•The intrinsic numerical diffusion associated to shear waves for the ARoe and HLLS solver in the framework of the shallow water equations is studied.•The solvers are assessed using an ideal and a ...turbulent shear layer flow configuration.•The initial width of the viscous profile, the evolution time from linear to turbulent flow and the turbulence energy spectrum are used as evaluation criteria.•It is shown that the ARoe solver should be suitable to resolve the larger horizontal vortices in quasi-2D shallow water flows under a depth-averaged URANS approach.
Current computational power allows the modelling of complex time dependent flows. In particular, shallow water flows are frequently simulated to achieve solutions for different problems in the field of civil and environmental engineering. The mesh resolution and related computational cost are primarily associated to the scale of the flow structures to be investigated. Nonetheless, turbulence also plays an important role on computational cost since it participates in the generation, shedding and support of such flow structures. Different mathematical models can be considered to numerically simulate the turbulence of unsteady shallow flows depending on the degree of turbulent scale resolution required. Depending on the adopted approach, the level of accuracy required (i.e. the range of scales that must be resolved with a low diffusive and dispersive error) is different. Such accuracy, namely the dispersive and dissipative characteristic, is directly related with the numerical scheme used to discretize the equations. In finite volume schemes, the range of scales of turbulent motion that a numerical model can accurately resolve strongly depends on the Riemann solver used (via its intrinsic numerical diffusion), apart from the order of accuracy and degrees of freedom of the method. In this work, we aim at the analysis of two well-known Riemann solvers in the framework of the classical shallow water equations (i.e. considering the full convective terms and neglecting dissipation): the ARoe and HLLS solvers. An important difference between the ARoe and HLLS solvers is the numerical diffusion inherent to each of them. This artificial diffusion combined with the mesh resolution determine the cut-off scale resolved by each numerical technique. For this purpose, we assess the suitability of each solver by means of the analysis of the kinetic energy cascade of the numerical solution using a double shear layer configuration. This analysis is combined with the examination of the analytical expression of he approximate solution for a shear wave, provided by the aforementioned solvers. The study herein presented allows to assess whether or not all the relevant turbulent flow structures are resolved and if the phenomenon of interest is thus accurately modeled. The numerical results evidence that a diffusive profile appears at the shear line during the first steps of the simulation, determining the duration of the linear regime prior to the turbulent motion. The strength of this profile, shown to be higher for the HLLS solver, is associated to the numerical diffusion of the solver. The analysis of the energy cascade also agrees with this observation.
Background and ImportanceInadequately treated postoperative pain can compromise the patient‘s recovery, prolong hospital stay and contribute to chronic pain. In our hospital there are only some ...surgical services with analgesia protocols. For this reason, it’s proposed a study of post-surgical pain treatment.Aim and ObjectivesDescriptive study of the management of acute postoperative pain in hospitalised patients after scheduled surgery and the degree of adherence to the analgesia protocols available in the hospital.Material and MethodsRetrospective observational study of hospitalised adults for scheduled surgery during November 2022. Data collection was carried out through the clinical history and Hospiwin2000® electronic prescription program. The collected variables were sex, age, prescribed analgesic regimen, usance or not of analgesia protocol and pain registration according to the numerical scale (NS). The NS classifies types of pain into three ranges: NS 1–3 mild pain, NS 4–6 moderate pain, NS 7–9 severe pain.Results125 patients were considered (49.6% male; 50.4% female). Of which the mean age was 57 years (19–89). Out of the 125 cases, there were 22 different analgesia regimens.The most frequently used intravenous analgesia treatment was dexketoprofen 50 mg/8h + acetaminophen 1 g/8h (19.2%); followed by dexketoprofen 50 mg/8h + acetaminophen 1 g/6h (17.6%). Overall, in only 59% of the cases the prescription of analgesia corresponded to the available protocols in the electronic prescription program. Pain level was recorded in 69% of the patients. All those patients in whom the NS was collected presented different range of pain during the hospital stay: 5% recorded severe pain; 29% moderate pain; and 66% mild pain. 43 prescriptions were detected that did not comply with the technical data sheet recommendations for intravenous analgesic drugs (Metamizole dose > 5 g/day, dexketoprofen > 48 hours).Conclusion and RelevanceA high prevalence of patients with pain and high variability of non-protocolised analgesic guidelines, and even with doses not included in the technical data sheet of the analgesic drugs, were detected.The analysis of the current situation in our hospital is the starting point for reviewing the existing protocols and developing new ones that unify and optimise the analgesia prescription guidelines.References and/or AcknowledgementsConflict of InterestNo conflict of interest.
•Hydro-climatic time-series and land cover were analyzed by wavelet analysis.•Temperature increased, precipitation slightly decreased and discharge declined.•Hydro-climatic coherence identifies ...distinct temporal discharge dynamics.•Re-vegetation process favors discharge functional homogenization and its reduction.
Water managers and researchers noted with concern a nearly generalized decline in Mediterranean rivers discharge over the last decades. Changes in climatic forces (precipitation and air temperature) and land use and land cover (LULC) changes characterized by re-vegetation and greenness are the two most possible explanations for this discharge decline. The direct impact on river discharge stemming from these changes is difficult to assess and their role is generally studied separately. Here, we use the method of wavelet transformation to interpret the time-scale dependency of catchment discharge concerning the uneven temporal climatic fluctuations and re-vegetation processes. We analyzed the temporal variation of concurrent air temperature, precipitation and river discharge time-series for the Upper Aragón catchment, located in the Central Spanish Pyrenees. A long-term database collected over 60 years (1956–2020) was used. Land cover maps corresponding to different decades were used and the results indicated that the catchment experienced a significant increase in the area covered by mixed and broadleaf forests, mostly as a consequence of land abandonment. We show how temperature slightly increased and precipitation moderately decreased. However, catchment discharge experienced a sharp decline in its magnitude and also changes in its temporal variability dynamics. The relevance of the seasonal time-scales with regard to the available discharge is reduced, which strengthens the importance of the inter-annual time-scales for the catchment discharge dynamics. Furthermore, the catchment storage-discharge cycle at inter-annual time-scales is also reduced. Such changes can mostly be attributed to the changes in plant coverage, with an increasing weight in shaping hydrological processes at catchment scale due to the greenness effect. As such, we conclude that LULC changes have played a dominant role on the river discharge dynamics. Climatic trends, on the contrary, have been small, and they have played a secondary role in the decline of river discharge. Future research can use these observations to constrain the pace of upcoming water demands based on the available water resources at Mediterranean catchment scale.
BackgroundShortage of medicines is recognised as a global problem by the World Health Organisation. It has a significant impact on patients and health professionals.PurposeAnalysis of the impact of ...the shortages of medicines (SM) and pharmaceutical interventions (PI) in a tertiary hospital.Material and methodsRetrospective descriptive study of SM from January 2015 to February 2017. A database was set up where there was recorded: the medicine involved, pharmaceutical form and dosage, type of shortage, reason for and resolution of the shortage, and PI. The SM were classified according to their consequences and the PI carried out: requests for foreign medicines via the Spanish Medicines and Health Products Agency (SMHPA), the dispensation of another presentation available in the hospital pharmaceutical guide (HPG), change in supplier and elaboration of the magistral preparation.ResultsDuring the period of study 33 SM were registered. The main cause (60. 60%) was a temporary shortage in commercialisation. Some medicines involved were: aztreonam 1000 mg vials, vancomicine 500 mg vials and dexamethasone 1 mg tablets.The second cause of SM was suspension of commercialisation on the part of the SMHPA (30. 30%). Some medicines involved were: hydrocortisone 100 mg vials and flunitrazepam 1 mg tablets.The most frequent PI was ordering medicine from abroad, with 15 cases registered (45. 45%) followed by dispensation of a different medicine with the same active drug and the same mode of administration available in the hospital HPG with 12 cases registered (36. 36%). The change in provider occurred in four cases (12. 12%). The medicine digoxine 0. 25 mg/ml ampoule 1 ml ceased commercialisation, thereby requiring a change in supplier, and subsequently digoxin 0. 25 mg/ml 2 ml was acquired. In order to prevent errors in administration the medicine was relabelled, warning health workers of the new presentation, in order to increase safety for hospitalised patients.Magistral preparation was carried out for the medicine dexametasone 1 mg tablets (3. 03%).The medicine flunitrazepan 1 mg tablets has no commercialised therapeutic alternative and therefore it was suggested to the medical personnel to change to another benzodiazepine.ConclusionThe high incidence of SM in the pharmaceutical service makes PI necessary in order to guarantee treatment of hospitalised patients, thus preventing potential errors in medication and increasing the quality and safety of the pharmaceutical process.No conflict of interest
BackgroundSome drugs can be considered hazardous because of their potential to cause irreversible effects.PurposeTo describe the actions carried out in a pharmacy service after the publication of ...Spanish National Institute of Occupational Health and Safety (INSHT) recommendations about hazardous drugs (HD).Material and methodsA list with the HD included in the pharmacotherapeutic guide was drawn up.HD were classified according to the requirements when handling them and actions about their storage, repackaging, preparation and dispensation needed.The pharmacotherapeutic guide and the guidelines for nasogastric drug administration were updated.The actions carried out were communicated to the Hospital’s management team and nursing staff.ResultsOf the 321 pharmaceutical forms included in the INSHT list, 134 were excluded (not included in the pharmacotherapeutic guide) and four were withdrawn from the guide because of the low level of consumption.The 183 drugs included were classified as: 101 from group 1, 44 from group 2 and 38 from group 3.The HD were classified according to the actions carried out in six groups:64 parenteral antineoplastic drugs which are prepared in a class IIb Biological Safety Cabinet (IIb–BSC).40 oral antineoplastic drugs for which the pharmacotherapeutic guide and the guidelines for nasogastric drug administration were modified to avoid splitting or crushing. Nursing staff should contact the pharmacy service to assess that the treatment is temporarily stopped, administered via another route or split in a IIb–BSC.15 drugs that do not require any manipulation to compound them (pre–filled syringes, ointments, vaginal tablets and oral solutions).47 oral drugs (groups 2 and 3) for which the pharmacotherapeutic guide and the guidelines for nasogastric drug administration were modified to avoid splitting or crushing.10 drugs that must be reconstituted in a IIb–BSC.7 parenteral drugs with recommendations only if the handler is at reproductive risk.Furthermore, the repackaging process of five drugs and the Standard Operating Procedures of five compounded medications were modified to be carried out inside the IIb-BSC.ConclusionThe actions adopted have supposed a decrease in the risk of occupational exposure in nursing staff, minimising the handling of HD with a consequent increase in safety.These modifications have led to an increase in the workload of the pharmacy service.References and/or AcknowledgementsINSHT recommendations about Hazardous Drugs.2017.No conflict of interest
BackgroundThe double drawer cupboards (DDC) found in the clinical units (CU) allow a better traceability, prevention of medicines expiring and efficiency of peripheral medical stock.PurposeTo check ...and to restructure the DDC storage system in the CU to improve its function with the aim of guaranteeing quality of care and increasing the safety of hospitalised patients.Material and methodsA prospective study was carried out over 3 months in a tertiary hospital which has DDC systems in their CU. An information sheet was compiled with data on which was recorded: requests for inclusion and change of place of medication, a list of medications with change in presentation, and broken or lost cards.ResultsTwenty-three new medicines were included in the DDC after a request from the supervisors of the CU to adapt the contents to actual consumption and speed up the administration of the hospitalised patients’ treatment.The location of 25 medicines was changed, four of which were susceptible to confusion and were found in places nearby, for example diazepam 5 mg and 10 mg tablets. In the rest of the medicines the change of location made the day-to-day work of the CU health personnel easier.Due to the change in presentation of six medicines, we modified 114 labels of the different CU.During the check we came across 74 broken or lost cards which were redone.Two medicines which were officially recognised as a health product by the relevant authorities were withdrawn.With the aim of improving the use of the DDC for the health personnel of the CU, a training programme was carried out reminding them of the correct working of the system, and the list with the cupboards’ contents and position of medicines were updated.ConclusionThe new technology applied to the storage of medicines in the CU constitutes a support system which allows for an increase in safety and quality in the whole care process, requiring the involvement of the supervisors of the CU as well as the Pharmacy Service.With this pharmaceutical intervention we reduced the incidence of administration errors, thus increasing the patients’ safety.No conflict of interest
Background and importanceTherapeutic equivalents are drugs with a different chemical structure but with similar therapeutic and adverse effect profiles when equivalent doses are administered.Aim and ...objectivesTo analyse the pharmacotherapeutic interventions of proposing therapeutic equivalents (PIPTEs) for prescribed not included in the pharmacotherapeutic guide medications (NIGM), as well as their degree of acceptance.Material and methodsA retrospective observational study was carried out over a period of 2 months. The PIPTEs were realised during pharmaceutical validation. The following items were collected: age, sex, prescribed NIGM, acceptance of the PIPTE (it was considered accepted when changes were generated in the prescription), measure adopted by the doctor (change to the proposed equivalent, change to another equivalent, patient contribution or suspension of treatment) and the medical service.ResultsA total of 211 patients (122 men) with a median of 76 years (20–98 years) were reviewed. A total of 2197 interventions were performed: 1294 (58.9%) were about NIGM. Of these, 228 (17.62%) were PIPTEs, with the following distribution according to pharmacotherapeutic group: 78 (34.21%) ARA-II, 65 (28.5%) ACEIs, 34 (14.91%) statins, 32 (14.05%) calcium antagonists, 5 (2.19%) PPIs, 1 (0.44%) anti-H2 and 13 (5.7%) of other groups.Most of the PIPTEs were accepted (79.82% (182)). The degree of acceptance of each pharmacotherapeutic group was: 79.49% (62) for ARA-II, 89.23% (58) for ACEIs, 73.53% (25) for statins, 75.0% (24) for calcium antagonists, 40.0% (2) for PPIs, 100% (1) for anti-H2 and 69.23% (9) for other groups.In 52.19% (95) of cases, the proposed therapeutic equivalent was changed (25 ARA-II, 41 ACEIs, 13 calcium antagonists, 10 statins, 2 PPIs, 1 anti-H2 and 3 other groups). In 25.82% (47) of patients the drug was contributed by the patient, 14.84% (27) were suspended and 7.14% (13) were changed to a drug different from the one proposed.Conclusion and relevanceThe majority of the interventions performed by pharmacists were in relation to NIGM. ARA-II and ACEIs were the groups with the highest number of PIPTEs. More than 75% of the PIPTEs caused a change in the prescription, which resulted in more than 50% of cases substituting the NIGM for the equivalent proposed by the pharmacy service. This reflects the great contribution of the hospital pharmacist to therapeutic exchange programmes.References and/or acknowledgementsNo conflict of interest.
Background and importanceThe new direct acting antivirals (DAAs), indicated in chronic hepatitis C (HCV), show a sustained virological response at 12 weeks (SVR12) >90% in clinical trials, with worse ...results in patients with genotype 3.Aim and objectivesTo analyse the effectiveness of the new DAAs in a real cohort of HCV patients during 2018, and establish if there are differences between genotypes.Material and methodsThis was a retrospective observational study including all patients treated with DAAs in 2018. The variables collected were: age, sex, HCV/HIV coinfection, genotype (G), degree of fibrosis (F), previous treatments, basal viral load (BVL), treatment duration, viral load at 12 weeks post-treatment, adherence and adverse effects (AEs). Effectiveness was evaluated according to SVR12.ResultsNinety-one patients (57.1% men) received treatment with DAAs, with a mean age of 55.6±10.4 years; 20 (22%) were coinfected with HIV, and 55 (60,4%) had BVL >800 000 UI/mL. The genotype distribution was: 29 (31.9%) G1a, 28 (30.8%) G1b, 1 (1.1%) G2, 15 (16.5%) G3 and 18 (19.8%) G4. Degree of fibrosis: 27 F0–F1, 16 F1, 10 F2, 15 F3, 2 F3–F4 and 14 F4; 7 (7.7%) patients were without data (WD). There were 75 (82.4%) naive patients; 6 had received treatment with DAAs (2 with two different lines).Treatment distribution was: 36 (39.6%) glecaprevir/pibrentasvir, 28 for 8 weeks and 8 for 12 weeks; 29 (31.9%) elbasvir/grazoprevir, 28 for 12 weeks and 1 for 16 weeks; 23 (25.3%) sofosbuvir/velpatasvir for 2 weeks, 2 with ribavirin; 1 (1.1%) ledipasvir/sofosbuvir for 8 weeks; 2 (2.2%) sofosbuvir/velpatasvir/voxilaprevir for 12 weeks, both after relapse to two previous lines with DAAs.The response observed was: glecaprevir/pibrentasvir 32 SVR12, 3 WD and 1 treatment suspension because of the patient‘s poor clinical condition; elbasvir/grazoprevir 26 SVR12 and 3 WD; sofosbuvir/velpatasvir 17 SVR12, 3 WD, 1 died (sepsis) and 2 virological failure (VF) (both G3, 1 F3, 1 F4, 1 relapsed to DAAs); ledipasvir/sofosbuvir: 1 SRV12; sofosbuvir/velpatasvir/voxilaprevir 2 SRV12. Of the total evaluable responses (n=80), 78 (97.5%) SRV12 and 2 (2.5%) VF were observed.Conclusion and relevanceOur data confirm the effectiveness of the new DAAs, with SVR12 >95%, and are consistent with clinical trials which show that patients with G3 have the worst SVR12 rates.References and/or acknowledgementsNo conflict of interest.
BackgroundAs many medicines are not available for paedriatic use they have to be elaborated in the pharmacy service. Generally, there are different formulations described in the ...bibliography.PurposeTo compare two liquid formulations of omeprazole elaborated in the pharmacy service of a tertiary hospital evaluating physicochemical stability and organoleptic characteristics (OC) with the aim of defining the most ideal formulation.Material and methodsA bibliographic check of the different formulations of omeprazole was carried out and two liquid magistral preparations were elaborated in triplicate. Formulation 1 was prepared from omeprazole monohydrate salt, using as excipients: simple syrup, mixture conservans and purified water. Formulation 2 was prepared from omeprazole capsules using bicarbonate 1 M as excipient. Conditions of refrigeration and of light protection were established. As an indicator of physicochemical stability, the pH was selected. For its determination a pH measurer, Mettler Toledo SevenMulti was used. The data was analysed using an Excel 2010 spreadsheet. The results were expressed as average ±SD. Also colour, smell and taste (OC) were evaluated, as well as homogeneity of the formulations. Thirty days was established as a period of study. The determinations were carried out on days 0,10,17,24 and 30 post-elaboration.ResultsThe pH was stable with barely any oscillations during the period of study. The data obtained for formulation 1 was: 8.476±0.012 (sample 1), 8.544±0.01 (sample 2) and 8.547±0.018 (sample 3). For formulation 2 it was: 6.777±0.026 (sample 1), 6.373±0.005 (sample 2) and 6.382±0.003 (sample 3).The homogeneity of the formulations remained stable. The OC fluctuated significantly during the period of study. The colour of formulation 1 evolved from amber and opaque to dark brown, and the smell evolved from sweet to metallic and the taste (bitter-sweet) remained stable. In formulation 2 the opaque white colour and the disagreeable metallic smell remained unchanged. The taste changed, from very bitter to salty.ConclusionIn both formulations the pH remained stable.The formulation based on raw material presents significant changes in OC, mainly in colour.With regard to the formulation whose elaboration is made from capsules, the OC remained more stable.As a result of this, it was decided to establish formulation 2 as a preferential formula in spite of its more disagreeable taste.References and/or acknowledgementsNo conflict of interest.
BackgroundMucositis is a complication arising from chemotherapy that reduces the quality of life of a cancer patient. Its prevention and treatment are important.PurposeTo evaluate the effectiveness ...and satisfaction of the suspension for mucositis elaborated in the pharmacy service, destined for patients with mucositis as a consequence of cytostatic treatment, in order to identify where improvement is needed.Material and methodsObservational descriptive study for 1 month. Patients who attended the oncohematological day hospital to receive treatment and to pick up the suspension for mucositis were included. The master formula was composed of nystatin, methylprednisolone, mepivacaine, gentamicin and 1/6 M bicarbonate.All the patients who agreed to participate in the study were given an anonymous questionnaire. It included information about demographics, pathology, (degree of mucositis according to the World Health Organisation), tolerability, effectiveness and patient satisfaction. The replies referred to qualitative dichotomous or polytomous variables, with nominal or ordinal gradations. The replies were analysed via an Excel 2010 spreadsheet.ResultsSixty-nine questionnaires were collected. Twenty-six were men and four were excluded from the study for lack of information. The average age of the patients was 63±10.83 years old.The patients were classified based on the degree of mucositis: 21 patients grade 0, 19 grade 1, 23 grade 2, one grade 3 and one grade 4.Fifty-six patients (86.15%) indicated a considerable improvement in symptoms after the use of the master formula after 2–4 days of use. In five (7.69%) patients there was no improvement.As for the taste, the valuation of the majority (64.68%) was that it was disagreeable.In general, the valuation of the master formula was: 1 (3.07%), 2 (9.23%), 3 (40%), 4 (36.92%) and 5 (10.77%), 1 being nothing, 2 being a little, 3 being quite a bit, 4 being a lot and 5 being totally satisfactory.ConclusionThe master formula for mucositis elaborated in the pharmacy service is effectiveness in the control of the symptoms of mucositis in more than 90% of patients.The patients showed a high degree of satisfaction globally, palatability being the factor that required improvement. As an opportunity to improve we found the study of flavourings compatible with the formula and that they did not interfere with the therapeutic effect.References and/or acknowledgementsNo conflict of interest.
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