin therapy in the world. Although they are well tolerated by most patients and have a safety profile, some patients have muscle level alterations. The biological effects associated with these drugs are known as pleiotropic; they are of such interest and diversity that explains, in part, some of the actions of statins, especially in relation to inflammation and the immune system. Some patients have certain immune disorders that can turn into an undesirable clinical expression. Recent studies have shown that they can trigger autoimmune phenomena. Pathologies have been described in which these agents act as triggers such as immune-mediated necrotizing myopathy or indirectly in dermatomyositis or autoimmune hepatitis, among others. Given the high number of people being treated with statins, we believe that this is a clinically relevant problem and therefore worthy of study.

Effects of water flow regulation on ecosystem functioning in a Mediterranean river network assessed by wood decomposition.

Mediterranean rivers are extensively modified by flow regulation practises along their courses. An important part of the river impoundment in this area is related to the presence of small dams constructed mainly for water abstraction purposes. These projects drastically modified the ecosystem morphology, transforming lotic into lentic reaches and increasing their alternation along the river. Hydro-morphologial differences between these reaches indicate that flow regulation can trigger important changes in the ecosystem functioning. Decomposition of organic matter is an integrative process and this complexity makes it a good indicator of changes in the ecosystem. The aim of this study was to assess the effect caused by flow regulation on ecosystem functioning at the river network scale, using wood decomposition as a functional indicator. We studied the mass loss from wood sticks during three months in different lotic and lentic reaches located along a Mediterranean river basin, in both winter and summer. Additionally, we identified the environmental factors affecting decomposition rates along the river orders. The results revealed differences in decomposition rates between sites in both seasons that were principally related to the differences between stream orders. The rates were mainly related to temperature, nutrient concentrations (NO2(-), NO3(2-)) and water residence time. High-order streams with higher temperature and nutrient concentrations exhibited higher decomposition rates compared with low-order streams. The effect of the flow regulation on the decomposition rates only appeared to be significant in high orders, especially in winter, when the hydrological characteristics of lotic and lentic habitats widely varied. Lotic reaches with lower water residence time exhibited greater decomposition rates compared with lentic reaches probably due to more physical abrasion and differences in the microbial assemblages. Overall, our study revealed that in high orders the reduction of flow caused by flow regulation affects the wood decomposition indicating changes in ecosystem functioning.

Medication list assessment in Spanish hospital emergency departments.

BACKGROUND: Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. OBJECTIVES: This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. METHODS: We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. RESULTS: We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. CONCLUSIONS: The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.

Ultrasound and magnetic resonance angiography features of post-traumatic ulnar artery pseudoaneurysm: a case report and review of the literature.

Ulnar artery pseudoaneurysms are very uncommon. The least common etiological mechanism is a single direct trauma. It is important to identify these lesions, which may have important clinical complications such as distal thrombosis with digital ischemia or gangrene. This report describes the features of sonography and magnetic resonance angiography of a histologically confirmed ulnar artery pseudoaneurysm.

[State of public pneumology in Catalonia (Spain): 1993 versus 2003]. / Estado de la neumología pública en Cataluña: estudio comparativo entre 1993 y 2003.

The aim of this study was to perform a descriptive analysis of the state of public pneumology in Catalonia (Spain) in 2003 and to compare the results with data from 1993. A questionnaire was sent to all hospitals of the public hospitals network in Catalonia requesting information on the number of pulmonologists. To determine the number of pulmonologists working in primary care, we also contacted all the primary care services (PCS) in Catalonia. All the hospitals and PCS contacted responded. Eighty-three percent of the public network hospitals had a pneumology service. From 1993-2003, the proportion of hospitals with this specialty increased. The rate of pulmonologists per 100,000 persons for the whole of Catalonia was 3.15. The degree of implantation of pneumology in the public hospitals network of Catalonia significantly improved in the decade between 1993 and 2003.

Estado de la neumología pública en Cataluña: estudio comparativo entre 1993 y 2003 / State of public pneumology in Catalonia [Spain]: 1993 versus 2003

El objetivo de este estudio era realizar un análisis descriptivo de la situación de la neumología pública en Cataluña en el año 2003 y comparar los resultados con datos de 1993. Se remitió un cuestionario a todos los hospitales de la red pública de Cataluña (XHUP) solicitando información sobre el número de neumólogos. También se contactó con los servicios de atención primaria (SAP) de Cataluña para conocer el número de neumólogos que trabajan en atención primaria. Se ha obtenido respuesta del 100% de los hospitales y SAPcontactados. El 83% de los hospitales de la XHUP disponende servicio de neumología, y se observa un incremento significativo en la proporción de hospitales que disponen de la especialidad respecto a 1993. La tasa de neumólogos por 100.000 habitantes para toda Cataluña es de 3,15.El grado de implantación de la neumología en la XHUP hamejorado significativamente en el decenio 1993-2003

The aim of this study was to perform a descriptive analysis of the state of public pneumology in Catalonia (Spain) in 2003 and to compare the results with data from 1993.A questionnaire was sent to all hospitals of the public hospitals network in Catalonia requesting information on the number of pulmonologists. To determine the number of pulmonologists working in primary care, we also contacted all the primary care services (PCS) in Catalonia.All the hospitals and PCS contacted responded. Eighty-three percent of the public network hospitals had a pneumology service. From 1993-2003, the proportion of hospitals with this specialty increased. The rate of pulmonologists per 100,000 persons for the whole of Catalonia was 3.15.The degree of implantation of pneumology in the public hospitals network of Catalonia significantly improved in the decade between 1993 and 2003

Bakery products enriched with phytosterol esters, alpha-tocopherol and beta-carotene decrease plasma LDL-cholesterol and maintain plasma beta-carotene concentrations in normocholesterolemic men and women.

The hypocholesterolemic effects of phytosterols have not been evaluated in bakery products, and the addition of liposoluble antioxidants to the carrier has never been tested. We investigated the effects of consuming croissants and magdalenas (Spanish muffins) enriched with sterol esters, alpha-tocopherol and beta-carotene on plasma lipid and fat-soluble antioxidant concentrations in normocholesterolemic, habitual consumers of bakery products following their usual diet and lifestyle. Using a randomized, double-blind, placebo-controlled design, the control (C) group (n = 29) received two pieces daily (standard croissant and muffin) and the sterol ester (SE) group (n = 28), the same products with sterol esters added (3.2 g/d) for 8 wk. Total and LDL cholesterol (LDL-C) decreased in the SE group by 0.24 mmol/L (P < 0.01) and 0.26 mmol/L (P < 0.005), respectively, whereas these variables did not change in the control group. The total difference in total and LDL-C changes between groups was 0.38 mmol/L (8.9%) and 0.36 mmol/L (14.7%), respectively (P < 0.001). Within-group changes in HDL cholesterol, triacylglycerol or lipoprotein(a) concentrations did not differ. Similarly, within-group changes over time in plasma tocopherol and carotenoid concentrations did not differ between groups. Our findings suggest that bakery products are excellent carriers for phytosterols, and their consumption is associated with a decrease in total and LDL-C concentrations, with no changes in alpha-tocopherol and beta-carotene. The ability of bakery products to include sufficient quantities of beta-carotene to compensate for a potential deficiency, and the fact that their efficacy was not associated with the time of day at which they were consumed, are interesting findings.

Bases para el desarrollo y aprovechamiento sanitario de la farmacia hospitalaria / Basis for the development and sanitary use of hospital pharmacies

El presente documento contiene las bases estructurales, organizativas y de funcionamiento de las farmacias hospitalarias. Describe las funciones basicas relacionadas con la adquisicion, elaboracion, control,almacenamiento y conservacion de medicamentos; su distribucion y control de sonsumo; educacion sanitaria sobre medicamentos; estudios sobre utilizacion de medicamentos; control de tratamientos; colaboracion en los programas de nutricion y dietetica; participacion en el diseno de protocolos institucionales en los aspectos de tratamiento; participacion en los programas de farmacovigilancia en el hospital; farmacocinetica clinica y aspectos relacionados con la adaptacion y aplicacion de la experiencia de la farmacia hospitalaria a la asistencia primaria.