Primary care services in the UHC: Cost identification study

Background@#In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. @*Objective@#The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector.@*Method@#This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility.@*Results@#The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. @*Conclusion@#Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.

X-ray Photoelectron Spectroscopic Study of Some Organic and Inorganic Modified Clay Minerals.

Layered clay systems intercalated with inorganic and organic compounds were analyzed to highlight how XPS can provide information on the different environments surrounding a particular atom as well as provide discernments on the size, coordination, and structural and oxidative transformations of the intercalating/pillaring compounds. XPS data on the intercalation of urea and K-acetate in low- and high-defect kaolinite revealed the interaction of the intercalating group NH2 with the siloxane functional groups in the interlayer surface. The intercalation of HDTMA in Mt demonstrated the use of XPS in monitoring the change in conformation assumed by alkylammonium intercalating compounds in Mt with increasing CEC. Studies on the pillaring of Mt by Al13 and Ga13 by XPS allowed determination of the coordination of the pillaring compound within the Mt layer. Lastly, the intercalation of hexacyanoferrate in hydrotalcite demonstrated the capability of XPS in following changes in the oxidation state of the iron compound. These were gleaned from interpretation of the shifts in binding energies and presence of multiplet splitting in the XPS of the component elements of the minerals or the intercalating compounds.

Clinical pathway for the diagnosis and management of patients with COVID-19 in family practice

Background@#Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, causing a pandemic. The Philippines ranks 3rd in Southeast Asia with more than 15,000 confirmed cases, and a case fatality rate of 6.01%, close to the global average of 6.33%.@*Objective@#This clinical pathway was developed to guide family and community physicians on the diagnosis and initial management of COVID-19 in terms of 1) clinical history and physical examination; 2) laboratory and ancillary procedures to be requested; 3) pharmacologic interventions; 4) non-pharmacologic interventions, and 5) patient outcomes to expect.@*Method@#The PAFP Clinical Pathways Group reviewed the published medical literature to identify, summarize, and operationalize the evidence in clinical publication on the management of patients with COVID-19 in family and community practice.@*Recommendations@#The recommendations are time-bound tasks on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions. The recommendations are presented as a table and algorithm.@*Implementation@#At the clinic level, self-audit using the recommendations of this clinical pathway as the standard may be done. At the organizational level, the PAFP should establish a new model of quality improvement initiative where self-practice audits are included as part of the program.

Urea-Assisted Synthesis and Characterization of Saponite with Different Octahedral (Mg, Zn, Ni, Co) and Tetrahedral Metals (Al, Ga, B), a Review.

Clay minerals surfaces potentially play a role in prebiotic synthesis through adsorption of organic monomers that give rise to highly concentrated systems; facilitate condensation and polymerization reactions, protection of early biomolecules from hydrolysis and photolysis, and surface-templating for specific adsorption and synthesis of organic molecules. This review presents processes of clay formation using saponite as a model clay mineral, since it has been shown to catalyze organic reactions, is easy to synthesize in large and pure form, and has tunable properties. In particular, a method involving urea is presented as a reasonable analog of natural processes. The method involves a two-step process: (1) formation of the precursor aluminosilicate gel and (2) hydrolysis of a divalent metal (Mg, Ni, Co, and Zn) by the slow release of ammonia from urea decomposition. The aluminosilicate gels in the first step forms a 4-fold-coordinated Al3+ similar to what is found in nature such as in volcanic glass. The use of urea, a compound figuring in many prebiotic model reactions, circumvents the formation of undesirable brucite, Mg(OH)2, in the final product, by slowly releasing ammonia thereby controlling the hydrolysis of magnesium. In addition, the substitution of B and Ga for Si and Al in saponite is also described. The saponite products from this urea-assisted synthesis were tested as catalysts for several organic reactions, including Friedel-Crafts alkylation, cracking, and isomerization reactions.

Características epidemiológicas de los pacientes fallecidos en los servicios de urgencias hospitalarios del sistema aragonés de salud y su relación con el índice de comorbilidad / Deaths in hospital emergency departments in Aragon: patient characteristics and association with comorbidity

OBJETIVO: Conocer las características clínico/epidemiológicas de los pacientes fallecidos en los servicios de urgencias (SU) de Aragón (España) y su relación con el índice de comorbilidad de Charlson. MÉTODO: Estudio observacional descriptivo y transversal realizado con datos recogidos entre los años 2013-2017. Las variables se obtuvieron de la base de datos "Puesto clínico hospitalario" (PCH) y estas se relacionaron con el índice de comorbilidad de Charlson mediante el estadístico ji cuadrado (ajustado a un nivel de significación de p < 0,05). RESULTADOS: Se obtuvo un valor medio de 6,58 en el índice de Charlson, con un total de 1.177 pacientes con valores mayores o igual a 7 puntos. La edad media fue de 81,1 años (DE: 12,1), con un 52,1% de hombres. El tiempo medio de fallecimiento en el servicio fue de 639 (DE: 777) minutos. Se encontró una relación estadísticamente significativa entre la variable Índice de Charlson con la mayoría de variables de estudio, exceptuando el sexo y año de fallecimiento. CONCLUSIONES: Los pacientes fallecidos en los SU de Aragón poseen elevados índices de comorbilidad. Entre estos se observa un grupo importante de pacientes con una elevada edad, alta frecuencia de patología crónica avanzada y polifarmacia. Se resalta la necesidad de incorporar estrategias de atención crónica y paliativa en los SU para este gru¬po cada vez más numeroso de pacientes por el progresivo envejecimiento poblacional

OBJECTIVE: To describe the clinical and personal characteristics of patients who died in hospital emergency departments in Aragon, Spain, and explore associations with the Charlson Comorbidity Index (CCI). METHODS: Descriptive, observational, cross-sectional study of deaths between 2013 and 2017. Data was extracted from the clinical database for hospital emergencies (official name, Puesto Clínico Hospitalario). Associations between variables and the CCI were explored with the χ2 test (significance level P<.05). RESULTS: The mean CCI was 6.58. A total of 1177 patients had CCIs of 7 or higher. The mean age was 81.1 years, and 52.1% were men. The mean (SD) time until death in the emergency department was 639 (777) minutes. The CCI was significantly associated with most clinical and personal variables studied, with the exception of sex and year. CONCLUSIONS: Patients who die in Aragon's emergency departments have high levels of comorbidity. A large proportion of patients are of advanced age. Polypharmacy and advanced chronic conditions are common. We stress the need to implement emergency department approaches to ongoing and palliative care for this group, which is growing as the population ages

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes.

The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

Community-oriented health care during a COVID-19 epidemic: A consensus statement by the PAFP task force on COVID-19

Initial Planning@#Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions.@*Adjustment in the Community Organization and Environment@#Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings@*Performance of Routine Tasks and Activities@#Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19@*What to Do When a Member or Household is Exposed or Diagnosed COVID-19@#Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days@*Epidemiology and Surveillance@#Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices

Family-focused home care plan during a COVID 19 epidemic: A consensus statement by the PAFP task force on COVID 19

Initial Planning@#Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic@*Adjustment in the Family Structure and Home Environment@#Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home@*Performance of Routine Tasks and Activities @#Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol@*What to Do When a Member is Exposed@#Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice

Nanoscale Structure, Dynamics, and Aging Behavior of Metallic Glass Thin Films.

Scanning tunnelling microscopy observations resolve the structure and dynamics of metallic glass Cu100-xHfx films and demonstrate scanning tunnelling microscopy control of aging at a metallic glass surface. Surface clusters exhibit heterogeneous hopping dynamics. Low Hf concentration films feature an aged surface of larger, slower clusters. Argon ion-sputtering destroys the aged configuration, yielding a surface in constant fluctuation. Scanning tunnelling microscopy can locally restore the relaxed state, allowing for nanoscale lithographic definition of aged sections.

Spectroscopic and Structural Studies of a Surface Active Porphyrin in Solution and in Langmuir-Blodgett Films.

Controlling aggregation of the dual sensitizer-emitter (S-E) zinc tetraphenylporphyrin (ZnTPP) is an important consideration in solid state noncoherent photon upconversion (NCPU) applications. The Langmuir-Blodgett (LB) technique is a facile means of preparing ordered assemblies in thin films to study distance-dependent energy transfer processes in S-E systems and was used in this report to control the aggregation of a functionalized ZnTPP on solid substrates. This was achieved by synthetic addition of a short polar tail to one of the pendant phenyl rings in ZnTPP in order to make it surface active. The surface active ZnTPP derivative formed rigid films at the air-water interface and exhibited mean molecular areas consistent with approximately vertically oriented molecules under appropriate film compression. A red shift in the UV-vis spectra as well as unquenched fluorescence emission of the LB films indicated formation of well-ordered aggregates. However, NCPU, present in the solution phase, was not observed in the LB films, suggesting that NCPU from ZnTPP as a dual S-E required not just a controlled aggregation but a specific orientation of the molecules with respect to each other.

Experiencias de donación de leche humana en Andalucía-España: un estudio cualitativo / Experiences of human milk donation in Andalucía-Spain: a qualitative study

Introducción: Los beneficios de la lactancia materna para los bebés han sido bien documentados. Recoger el exceso de leche humana de madres lactantes es un servicio social importante. Los bancos dependen de las donaciones de madres lactantes, por ello la importancia de conocer los aspectos subjetivos que interfieren en la donación. Objetivo: Conocer las vivencias, creencias, motivaciones y dificultades respecto la donación de leche de un grupo de mujeres donantes en el Banco de Leche Humano de Granada-Andalucia. Métodos: Estudio descriptivo, con abordaje cualitativo, realizado en el período de mayo y junio de 2013. La muestra estuvo constituida por 7 mujeres que donaron leche en el banco de leche humana del Hospital Virgen de las Nieves de Granada. Para la recogida de datos se utilizaron entrevistas semi-estructuradas. Resultados: Las informantes tenían en su mayoría más de treinta años, con nivel universitario, casadas y con uno o dos hijos como máximo. De los discursos de las madres emergieron las siguientes categorías: Decisión de hacerse donante; Motivaciones donación; Apoyo donación y Dificultades donación. Conclusión: Como se evidencia, el banco de leche es todavía poco conocido. Todavía existen pocos bancos de leche en España, intentar ampliar esa red sería fundamental para cientos de prematuros que necesitan de esa leche (AU)

Introduction: The benefits of feeding human milk to infants have been well-documented. Collecting excess human milk from lactating mothers is an important social service. The Human Milk Banks depend on donors, and knowing the subjective aspects of donors seems quite important. Objective: Compiling the experiences, beliefs, motivations and difficulties concerning milk donation in a group of donors belonging to the Human Milk Bank of Granada- Andalucia. Methods: A descriptive qualitative study was conducted from May to June of 2013. The sample consisted of 7 women who donated milk to the Human Milk Bank located in the Virgen de las Nieves hospital of Granada. Data was collected using a semi-structured interview. Results: Most of the interviewees were over thirty years olºd, had completed or were in the process of completing university, married, and had one or two children. During the interview, the following subjects were discussed with the mothers: Decision of becoming a donor, support to the donor, motivation for donating, and difficulties donating. Conclusion: The results of our study suggest that many mothers are still not aware that there are milk banks present in their location. Expanding the number of milk banks in Spain is essential for hundreds of premature babies who are in need of this necessary resource (AU)

Propene epoxidation with O2 or H2-O2 mixtures over silver catalysts: theoretical insights into the role of the particle size.

The adsorption and dissociation of molecular O2 over silver extended surfaces, nanoparticles and clusters of different size, as well as the reaction between adsorbed O2 and H2 to form less nucleophilic hydroperoxide groups have been investigated by means of periodic DFT calculations. Hydroperoxide formation from O2 and H2 is in all systems kinetically favoured over O2 dissociation, which becomes energetically forbidden on small planar clusters. The nature and reactivity towards propene of all oxygen species present on silver, including adsorbed molecular O2, atomic O, and hydroperoxide groups, have been theoretically explored. Formation of the oxametallacycle intermediate involved in propene epoxidation is energetically accessible on subnanometric three-dimensional silver nanoparticles, but competitive pathways leading to hydrogen abstraction and allyl formation always involve lower activation barriers. Theoretical findings have been experimentally confirmed by Raman spectroscopy of O2 adsorption and catalytic testing of planar and three dimensional silver clusters.

Photophysics and halide quenching of a cationic metalloporphyrin in water.

In this work, the steady state S0-S1 and S0-S2 absorption and emission behaviour of the water-soluble tetrakis(N-methyl-4-pyridyl)porphyrin zinc(ii) tetrachloride (ZnTMPyP) in media of constant and high ionic strength, both with and without iodide ions as a fluorescence quencher, was measured. The quenching of the ZnTMPyP S1 state by iodide ions proceeds primarily through diffusion-limited interaction in an encounter pair but the formation of a loose association between the ZnTMPyP S1 state and iodide ions also provides a minor quenching pathway. The ZnTMPyP S2 state was quenched minimally by iodide, likely through an electron transfer mechanism at an average donor-acceptor distance of ~0.7 nm. The results presented here highlight the notion that significant iodide quenching of the ZnTMPyP S1 state can be a source of inefficiencies in porphyrin-based dye-sensitized solar cells. The minimal quenching of the S2 state indicates that no significant loss of efficiency will be introduced by using iodide as component of the electrolyte system in upconversion by triplet-triplet annihilation (UC-TTA) enhanced solar cells.

Efectos de un programa de formacion en cuidados paliativos sobre el afrontamiento de la muerte / The effects of a training program on coping with death in palliative care

Objetivos: Evaluar el efecto de un programa de formación en cuidados paliativos dirigido a estudiantes de ciencias de la salud, usando la escala de Bugen de afrontamiento de la muerte. Método: Estudio cuasi-experimental. Se desarrolló un programa de formación dirigido a futuros profesionales de la salud (enfermería, medicina, psicología, terapia ocupacional y fisioterapia)que participaron voluntariamente y cuyo único criterio de selección es que no hubiesen tenido formación previa en cuidados paliativos. La duración del curso fue de 45 horas, distribuidas en15 semanas, desde octubre de 2008 a febrero de 2009. Iniciaron el programa 90 participantes, de los cuales tres abandonaron la formación, finalizando 87. Al inicio y al final del mismo se administró la «escala de Bugen de afrontamiento de la muerte» a los 87 participantes para determinar su grado de afrontamiento de la muerte en cada uno de los momentos. Resultados: De los 87 participantes un 74% son mujeres y el resto hombres. La edad media es de 21,35 años. La mayoría de los participantes son de enfermería (64%), seguidos de terapia ocupacional (23,6%), psicología (5,6%), por último medicina y fisioterapia (2,2%). Se encontraron diferencias significativas respecto al afrontamiento de la muerte tras el programa formativo(p = 0,000). Antes del mismo la media era de 121,46 ± 19,7 y tras el curso la media fue de (..) (AU)

Objective: To evaluate a training program in palliative care for Health Science students using Bugen’s Coping with Death Scale. Method: Quasi-experimental research. A training program was designed for future health professionals (nursing, medicine, psychology, occupational therapy and physiotherapy). Students’ participation was voluntary. The sole selection criterion was not having previous training in palliative care. The course duration was 45 hours over 15 weeks from October 2008 to February2009. A total of 90 participants started the program, and 87 completed it (three stopped attending). Bugen’s Coping with Death Scale was filled in by all participants both at the beginning and at the end of the program in order to establish their coping skills before and after the program. Results: Of the 87 participants, 74% were female, with the rest being male. The mean age was21.35 years. Most participants were nurses (64%), followed by occupational therapy (23.6%),psychology (5.6%), and finally medicine and physiotherapy (2.2%). A clear difference could be observed in coping skills before and after the program (p=.000). Before the training program the average score was 121.46 ± 19.7, while after the course it was 158.16 ± 20.6. The Scale’s minimum score is 30, the maximum being 210. Values below 105 (percentile 50) indicate inadequate (..) (AU)

Vivencias y experiencias de duelo en madres tras un proceso de enfermedad oncológica de sus hijos / Grieving experiences in mothers after the death of a child due to cancer

Objetivo: Conocer las vivencias y experiencias de duelo en madres que sufrieron la pérdida de sus hijos tras un proceso de enfermedad oncológica. Método: Estudio descriptivo cualitativo, de corte fenomenológico. Las madres fueron seleccionadas de entre las que habían sido atendidas en la Delegación de Granada de la AECC. Los criterios de inclusión fueron el tiempo desde el fallecimiento del hijo (entre uno y tres años) y la aceptación a participar en el estudio. Para la recogida de datos se utilizó la entrevista semiestructurada, a partir de un guión de preguntas elaborado «ad hoc». El análisis se hizo en base a la propuesta de Taylor y Bogdan: descubrimiento de temas, codificación e interpretación. Resultados: Cuatro madres accedieron a participar en el estudio. De acuerdo a las categorías de análisis, encontramos: Proceso clínico: El retraso en la identificación del proceso de fin devida de sus hijos lleva a las madres a mantener una constante actitud de lucha contra la enfermedad de sus hijos y a la activación de un mecanismo de «negación» como afrontamiento de la situación. Fallecimiento: Agradecen el haber estado presentes durante los últimos momentos (..) (AU)

Aim: To determine the experiences of grieving in mothers who suffered the loss of their child after a cancer disease process. Method: This is a descriptive and a qualitative research with a phenomenological approach. The mothers were selected among those who were treated in a cancer control unit in Granada. The selection criteria for including them were: the time elapsed since the death of their child(one to three years) and the acceptance in participating in this research. In order to collect data, we used a semi-structured interview based on a number of questions ‘‘ad hoc’’. The analysis was based on the Tylor and Bogdan method: discovery of topics, codification and interpretation. Results: Four mothers agreed to participate in the research. According to the analysis category we can find: Clinical process: the delay in identifying the end of life process of children leads mothers to maintain an attitude of struggling against the disease, and the activation of a ‘‘denial’’ mechanism to cope with the situation. Death: They appreciate the fact of being (..) (AU)

Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica / Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology

Antecedentes: Tras la finalización y análisis de resultados del estudio CIVIC, la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC) plantea la necesidad de revisar sus recomendaciones para la prevención del VRS en niños con cardiopatías congénitas. Para considerar tanto la valoración de las nuevas evidencias disponibles como la experiencia preventiva acumulada por los cardiólogos infantiles, se propone efectuar dicha actualización mediante un método estructurado de consenso profesional. Objetivos: Desarrollar un consenso clínico español sobre la prevención de la infección por virus respiratorio sincitial, bajo el auspicio de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Métodos: Consenso Delphi modificado en 2 rondas. El estudio se efectuó en 4 fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con 75 representantes de la especialidad; 3) encuesta postal en 2 rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Cincuenta y cinco expertos consultados completaron las 2 rondas de evaluación del cuestionario. En la primera ronda se lograron consensuar 44 de las 70 cuestiones analizadas. Tras la interacción del panel, se aumentó el consenso hasta un total de 54 ítems de la encuesta (el 77% de los contenidos propuestos). En las 16 cuestiones restantes no se consiguió un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones: Se presenta y actualiza una lista de recomendaciones profilácticas frente al virus respiratorio sincitial, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. Objectives: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Methods: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Results: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Conclusions: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review (AU)

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.]. / Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica.

BACKGROUND: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. OBJECTIVES: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. METHODS: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. RESULTS: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. CONCLUSIONS: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review.

Inotropic activity of hydroindene amidinohydrazones.

Several hydroindenic derivatives (7a-methyl-2,3,5,6,7,7a-hexahydro-1H-indenes), bearing an amidinohydrazone at C-5 and different moieties at C-1, have been synthesized and evaluated for their inotropic and chronotropic effects on right- and left-guinea-pig-atria activity. Three of them showed the same profile as digoxin, although with lower potency. The effect on Na(+),K(+)-ATPase (NKA) was also evaluated for these three compounds, observing that two of them, with the same absolute configuration as natural cardenolides, are also NKA inhibitors, while the compound with the opposite configuration lacks such an effect. More interestingly, both active compounds act without affecting the cardiac rhythm. This could be related to the selective inhibition of the human alpha2beta1 isozyme (associated with the inotropic effect) with respect to the alpha1beta1 isozyme (associated with the maintenance of basal ionic levels in the cell and the toxic effect of cardenolides).

[Risk factors in the Glenn bidirectional shunt as an intermediate procedure before Fontan correction]. / Factores de riesgo en el shunt de Glenn bidireccional como proceder intermedio antes de la corrección de Fontan.

OBJECTIVE: The bidirectional Glenn shunt is the most common palliation before the Fontan repair, especially in high-risk patients. We studied the influence of certain risk factors in bidirectional Glenn results, with and without an additional source of pulmonary blood flow. METHODS: Between 1993 and 1998 twenty patients (6-53 months of age) underwent a bidirectional Glenn shunt as the intermediate repair for the Fontan procedure. Diagnoses were: 7 cases of double inlet single ventricle, 4 of tricuspid atresia, 3 of unbalanced AV septal defect, 4 of mitral atresia, 1 hypoplastic left heart syndrome and 1 TGA with hypoplasia of the right ventricle. 17 patients had undergone previous operations. Mean preoperative arterial oxygen saturation was 78.5%. In 6 patients an auxiliary source of pulmonary blood flow was added. RESULTS: Hospital mortality was 15%. In 4 patients the bidirectional Glenn failed. By univariate analysis low weight, preoperative functional status and high pulmonary pressure were factors associated with early death. In bidirectional Glenn failure only the duration of ventilatory support was significant. By multivariate analysis, preoperative functional status and pulmonary pressure were significant. Mean postoperative arterial oxygen saturation at a mean follow-up of 10 months was 84%. CONCLUSIONS: Bidirectional Glenn shunt is an effective and low-risk palliation for patients with univentricular hearts. Only low weight and high pulmonary pressure were significant in hospital mortality, and we advise the association of an additional source of pulmonary blood flow in these patients at the start. Early extubation provides correct performance of the shunt.