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Objective: To evaluate the impact of a pharmaceutical intervention on treatment optimization in patients with type 2 diabetes mellitus., Design: Before-after intervention study. SITE: Health centers of the Primary Care Department of Camp de Tarragona., Participants: Patients aged ≥ 18 years, diagnosed with type 2 diabetes mellitus and under treatment with antidiabetic drugs., Interventions: Review of pharmacological treatment for type 2 diabetes mellitus and issuance of proposals for its adequacy., Main Measurements: Demographic and clinical variables were collected to assess the adequacy of antidiabetic treatment. A consensus meeting was arranged with the patients' primary care physician to evaluate the proposals for improvement. The implementation of the proposals and the variation in postintervention glycemic control were assessed., Results: A total of 907 patients (59% men) were included. A total of 782 proposals for intervention were made in 65.8% of the patients reviewed. Of the proposals, 43.5% corresponded to drug discontinuation, 16% to intensification of dosing and 12.6% to exchange for a therapeutic equivalent. Of the consensual proposals, 54.7% were implemented. HbA1c was reduced by 0.2% after the intervention (7.4 vs 7.2%)., Conclusions: Review of the pharmacological treatment of patients with type 2 diabetes mellitus by a pharmacist or pharmacologist facilitates its optimization., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Objective: To describe perceived quality of life in Latin American caregivers working in Spain and how it varies in relation to certain variables shared by this group., Methods: We used the SF-36 to measure perceived quality of life in 517 women residing in five Spanish regions: the Balearic Islands, Catalonia, the Basque Country, the Canary Islands, and Madrid. Several variables related to the socio-demographic profile and migration process were studied using Student's t test, ANOVA and linear regression models., Results: The participants scored very low on the dimensions of physical and emotional roles. The factors associated with lower quality of life scores within the group were working as a live-in caregiver, lack of contract, multitasking, irregular status, and younger age., Conclusions: The vulnerability of these women can be explained by poor working conditions and other factors related to the migratory process., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received., Methods: It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants., Results: Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found., Conclusions: Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care., (Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.)

Objectives: To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality., Material and Methods: In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced., Results: The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence., Conclusions: The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality., (Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.)

Introduction: Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context., Objectives: To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view., Material and Methods: A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients., Results: Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares., Conclusions: The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception., (Copyright © 2012 Elsevier España, S.L. y SEEIUC. All rights reserved.)

The preparation of paediatric parenteral nutrition admixtures varies greatly. There is still a clear lack of consensus on many points. These points include the use of organic or inorganic phosphate or calcium salts, preparing binary or ternary mixtures, the type of lipid used, and the addition or suppression of heparin or carnitine, etc. The process must be standardised in order to guarantee that prepared mixtures will be stable. However, there is still no information on how to predict their stability with any degree of precision, particularly for ternary mixtures. For that reason, any change applied may trigger a destabilisation process that places patient safety at risk. We describe a case of a ternary paediatric parenteral nutrition admixture in which creaming was observed. We indicate the factors that gave rise to this phenomenon and the measures taken to avoid it., (Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.)

Objective: Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients., Method: Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment., Results: Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE)., Conclusion: LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs., (Copyright © 2008 SEFH. Published by Elsevier Espana. All rights reserved.)

Objective: To correlate blood coagulation factor levels with disease severity in cirrhotic patients evaluated as candidates for liver transplantation., Material and Method: We included 87 patients (75.9% men) with a mean age of 54+/-9.4 years. Etiology and Child-Turcotte-Pugh (CTP) class were as follows: alcohol-related (36.8%), hepatitis C virus infection (35.6%), hepatitis B virus infection (11.5%) and other (16.1%); class A (13.8%), class B (40.2%) and class C (46%), respectively. The mean value of the Model for End-Stage Liver Disease (MELD) score was 14.5+/-5.9. Levels of factors II, V, VII, VIII, IX and X were compared between each CTP grade and with the MELD score., Results: Except for factor VIII, all the clotting factors were reduced in our series (in particular factors II, V and VII) and deficiencies in these factors were closely related to CTP grade with statistical significance for stage C (p <0.05). We also found a marked inverse correlation between the MELD score and factors II, V, VII, IX and X values (p <0.05)., Conclusions: A correlation was found between reduced levels of factors II, V, VII, IX and X in liver cirrhosis and the severity of liver disease.

Objective: To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies., Design: Cality study., Setting: Short Stay Medical Unit in Elda General Hospital, Alicante, Spain., Participants: All patients discharged were included., Intervention: The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation., Conclusion: Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.

The authors carried out a systematic search in main data bases and a methodological content review by paired authors about selected publications. The authors reviewed and analyzed 332 articles about informal caretakers and they chose 182 which complied with their selection criteria. The profile for informal caretakers of persons aged over 65 in Spain is identified as well as the type of care he/she provides. It is worth highlighting the introduction of a new factor in caretaking for the elderly during recent years at a national Spanish level, and since the 1990s on an international level: paid non-professional immigrant caretakers. This phenomenon makes the different traits which ethnic minority caretakers have reflect on the dynamics and the results of this study.

ST segment elevation acute coronary syndrome is a clinical condition that is rarely observed in pregnant women. However, its manifestation is a situation of high maternal-fetal risk. Pharmacotherapeutical management of these patients is difficult and requires individualized care by a multidisciplinary team since many of the standard treatments are included within the categories of teratogencity C or D of the Food and Drug Administration and experience with techniques such as coronary angioplasty with stent placement is scarce. The case of a 32-year woman who was 11 weeks pregnant and diagnosed of acute coronary syndrome with ST segment and its therapeutic approach are described. Furthermore, the information available on epidemiology, etiology and pathophysiology of acute coronary syndrome with ST segment during pregnancy and the specific role of the currently available treatment options are reviewed.

Disseminated intravascular coagulation as associated to sepsis contributes to the development of clinical multiple organ failure by extensive thrombosis in microcirculation vessels. This condition commonly manifests itself in severe meningococcal sepsis. On the skin, its clinical manifestation is extensive purpura with necrotic lesions that usually progress to serious distal ischemia and may call for amputation. A common denominator in these events regarding hemostasis is a depletion of so-called natural anticoagulant proteins, particularly protein C. According to clinical observations replacement therapy with human plasma-derived protein C concentrates has been associated with significantly improved clinical outcome in patients with meningococcal sepsis and fulminant purpura. This paper reports a case of acquired protein C deficiency in a girl with meningococcal sepsis, fulminant purpura, disseminated intravascular coagulation, and septic shock. Fresh plasma therapy was intended to increase consumption coagulopathy-depleted coagulation factors and to provide small amounts of protein C. The inability to restore protein C concentrations above 30%, and the presence of severe thrombopenia in the setting of disseminated intravascular coagulation led to the onset of replacement therapy using a human protein C concentrate (Ceprotin), which increased plasma protein C concentrations and contributed to revert the existing hypercoagulability status. Finally, evidence available in the literature regarding fulminant meningococcal sepsis management using human protein C concentrates and recombinant activated protein C is discussed.

A number of literature references suggest that carbapenem-like antibiotics decrease plasma concentrations of valproic acid in epileptic patients. This interaction may result in a recurrence of epileptic seizures in these patients. To clarify the possible mechanism of such carbapenem-valproic acid interaction several experimental studies have been carried out in animals. However, the mechanism of this drug-drug interaction is as yet uncertain. in this article we report three new cases that were observed in our hospital within three months. One of these patients developed seizures. We also review the different mechanisms proposed, as well as cases published to this day. All these data demonstrate that care should be taken in using these potent antibiotics in patients receiving valproic acid.

Background: Sucralfate has been used in the prophylaxis of acute enteric toxicity induced by radiation therapy of pelvic organs. The aim of the study was to demonstrate the efficacy of sucralfate in the prevention of the acute enteric toxicity induced by pelvic irradiation in cancer patients, compared with placebo, in a multicentric double-blind randomised clinical trial., Patients and Method: One hundred and twenty patients, with a localised pelvic cancer, 18 to 80 years old, with a Karnofsky index of 80% or more, and "normal" defecation habits (3-10 defecations/week), undergoing whole pelvic irradiation, were included. The duration of the study was 7 weeks, with weekly controls. The first week all patients received placebo. In the second week the patients were randomised into two groups: sucralfate (61 patients, 2 g/tid p.o. before meals) and placebo (59 patients). Radiotherapy started at the beginning of the third week and lasted until the end of the study. All patients received 45-50 Gy total dose (1.8-2 Gy/day, 5 days/week) with the "box technique". The main variables were the number of stools per week and the number of loperamide pills per week., Results: The number of stools per week showed no differences between groups. By the contrary in the group intention to treat (120 patients) and per protocol (100 cases) the percentage of diarrhoeal stools per week showed a statistical significance in favour of sucralfate: (p < 0.05) and (p < 0.03) respectively, concerning the evolution of this variable from the baseline (first week) to the end of the pelvic radiotherapy (seventh week). Furthermore, the consumption of loperamide was significantly lower in the sucralfate group (p < 0.001)., Conclusion: Sucralfate is effective in the preparation of acute enteric toxicity induced by pelvic irradiation.

Results of CNS prophylaxis of 43 LLA children are studied. Prognostic characteristics of the group, follow-up time, and controls made are reported. Prophylaxis was made with intrathecal methotrexate associated to craneal (24 patients) or craneospinal irradiation. There was a 13% of meningosis between three and 27 months of the first complete remission. There were no differences of effectiveness between the two methods of treatment. The side effects were mild. Fifty five percent of patients showed fever, and vomits after intrathecal methotrexate injections, and 16% somnolence postradiotherapy syndrome. There were two more severe complications, one sepsis and one necrotizing leukoencephalopathy.