Implantación de un robot para la elaboración de antineoplásicos / Implementation of a robot for the preparation of antineoplastic drugs in the Pharmacy Service

Objetivo: Describir la implantación de un robot para la elaboración de antineoplásicos en el Servicio de Farmacia y evaluar el valor añadido al proceso farmacoterapéutico. Método: La implantación se llevó a cabo en Junio 2012 en un hospital de tercer nivel, realizándose en dos períodos: 1-Período de pruebas con la instalación del robot, configuración técnica del equipo, validación de 29 principios activos e integración con el software de prescripción electrónica (9 meses); 2-Período de utilización (22 meses). Se impartieron cursos de formación a farmacéuticos y personal de enfermería. Para su funcionamiento el robot emplea reconocimiento fotográfico, identificación por código de barras y controles gravimétricos, que proporcionaron datos de error cometido por preparación, tolerando ±10% y restringiéndolo, tras un estudio piloto, a un intervalo de tolerancia de ±4%. El robot fue programado para reconocer bolsas, infusores, jeringas y viales. El valor añadido se evaluó durante 31 meses con la identificación de los errores de preparación. Resultados: Se realizaron 11.865 preparaciones en el robot, que correspondieron al 40% del global de antineoplásicos elaborados, de 29 principios activos diferentes. Se identificaron y evitaron errores de dosificación en el 1,12% (n=133) de las preparaciones, que no alcanzaron al paciente al ser identificadas por el robot como preparaciones con desviación negativa (-4%) y ser corregidas manualmente. Conclusiones: La implantación de un robot en la elaboración de antineoplásicos permite identificar los errores de elaboración y evitar que lleguen al paciente, promoviendo la seguridad y calidad del proceso farmacoterapéutico de antineoplásicos y reduciendo la exposición del manipulador a los mismos (AU)

Objective: To describe the implementation of a robot for the preparation of antineoplastic drugs in the Pharmacy Service and to be able to analyze the added value to pharmacotherapy. Methods: The implementation was carried out in June 2012 at a tertiary level Hospital, taking place in two periods: 1- test period with the installation of the robot, with technical configuration of the equipment and validation of 29 active ingredients and the integration of electronic prescribing software with the robot application (9 months). 2- Usage period (22 months). On the other hand, training was given to pharmacists and nurses. The robot uses image recognition, barcode identification and gravimetric controls for proper operation. These checks provide information about the error ratio in the preparation, with a margin of ± 10%, which after a pilot study was restricted to a range of ±4%. The robot was programmed to recognize bags, infusion pumps, syringes and vials. The added value was assessed for 31 months by identifying preparation´s errors. Results: 11,865 preparations were made by the robot, which meant approximately 40% of all antineoplastic prepared from 29 different active ingredients. 1.12% (n=133) of the errors were identified by the robot and therefore didn´t reach the patient (negative desviation - 4%). These errors were corrected manually. Conclusion: The implementation of a robot in the preparation of antineoplastic drugs allows to identify errors therefore preventing them to arrive to the patient. This promotes safety and quality of the process, reducing the exposure to cytotoxic drugs from the manipulator (AU)

[Implementation of a robot for the preparation of antineoplastic drugs in the Pharmacy Service]. / Implantación de un robot para la elaboración de antineoplásicos.

OBJECTIVE: To describe the implementation of a robot for the preparation of antineoplastic drugs in the Pharmacy Service and to be able to analyze the added value to pharmacotherapy. METHODS: The implementation was carried out in June 2012 at a tertiary level Hospital, taking place in two periods: 1- test period with the installation of the robot, with technical configuration of the equipment and validation of 29 active ingredients and the integration of electronic prescribing software with the robot application (9 months). 2- Usage period (22 months). On the other hand, training was given to pharmacists and nurses. The robot uses image recognition, barcode identification and gravimetric controls for proper operation. These checks provide information about the error ratio in the preparation, with a margin of ± 10%, which after a pilot study was restricted to a range of ±4%. The robot was programmed to recognize bags, infusion pumps, syringes and vials. The added value was assessed for 31 months by identifying preparation's errors. RESULTS: 11,865 preparations were made by the robot, which meant approximately 40% of all antineoplastic prepared from 29 different active ingredients. 1.12% (n=133) of the errors were identified by the robot and therefore didn't reach the patient (negative desviation - 4%). These errors were corrected manually. CONCLUSION: The implementation of a robot in the preparation of antineoplastic drugs allows to identify errors therefore preventing them to arrive to the patient. This promotes safety and quality of the process, reducing the exposure to cytotoxic drugs from the manipulator.

Objetivo: Describir la implantación de un robot para la elaboración de antineoplásicos en el Servicio de Farmacia y evaluar el valor añadido al proceso farmacoterapéutico. Método: La implantación se llevó a cabo en Junio 2012 en un hospital de tercer nivel, realizándose en dos períodos: 1-Período de pruebas con la instalación del robot, configuración técnica del equipo, validación de 29 principios activos e integración con el software de prescripción electrónica (9 meses); 2-Período de utilización (22 meses). Se impartieron cursos de formación a farmacéuticos y personal de enfermería. Para su funcionamiento el robot emplea reconocimiento fotográfico, identificación por código de barras y controles gravimétricos, que proporcionaron datos de error cometido por preparación, tolerando ±10% y restringiéndolo, tras un estudio piloto, a un intervalo de tolerancia de ±4%. El robot fue programado para reconocer bolsas, infusores, jeringas y viales. El valor añadido se evaluó durante 31 meses con la identificación de los errores de preparación. Resultados: Se realizaron 11.865 preparaciones en el robot, que correspondieron al 40% del global de antineoplásicos elaborados, de 29 principios activos diferentes. Se identificaron y evitaron errores de dosificación en el 1,12% (n=133) de las preparaciones, que no alcanzaron al paciente al ser identificadas por el robot como preparaciones con desviación negativa (-4%) y ser corregidas manualmente. Conclusiones: La implantación de un robot en la elaboración de antineoplásicos permite identificar los errores de elaboración y evitar que lleguen al paciente, promoviendo la seguridad y calidad del proceso farmacoterapéutico de antineoplásicos y reduciendo la exposición del manipulador a los mismos.

The orchestration of processes in relation to the product, and the role of psychological variables in written composition / La orquestación de procesos en relación con el producto, y papel de las variables psicológicas en la composición escrita

We studied the timing of writing processes using a direct retrospective online technique, and differences in the textual product from the earliest school years where such a study is feasible to the final years of compulsory education. We also analysed a range of psychological variables to determine their modulating effect on writing. Participants comprised a highly purified sample of 348 students aged between 9 and 16 years old who presented standard development and average levels of curricular and writing competence. Our results reveal complex patterns in the development of the writing process and its orchestration, compared with the textual product, and no direct relationship was observed between development of the writing process and its timing, and improvement in the textual product. Among the youngest students, all this was mediated by psychological variables related to the existence of inaccurate perceptions of self-efficacy as regards the deployment and use of writing processes and causal attributions to external factors. The implications, limitations and future perspectives are discussed

Se investiga la distribución temporal de los procesos de escritura, mediante una técnica on-line de retrospección directa, y diferencias en el producto textual, desde los cursos más inferiores donde es posible atender a su estudio hasta últimos cursos de la enseñanza obligatoria. Además, se atiende al análisis de diversas variables psicológicas para analizar su incidencia moduladora en la escritura. Se utilizó una muestra muy depurada de 348 alumnos, con edades comprendidas entre los 9 y 16 años, con un desarrollo normalizado y unos niveles de competencia curricular y escritora dentro de la media. Los resultados indican patrones complejos de evolución del proceso de escritura y su orquestación, en comparación con el producto escrito, constatando que no existe una traducción directa entre la evolución del proceso de escritura y su distribución temporal, y la mejoría del producto escrito; todo ello mediado por variables psicológicas relacionadas con la presencia de creencias de autoeficacia hacia el despliegue y uso de procesos escritores no calibradas de forma adecuada y la realización de atribuciones causales a factores externos, en los niveles educativos más inferiores. Se discuten las implicaciones, limitaciones y perspectivas futuras

Respuesta al caso clínico publicado: tratamiento con urea como alternativa al tolvaptán en el síndrome de secreción inadecuada de la hormona antidiurética / Response to clinical case report: treatment with urea as an alternative to tolvaptan for the syndrome of inappropriate secretion of antidiuretic hormone

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Male preventive health behaviors: perceptions from men, women, and clinical staff along the U.S. Mexico border.

Mexican American males have higher levels of total cholesterol and triglycerides, higher body mass indexes, and a higher prevalence of diabetes than do non-Hispanic White males. They are the least likely Hispanic subgroup to be insured, to have recently visited a physician, or to have preventive exams. To explore factors related to the use of preventive exams among mature men, and specifically among Mexican American men residing along the Arizona, United States/Sonora, Mexico border, information on barriers and motivating factors to male participation in preventive screening exams was collected. Interviews were conducted with mature men and women from a single border community and with clinical staff from three different border communities who deliver services to similar populations. Responses were triangulated. Common themes identified include health education/information/advertisement and female/family support as motivating factors and machismo/denial/fatalism as a barrier to male health-seeking behavior.

The impact of a promotora on increasing routine chronic disease prevention among women aged 40 and older at the U.S.-Mexico border.

A randomized controlled intervention tested the effectiveness of a community health worker (CHW) program in increasing compliance with annual preventive exams among uninsured Hispanic women living in a rural U.S.-Mexico border area. During 1999-2000, household surveys were administered to women aged 40 and older. Uninsured women not receiving routine comprehensive preventive care were invited to participate in a free comprehensive clinical exam. Participants in the initial exam were eligible to participate in the CHW (promotora) intervention. Women were randomized to one of two intervention arms. One arm received a post-card reminder for an annual preventive exam, the other a postcard reminder and follow-up visit by a promotora. Receiving the promotora intervention was associated with a 35% increase in rescreening over the postcard-only reminder (risk ratio [RR] = 1.35, 95% confidence interval 0.95-1.92). Using promotoras to increase compliance with routine screening exams is an effective strategy for reaching this female population.