Integración del modelo biopsicosocial en la implantación de Comprehensive Medication Management para pacientes tratados en una institución oncológica en Colombia / Biopsychosocial Model Integration in the implementation of Comprehensive Medication Management for patients treated in an oncological institution in Colombia

Introducción: Las personas con cáncer necesitan recibir cuidados enfocados en aspectos biopsi-cosociales considerando la experiencia con la medicación (MedExp), la evolución de esta enfermedad y la calidad de vida relacionada con la salud (CRVS). Se presentan los resultados del Compre-hensive Medication Management (CMM) implanta-do en una institución colombiana especializada en oncología. Método: Diseño cuali-cuantitativo mixto observacional, descriptivo y prospectivo. Los datos se obtuvieron mediante triangulación de técnicas cualitativas (entrevistas en profundidad y observación participante) y cuantitativas (entrevistas clínicas con cuestionarios validados). Las entrevistas fueron presenciales y telemáticas por la pandemia (febrero-octubre 2021). Según los estándares del CMM, se generó la historia farmacoterapéutica, se registró la información biopsicosocial y se analizó la MedExp y la CVRS utilizando Medicines Optimisation Software®. Resultados: Se evaluaron los estándares antes y después de su implantación. La valoración inicial tuvo un análisis DAFO (Debilidades, Amenazas, Fortalezas, Oportunidades) consensuando estrategias para desarrollar CMM. El servicio de oncología derivó 17 personas, 10 mujeres aceptaron participar. Se completaron 30 entrevistas recogiendo narrativas sobre experiencias, observaciones y datos clínicos contextualizados a partir de las que se realizaron intervenciones biopsicosociales. Se resolvieron 2 condiciones clínicas, 2 mejoraron, 7 permanecieron estables, 9 mejoraron parcialmente y 4 no tuvieron mejoría. Tras recibir CMM, las participantes mejoraron su autopercepción en salud, y mejoraron principalmente las dimensiones de movilidad, realización de actividades cotidianas y ansiedad/depresión. Conclusiones: En la implantación del CMM se integró el modelo biopsicosocial considerando las experiencias reales de padecer cáncer alcanzando mejoría en condiciones clínicas y en CVRS de las pacientes atendidas. (AU)

Introduction: People with cancer need to receive care focused on biopsychosocial aspects, consid-ering medication experience (MedExp), disease and illness progression, and health-related quality of life (HRQoL). The results of the Comprehensive Medication Management (CMM) implemented in a Colombian institution specialized in oncology are presented. Method: Mixed observational, descriptive, and pro-spective qualitative-quantitative design. Data were obtained by triangulating qualitative (in-depth inter-views and participant observation) and quantitative techniques (clinical interviews with validated ques-tionnaires). Data was collected through interviews carried out face-to-face and remotely due to the pandemic situation during February-October 2021. According to CMM standards, the pharmacothera-peutic history was obtained, recorded, and MedExp and HRQoL were analyzed using Medicines Optimi-zation Software®. Results: The standards of pharmaceutical care practice were established through the implemen-tation of a SWOT analysis to support care process. The oncology service referred 17 people; 10 women agreed to participate. Thirty interviews were completed collecting narratives about experiences, observations and contextualized clinical data from which biopsychosocial interventions were carried out. Clinical results obtained were: 2 clinical condi-tions resolved, 2 improved, 7 stable, 9 partially im-proved and 4 unimprovement. After receiving CMM, the participants improved their self-perception of health, and HRQoL dimensions of mobility, daily activities, and anxiety/depression improved. Conclusions: Through the implementing of CMM, clinical conditions related to the patients’ medica-tions were improved. Results guided the actions to be followed when implementing this biopsychoso-cial model in the institution. Providing benefits for patients and caregivers, in terms of avoiding the deterioration of quality of life despite suffering from of oncological diseases.

Gestión integral de la farmacoterapia en un paciente hospitalizado con VIH y tuberculosis / Comprehensive medication management in a patient hospitalized with HIV and tuberculosis

Paciente varón de 27 años derivado desde infectología al Servicio de Gestión Integral de la Farmacoterapia para optimizar la administración del tratamiento antifímico. Se encontraba internado en hospital por un absceso submaxilar y axilar, candidiasis esofágica, desnutrición proteico-calórica, infección por VIH, tuberculosis pulmonar y ganglionar. Se analizó la experiencia farmacoterapéutica para lograr una mejor comprensión del uso de la medicación en el paciente y posteriormente lograr establecer un plan de cuidados individualizado para identificar y resolver 7 problemas farmacoterapéuticos mediante el sistema Pharmacotherapy Workup, obteniendo mejoría y estabilidad de su estado de salud. En las 11 condiciones clínicas que padecía el paciente, se realizaron un total de 7 intervenciones, para resolver los 6 problemas farmacoterapéuticos y prevenir la nueva aparición de uno de ellos. Uno de los problemas que consistía en que el paciente no deseaba tomar la medicación debido a los efectos adversos, fue resuelto con el propio paciente mediante la comprensión de su experiencia farmacoterapéutica, de esta forma se llegó a un acuerdo para lograr la tolerancia del fármaco. El resto se resolvieron mediante el trabajo colaborativo con la médica infectóloga y la nutricionista. (AU)

A 27-year-old male patient referred from infectious diseases to the Comprehensive medication Man-agement Service to optimize the administration of antifungal management. He was hospitalized for a submaxillary and axillary abscess, esophageal candida infection, protein-calorie malnutrition, HIV infection, pulmonary and ganglial tuberculosis.The pharmacotherapeutic experience was analyzed to achieve a better understanding of the patient's medication use and subsequently establish an indi-vidualized care plan to identify and solve 7 pharma-cotherapeutic problems through the Pharmacother-apy Workup system, obtaining improvement and stability in the patient's state of health.In the 11 clinical conditions suffered by the patient, a total of 7 interventions were performed to solve the 6 pharmacotherapeutic problems and prevent the new appearance of one of them. 1 of the prob-lems was solved by the patient himself because it was necessary to understand his medication expe-rience. The rest were solved through collaborative work with the infectious disease physician and the nutritionist. (AU)

[Translated article] Medication experience and clinical interventions in patients receiving pharmaceutical care: A scoping review of pharmaceutical care practice.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience-MedExp-and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: (1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management CMM and (2) explain which categories they establish and how they explain the individual, psychological, and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923, 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological, and social qualities. This MedExp is corporal, intentional, intersubjective, and relational, expanding to the collective because it implies beliefs, culture, ethics, and the socioeconomic and political reality of each person located in their context.

Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance / Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice

Objetivo: analizar la literatura científica sobre investigaciones cualitativas que estudian la experiencia con la medicación (MedExp) y las intervenciones farmacéuticas relacionadas que aportan cambios en la salud de los pacientes. A través del análisis de contenido de esta revisión de alcance se pretende: 1) comprender cómo analizan los farmacéuticos la MedExp de sus pacientes que reciben Comprehensive Medication Management (CMM) y 2) explicar cuáles categorías establecen y cómo explican las dimensiones individuales, psicológicas y culturales de MedExp. Métodos: la revisión de alcance siguió las recomendaciones PRISMA Extension for Scoping Reviews. Se hizo una búsqueda en Medline (Pubmed), SCOPUS, Web of Science y Psycinfo para identificar investigaciones sobre MedExp de pacientes atendidos por farmacéuticos y que cumplieran con estándares de calidad, Standards for Reporting Qualitative Research. Se incluyeron artículos publicados en inglés y español. Resultados: se identificaron 395 investigaciones cualitativas, se excluyeron 344. En total 19 investigaciones cumplieron con los criterios de inclusión. Concordancia entre los revisores, índice de kappa 0,923; IC 95% (0,836-1,010). Las unidades de análisis de los discursos de los pacientes se relacionaron con una construcción de la MedExp en el transitar de las personas con sus medicamentos, la influencia que tiene en la experiencia de enfermar, la conexión con aspectos socioeconómicos y las creencias. A partir de la MedExp, los farmacéuticos plantearon propuestas culturales, redes de apoyo, a nivel de políticas sanitarias, y brindar educación e información acerca de la medicación y la enfermedad. Adicionalmente, se identificaron características de las intervenciones como modelo dialógico, relación terapéutica, toma de decisiones compartidas, abordaje integral y derivaciones a otros profesionales. Conclusiones ... (AU)

Objective: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients’ health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. Methods: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. Results: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. Conclusions ... (AU)

Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice. / Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological and social qualities. This MedExp is corporal, intentional, intersubjective and relational, expanding to the collective because it implies beliefs, culture, ethics and the socioeconomic and political reality of each person located in their context.

Revisión bibliográfica sobre la Gestión Integral de la Farmacoterapia en pacientes hospitalizados en Cirugía Ortopédica y Traumatología / Literature review on Medication Therapy Management in patients admitted to Orthopedic Surgery and Trauma Departments

Objetivo: Explorar la literatura científica sobre las intervenciones farmacéuticas (IF) y la Gestión Integral de la Farmacoterapia (GIF) brindada por farmacéuticos en pacientes hospitalizados en Cirugía Ortopédica y Traumatología (COT). Métodos: Se realizó una búsqueda de artículos originales y revisiones, publicados en inglés o castellano, hasta el 17 de junio de 2021, cuyo tema principal fueran las IF en pacientes hospitalizados en COT. Bases de datos consultadas: Medline, Cochrane Library y Scielo. Términos empleados: “Orthopedics”, “Traumatology”, “orhopedic surgery”, “orhopedic trauma”, “Medication Therapy Management”, “Pharmacy Service, Hospital”, “Pharmacists”, “Medication Reconciliation”, “Pharmaceutical Care”, “Clinical Pharmacy”. La IF fue considerada GIF cuando implicaba una revisión profunda de la medicación del paciente (Valoración inicial/“Assessment”), evaluando indicación, efectividad, seguridad y cumplimiento/adherencia de cada uno de los medicamentos, y comprobando que todas sus necesidades farmacoterapéuticas estuvieran cubiertas. La implantación de la GIF fue considerada completa cuando además se realizaba un plan de cuidados farmacoterapéutico (“Care Plan”) y evaluación/seguimiento (“Follow up-evaluation”). Resultados: Se seleccionaron 29 artículos, principalmente estudios observacionales descriptivos (51,7%). La mayoría fueron publicados en Estados Unidos (27,6%) y España (20,7%). IF mayoritarias: conciliación de medicación (55,2%), revisión de medicación (44,8%), seguimiento farmacoterapéutico (SFT) (34,5%), manejo del dolor físico postquirúrgico (27,6%) y evaluación/reducción de riesgos (27,6%). La GIF fue analizada en cinco referencias bibliográficas (17,2%); siendo su implantación completa solamente en tres (10,3%). Conclusiones: La presente revisión bibliográfica sintetiza las principales IF en pacientes hospitalizados en COT, destacando: conciliación de medicación, revisión de medicación y SFT... (AU)

Objective: To review the scientific literature on Pharmaceutical Interventions (PIs) and Medication Therapy Management (MTM) by pharmacists in patients admitted to Orthopedic Surgery and Trauma (OST) Departments. Methods: A search was conducted of Medline, Cochrane Library, and Scielo databases for original articles and reviews on PIs in adults (≥18 yrs) hospitalized in OST published in English or Spanish up to June 17 2021. Search terms were: “orthopedics”, “traumatology”, “orthopedic surgery”, “orthopedic trauma”, “medication therapy management”, “pharmacy service, hospital”, “pharmacists”, “medication reconciliation”, “pharmaceutical care”, “clinical pharmacy”. Titles and abstracts of retrieved items were examined. A PI was considered MTM when part of a more in-depth review of the patient’s medication, evaluating the indication, effectiveness, safety, and treatment adherence for each medication and ensuring that all pharmacotherapeutic needs were covered (Assessment). MTM implementation was considered complete when plans for pharmacotherapy care (Care Plan) and follow-up (Follow-up evaluation) were developed. Results: The review included 29 articles, mainly descriptive observational studies (51.7%). The majority were published in the USA (27.6%) or Spain (20.7%). The most frequent PIs were: medication reconciliation (55.2%); medication review (44.8%); pharmacotherapeutic follow-up (34.5%); post-surgical physical pain management (27.6%); health education (27.6%); and risk assessment/reduction (27.6%). MTM was analyzed in five retrieved articles (17.2%) and its complete implementation in only three (10.3%). Conclusions: This literature review compiles the main PIs implemented in patients hospitalized in OST, highlighting medication conciliation, medication review, and pharmacotherapeutic follow-up. MTM implementation remains scarce in these patients. (AU)

Percepción comunitaria sobre arrecifes coralinos en Golfo Dulce: bases para integración social en programas de restauración

Introducción: Enfrentar la acelerada degradación de arrecifes coralinos requiere una acción integrada en múltiples niveles sociales y ecológicos. A escala local se debe incluir la participación activa de los usuarios de los recursos. Objetivo: evaluar el conocimiento y percepción local sobre los arrecifes coralinos en Golfo Dulce, y así generar bases para la integración social en la restauración coralina. Métodos: se realizaron 183 entrevistas en siete comunidades costeras del Golfo Dulce entre septiembre del 2016 y marzo del 2017. Los entrevistados se clasificaron en: (1) Pesca artesanal (PA) = 57 entrevistados, (2) Turismo (T) = 62, y (3) Otros (O) = 64. La primera parte de la entrevista fue de conocimiento y se asignó una nota basada en respuestas correctas. Según la nota se clasificó como informado, información media o desinformado. La segunda parte se basó en escalas de percepción sobre: (I) visitación, (II) factores que dañan los arrecifes coralinos, (III) medidas de manejo y (IV) salud de recursos marinos en Golfo Dulce. Resultados: El grupo T tuvo el mayor porcentaje de entrevistados informados = 42 % y el grupo O de desinformados = 37 %. La segunda parte fue percepción, más del 50 % de PA y T consideran que la visita es frecuente. La sedimentación y contaminación por agroquímicos fueron identificados por más del 60 % de PA y T como la principal amenaza. El 35 % de PA y el 40 % de T perciben las boyas fijas como la mejor medida para el Golfo Dulce. La restricción de visitas fue la medida con menor aceptación. El 60 % de los entrevistados de PA y T consideran que los recursos marinos del golfo estarán peor que en la actualidad. Conclusiones: Estos resultados confirman la importancia de comprender el conocimiento y la percepción de los usuarios de los arrecifes de coral en los procesos participativos y educativos en la restauración y conservación de los arrecifes de coral.

Introduction: Addressing the accelerated coral reefs degradation requires integrated action at multiple social and ecological scales. At local level, active participation of the main users must be included. Objective: To evaluate local knowledge and perception about coral reefs in Golfo Dulce to generate bases for social integration in coral restoration. Methods: 183 interviews were conducted in coastal communities in Golfo Dulce, between September 2016 and March 2017. The interviewees were classified as: (1) Artisanal fishing (PA) = 57 interviewees, (2) Tourism (T) = 62, and (3) Others (O) = 64. The first part of the interview was about knowledge and a grade was assigned based on correct answers. According to the grade, they were classified as informed, medium information or uninformed. The second part was based on perception scales on: (I) visitation, (II) factors that damage coral reefs, (III) management measures, and (IV) health of marine resources in Golfo Dulce. Results: Group T had the highest percentage of informed interviewees = 42 % and group O uninformed = 37 %. The second part was perception, more than 50 % of PA and T consider that the visit is frequent. Sedimentation and contamination by agrochemicals were identified by more than 60 % of PA and T as the main threat. 35 % of PA and 40 % of T perceive permanent buoys as the best measure for the Golfo Dulce. The visitation restriction was the measure with the least acceptance. 60 % of the interviewees of PA and T consider that the marine resources of the gulf will be worse than today. Conclusions: These results confirm the importance of understading coral reefs users knowledge and perception in participatory and educational processes in coral reef restoration and conservation.

Implantación del Comprehensive Medication Management en pacientes costarricenses con enfermedad renal crónica / Implementation of Comprehensive Medication Management in Costa Rican patients with chronic kidney disease

Objective: Determine implementation results of the Comprehensive Medication Management (CMM) offered to patients with chronic kidney disease (CKD) who attended the Hospital Nephrology Service in Costa Rica.Methods: Mixed quantitative-qualitative, observative, descriptive and prospective study, in patients attending the Hospital Pharmaceutical Care Department through the CMM process, analysis of intermediate and preliminary results of health-related quality of life HRQOL using EQ 5D -5L.Results: Based on pilot study, 11 patients attended the first visit and 9 patients attended the third one. As result, 45 clinical conditions were analyzed, 1 of them was resolved, 20 were stable and 10 were improved. Total of 62 drug-therapy problems (DTP) were identified, with average of 5.6/patient. On regards to HRQOL, feedback obtained from kidney transplant patients indicated a better evaluation (mobility, personal care, daily activities, pain / discomfort), compared to CKD stage 5 5D dialysis patients (mobility impairment improvement). Utility measure reflected a change of 0.64±0.12 to 0.72±0.12, the health self-perception EQ VAS 68.18±23.58, to 87.22±8.53; and in terms of quality-adjusted life-year QALY, it showed a difference of 2.54±2.99.Conclusions: CMM implementation established in most health conditions improve or maintain patient stability. HRQOL was better for transplant patients compared to CKD 5D patients. Parameters such as utility, QALY, and EQ VAS were increased. (AU)

Objetivo: Determinar los resultados de la implantación del Comprehensive Medication Management (CMM) brindada a los pacientes con enfermedad renal crónica (ERC) que asistieron al Servicio de Nefrología de un Hospital en Costa Rica.Métodos: Estudio cuali-cuantitativo mixto, observacional, descriptivo y prospectivo, en pacientes que asisten al consultorio de Atención Farmacéutica de un hospital, mediante el proceso asistencial CMM, análisis de resultados intermedios y preliminares de calidad de vida relacionada con salud (CVRS) mediante EQ 5D-5L.Resultados: En el estudio piloto 11 pacientes completaron la primera visita y 9 pacientes la tercera visita; se analizaron 45 condiciones clínicas, y se obtuvo una condición clínica resuelta, 20 estables, 10 con mejoría. Se identificaron 62 problemas farmacoterapéuticos (DTP por sus siglas en inglés), media 5,6/paciente. Respecto a la CVRS los discursos de los pacientes trasplantados renales indicaron una mejor valoración (movilidad, cuidado personal, actividades cotidianas, dolor/malestar), en comparación con pacientes ERC estadio 5 diálisis 5D (mayor afectación movilidad). La utilidad cambió de una media 0,64±0,12 a 0,72±0,12, la autopercepción de salud EQ VAS 68,18±23,58, a 87,22±8,53; y respecto a los años de vida ganados ajustados por calidad de vida AVAC con una diferencia de 2,54±2,99.Conclusiones: La implantación de CMM logró en la mayoría de las condiciones de salud una mejoría o mantener la estabilidad. La CVRS fue mejor para los pacientes trasplantados, en comparación con los pacientes ERC 5D. Los parámetros como la utilidad, AVAC y EQ VAS aumentaron. (AU)

Entrevistas en profundidad: técnica complementaria a las entrevistas clínicas en las intervenciones basadas en necesidades del paciente / In-depth interviews: complementary technique to the clinical interviews in the interventions based on the patient’s needs

Se brindó Comprehensive Medication Management a una mujer de 78 años, con antecedentes de trombosis venosa profunda y fractura de cadera. Diagnosticada de hidrocefalia, artrosis, hipertensión arterial y dislipemia, que tomaba 12 medicamentos. Se evaluaron las necesidades farmacoterapéuticas integrando aspectos biomédicos y psicosociales, a través de un análisis clínico, que permitió detectar 7 necesidades y un análisis complementario de narrativas extraídas de entrevistas en profundidad, que permitió la detección de 5 necesidades adicionales. Utilizar entrevistas en profundidad para interrelacionar aspectos cualitativos de la experiencia personal al evaluar la farmacoterapia, permitió plantear intervenciones biopsicosociales adaptadas a la resolución integral de necesidades farmacoterapéuticas, que fueron recogidas en un plan de cuidados, donde se incluyó un informe al médico de atención primaria con 4 recomendaciones de las cuales 2 fueron aceptadas y otras 4 fueron propuestas y aceptadas por la paciente y su cuidador, consiguiéndose la resolución de 8 necesidades farmacoterapéuticas.(AU)

Comprehensive Medication Management was provided to a 78-year-old woman. Medical history: deep vein thrombosis, hip fracture, hydrocephalus, arthrosis, arterial hypertension and dyslipidemia. She was taking 12 medications. Patient’s medication-related needs were evaluated integrating biomedical and psychosocial aspects, through a clinical analysis, which allowed the de-tection of 7 medication-related needs. Complemen-tary analysis of narratives extracted from in-depth interviews allowed detection of 5 additional medi-cation-related needs. Using in-depth interviews to interrelate qualitative aspects of personal experience when evaluating pharmacotherapy, allowed to propose biopsycho-social interventions adapted to the comprehensive resolution of medication-related needs, collected in a care plan. Included a medical report with 4 recommendations whereby 2 were accepted by the primary care physician. Another 4 medication-re-lated needs were proposed and accepted by the patient and her caregiver, achieving the resolution of 8 medication-related needs.(AU)

Gestión integrada para la prevención y control del dengue y otras arbovirosis en la Municipalidad de Ambato / Integrated management for the prevention and control of dengue and other arboviruses in the Municipality of Ambato

Las arbovirosis por Dengue (VD), Zika (VZIK) y Chikungunya (VCHIK), transmitidas por vectores del género Aedes, tienen alta prevalencia en países tropicales, especialmente en Ecuador donde se les considera problemas de salud pública. Se realizó un estudio descriptivo para identificar el nivel de cumplimiento de la estrategia de gestión integrada (EGI) para prevención y control de VD y otros arbovirus en Ambato, Tungurahua - Ecuador. Se realizó perfil comunitario a partir de fuentes oficiales y secundarias, se evaluó componentes del ambiente mediante lista de verificación y se evaluó cumplimiento de EGI mediante encuesta al personal del sector salud. Datos consultados señalan que en la provincia existe 36% y 10% de pobreza y pobreza extrema, respectivamente; además adecuado servicio de agua potable, recepción de agua por tubería, gestión de residuos sólidos y servicio de electricidad en ambas zonas, urbana y rural. Se constató que más del 50% de la población rural presenta condiciones óptimas de salud ambiental: aire limpio (90,28%) y agua potable (66,94%); en la población urbana destaca higiene de alimentos (63,89%) y microambiente doméstico (69,44%), con deficiencia en recolección de residuos sólidos (33,89%). La EGI tuvo un nivel de cumplimiento de 100% en parroquias urbanas en componentes laboratorio, atención al paciente, promoción y comunicación, mientras que en parroquias rurales, salud ambiental tuvo 63% e investigación y capacitación menor nivel (47,78%); siendo necesario mejorar sistemas de desechos sólidos en la población urbana y promover el conocimiento y capacitación epidemiológica en la rural, para reducir el riesgo de transmisión por arbovirus(AU)

Dengue (DV), Zika (ZIKV) and Chikungunya (CHIKV) arboviruses, transmitted by vectors of the Aedes genus, have a high prevalence in tropical countries, especially in Ecuador where they are considered public health problems. A descriptive study was carried out to identify the level of compliance with the integrated management strategy (EGI) for prevention and control of DV and other arboviruses in Ambato, Tungurahua - Ecuador. A community profile was made from official and secondary sources, components of the environment were evaluated by means of a checklist and compliance with EGI was evaluated by means of a survey of health sector personnel. Consulted data indicate that in the province there is 36% and 10% of poverty and extreme poverty, respectively; In addition, adequate drinking water service, receiving water through pipes, solid waste management and electricity service in both urban and rural areas. It was found that more than 50% of the rural population presents optimal environmental health conditions: clean air (90.28%) and drinking water (66.94%); In the urban population, food hygiene (63.89%) and domestic microenvironment (69.44%) stand out, with a deficiency in solid waste collection (33.89%). The EGI had a compliance level of 100% in urban parishes in laboratory, patient care, promotion and communication components, while in rural parishes, environmental health had 63% and research and training lower level (47.78%); being necessary to improve solid waste systems in the urban population and promote epidemiological knowledge and training in rural areas, to reduce the risk of transmission by arbovirus(AU)

Incorporación del Counseling a la Gestión Integral de la Medicación para gestionar emociones que afectan enfermedades crónicas / Counseling integrated with Comprehensive Medication Management. Emotion management of chronic diseases

Se presenta un caso de una paciente que recibe Gestión Integral de la Medicación integrada con counseling debido a las dificultades para controlar la presión arterial tras haberse tratado con diferentes antihipertensivos y porque refiere que este descontrol está relacionado con su estado emocional. La paciente se presenta con una fuerte carga de ansiedad y anímicamente alterada. Asocia su dificultad para controlar su presión arterial a circunstancias emocionales. Se considera que puede beneficiarse de estrategias de counseling para gestionar emociones integradas con la Gestión Integral de la Medicación. Tras evaluar las intervenciones realizadas interdisciplinariamente, la presión arterial se normaliza, se reduce medicación antihipertensiva, se resuelvan otros problemas de salud y percibe mayor control y capacidad de autogestión. Incorporando la gestión de emociones a la Gestión Integral de la Medicación potenciamos los propios recursos de los pacientes, promovemos su autoconocimiento, mejoramos la toma de decisiones y fomentamos actitudes satisfactorias para reducir su sufrimiento e incrementar su bienestar pudiendo repercutir positivamente en la farmacoterapia.(AU)

A case of a patient who receives Comprehensive Medication Management-CMM- integrated with counseling is presented. The patient shows difficul-ties in controlling blood pressure after having been treated with different antihypertensives and she refers this lack of control is related with her emo-tional status. This patient was highly anxious and emotionally affected. She associates her difficulty in controlling her blood pressure to emotional circumstances. The care team considers that she can benefit from counseling strategies to manage emotions integrated with CMM. After evaluating the interdisciplinary interventions, blood pressure normalizes, antihypertensive medication is reduced, other health problems are resolved and greater control and capacity for self-management are perceived. By incorporating emotion management into CMM, we enhance the patients' own resources, promote their self-knowledge, improve the deci-sion-making process, and promote satisfactory atti-tudes. For these reasons, their suffering is reduced and their well-being increased, allowing a positive effect on pharmacotherapy.(AU)

Experiencia farmacoterapéutica de los pacientes con artritis reumatoide: el rol de la farmacia comunitaria / Exploring the medication experience of patients with rheumatoid arthritis: The role of community pharmacy

Introducción: La gestión integral de la farmacoterapia de la AR es altamente compleja y la experiencia del paciente con la medicación condiciona su conducta. Objetivos. Explorar las dimensiones socioculturales de la experiencia farmacoterapéutica y determinar las necesidades a cubrir desde la farmacia comunitaria. Métodos: Investigación cualitativa, exploratoria, descriptiva y transversal con análisis temático secundario por categorías y unidades de significado emergentes. Resultados: La medicación pre-diagnóstico se percibe como paliativa no siempre efectiva. Tras el diagnóstico–a su vez alivio y sentencia-, se construye una relación con la medicación basada en las experiencias vividas, sensaciones físicas y emocionales, valorando continuamente su efectividad y seguridad a partir de sensaciones físicas y brotes. Los participantes reclaman mejor comunicación con los facultativos, mayor coordinación asistencial y que su experiencia sea considerada en la toma de decisiones. Destacan como positiva la gestión colectiva del dolor, tanto por el acompañamiento incondicional en el ámbito del hogar, como de las asociaciones de pacientes, claves para su empoderamiento. Conclusiones: La experiencia farmacoterapéutica redefine las fases de la enfermedad y se vertebra con el padecimiento y el conocimiento propio de la AR. La experiencia de los pacientes sobre la efectividad y seguridad de la medicación debería ser considerada en la toma de decisiones. La farmacia comunitaria tiene un rol importante a desarrollar para reducir el retraso diagnóstico, ofrecer información técnica sobre medicamentos, contribuir a la optimización de la farmacoterapia y al paciente a empoderase e integrarse con las redes sociales de cuidados.(AU)

Introduction: Comprehensive Medication Management in rheumatoid arthritis is highly complex and the patients experience with the medication determines the way in which it is used by them. Objectives: To explore sociocultural dimensions of the medication experience and determine the needs that should be covered by the pharmacy. Methods: It was carried out a qualitative, exploratory, descriptive, and cross-sectional research with secondary thematic analysis by categories and emerging units of meaning. Results: Prediagnostic medication is perceived as palliative and often ineffective. The diagnosis is bitter-sweet. After it, a relationship with the medication is built based on the lived experiences -both physical and emotional-assessing continually its effectiveness and safety according to physical sensations and outbreaks. Participants demand a better communication with doctors and a greater coordinated assistance. Thus, their experience should be considered in the decision-making process. They highlight the collective management of pain, the unconditional support at home as well as patients’ associations, which are key to their empowerment. Conclusions: Patients’ medication experience redefines the phases of the disease and is built with the suffering and the own knowledge of the rheumatoid arthritis. Patients’ experience with the effectiveness and safety of medication should be considered in the decision-making process. Community Pharmacy has an important role to reduce the diagnostic delay, to offer technical information on medications, to contribute to the optimization of pharmacotherapy and to empower the patient and get him or her integrated with the social care networks.(AU)

An experience in integrated management of clinical risks.

BACKGROUND: Manage clinical risks under the integrated risk management model of the BUPA organization (British United Provident Association). MATERIALS AND METHODS: BUPA is an international group that provides health insurance and healthcare services. The project has been limited to Europe and Latin America (ELA) and this article presents the results related to hospitals. The integral risk management model was based on a governance structure, a risk management framework and the risk management itself (continuous process of identification, evaluation, management, monitoring and reporting). For the latter, a catalog of potential clinical risks was drawn up, using the Joint Commission International (JCI) standards as a reference and applied to a hospital to identify the risk to which they were exposed in their daily activity. An evaluation was conducted, based on its impact and probability of occurrence and depending on the residual and inherent score obtained, the action on each risk and the effectiveness of the controls were determined. A continuous monitoring of the risk profile and the information to share with the Board was defined. RESULTS: The catalog consisted of 126 risks and 479 controls, divided by areas of application. In the assessment of the inherent risk, 84% of the risks were at an acceptable and assumable level, and in 16% it was necessary to establish an action plan. CONCLUSIONS: Under the conditions of the study, we believe the benefits of implementing an integrated management of clinical risk system consisted in providing services that meet the legal requirements and standards of good practice (in our case, the JCI's standards). They allowed us to advance in the organization's management of, improving its efficiency in the allocation of resources for risk management and adaptation to the environment and the patient. In addition, this strategy can facilitate decision-making and encourage the organization's transformation capacity.

Modelo de salud y seguridad en el trabajo con gestión integral para la sustentabilidad de las organizaciones (SSeTGIS) / Health and safety at work model with integral management for sustainability of organizations (SSeTGIS)

RESUMEN Ante los desafíos que plantea hacer a las empresas sustentables con responsabilidad social, es necesario desarrollar procesos de mejora basados en una gestión integral con impactos medibles en los resul tados de calidad, productividad, salud y seguridad en el trabajo, el cuidado del medio ambiente y la cultura de protección civil. Para estas materias existen lineamientos internacionales y marcos jurí dicos nacionales que cumplir, los cuales establecen la metodología para reconocer, evaluar y controlar los factores de riesgo de todo tipo en el lugar de trabajo y para la comunidad. Este documento presenta un modelo de gestión integral para la sustentabilidad de las organizaciones desde la perspectiva de la salud y la seguridad en el trabajo sin limitarse a ellas: se denomina SSeTGIS; es holísti-co, multidisciplinar, centrado en las personas, preferentemente participativo, el cual se desarrolla como un proceso de ciclos de mejora continua en tres niveles de actuación: individual, lugar de trabajo y organizacional. Se exponen los argumentos, los propósi tos, los componentes, el proceso y la metodología, así como algunas notas de su aplicación.

ABSTRACT Faced with the challenges of making sustainable companies with social responsibility, it is necessary to develop improved processes based on comprehensive management with measurable impacts on the results of quality, productivity, health and safety at work, envi ronmental care and culture of civil protection. These subjects for which international guidelines and national legal frameworks exist for their fulfillment, establish the methodology for recognizing, evaluating and controlling all kinds of risk factors in the workplace and for the community. This document presents a model of integral management for the sustainability of organizations from the per spective of health and safety at work without limiting to them, referred to as SSeTGIS. It is holistic, multidisciplinary, people-cen tered, and preferably participatory. It is developed as a process of cycles of continuous improvement in three levels of performance: individual, workplace and organizational. The arguments, the pur poses, the components, the process and the methodology are pre sented as well as some notes of their application.

"Patient blood management" in orthopaedic surgery.

Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Blood Management (PBM) programs, which have as their objective to reduce or eliminate the need for ABT and improve clinical outcomes. These programs are supported by the implementation of four groups of perioperative measures: (1) use of restrictive transfusion criteria; (2) stimulation of erythropoiesis; (3) reduction of bleeding; and (4) autologous blood transfusion. In this article, a review is presented of the effectiveness, safety and recommendations of applicable strategies in OTS, as well as the barriers and requirements to the development and implementation of PBM programs in this surgical specialty.

Trazabilidad residuo químico líquido en laboratorios de docencia Caso: Universidad Colegio Mayor de Cundinamarca, Bogotá / Traceability of Liquid Chemical Residues at Teaching Laboratories: Case of Study Universidad Colegio Mayor de Cundinamarca, Bogotá / Traceability of Liquid Chemical Residues at Teaching Laboratories: Case of Study Universidad Colegio Mayor de Cundinamarca, Bogotá

Realizar seguimiento a la trazabilidad desde los reactivos hasta los residuos químicos líquidos (RQL) en los laboratorios de docencia destinados a prácticas de Química General en la Universidad Colegio Mayor de Cundinamarca, Bogotá, D.C- Colombia. Materiales y métodos: Revisión, identificación y análisis fisicoquímico de los volúmenes de RQL (básicos y ácidos) de las guías de laboratorio de la Química General. Resultados: Los resultados confirmaron que la solubilidad y en especial el solvente facilitan la formación de especies iónicas que pueden ser identificadas en los RQL. Las sustancias utilizadas en los laboratorios docentes continúan reaccionando después de finalizada la práctica, como consecuencia es pertinente tener clara la forma como se van a almacenar los productos de las reacciones...

To trace and follow chemical reagents from their initial use to their final disposition in the General Chemistry teaching laboratories at Universidad Colegio Mayor de Cundinamarca, Bogotá, D.C- Colombia. Materials and Methods: Laboratory guidelines were reviewed to determine type of reagents for General Chemistry practices and their corresponding volumes. Physical and chemical analyses were subsequently conducted on the identified compounds independent of their level of acidity. Results: Ionic species were identified and attributed to the type of solvent and their solubility properties. Once laboratory practices are completed, reagents continue to react and thereby is of the utmost importance to assure proper storage and handling conditions...

Abordaje metodológico para emprender acciones interinstitucionales e intersectoriales sobre cambio climático en el departamento de caldas / Methodlogical appproac to undertake inter-institutional and inter-secctorial actions about climate change in the department of caldas

Se presenta un abordaje metodológico para emprender acciones coordinadas incluyentes e interinstitucionales sobre el cambio climático en el departamento de Caldas, estableciendo como eje de acción la gestión integral del riesgo asociado a dicho cambio, direccionando acciones a corto, mediano y largo plazo en torno a cinco alertas develadas mediante una investigación cualitativa sobre los imaginarios sociales que la población caldense tiene sobre el mismo; categorizadas como variables críticas, variables dependientes y variables independientes a través de un análisis perceptual estructural sistémico. Se pretende plasmar la voz de la comunidad y hacer explícita la determinación y el compromiso de distintas instituciones del departamento para establecer sinergias en consonancia con sus potencialidades, de tal forma que se logre avanzar en el conocimiento de los efectos producidos por este fenómeno en nuestra región; así mismo contribuir de manera organizada y efectiva en la gestión integral del riesgo asociado al cambio climático de nuestro departamento, trabajando permanentemente en la prevención, mitigación y adaptación, para la preservación de nuestros ecosistemas y un desarrollo sustentable.

A methodological approach to undertake inclusive coordinated and inter-institutional actions about climate change in the Caldas Department is presented, establishing as the axis of action the comprehensive risk management associated to such change, directing short, medium and long term actions about the five alerts uncovered through the qualitative research about the social imaginary people from Caldas have about it, categorized as critical variables, dependent variables, and independent variables through a perceptual structural systemic analysis This article aims to give expression to the voice of the community and make explicit the determination and compromise of different institutions in the Department of Caldas to establish synergies according to their potentialities so that it can be possible to advance in the knowledge of the effects produced by this phenomenon in our region. Likewise, this text seeks to contribute in an organized and effective manner to comprehensive risk management associated with climate change in our Department, working permanently in prevention, mitigation, and adaptation for the preservation of our ecosystems and for sustainable development.