BackgroundEvaluation of patient satisfaction with outpatient pharmacy services (OPS) is important to help identify areas that require improvement and enhance positive changes in the service.PurposeTo ...analyse the evolution of patient satisfaction with the services of an outpatient pharmacy of a tertiary hospital, and compare the results with those of other OPS.Material and methodsA retrospective comparative study of the results of a satisfaction survey carried out on outpatients in 2015, 2016 and 2017 at a tertiary hospital, and a review of results reported by other OPS at the National Congress of Hospital Pharmacy.The survey consisted of four parts:general questions (sex, age, frequency of visits).organisation.time;quality of the information given by the pharmacy technician;hospital staff correctly identified;privacy;satisfaction with the services of the pharmacy technicians.pharmacists.availability for consultation;satisfaction with the information given by the pharmacist;satisfaction with pharmacist care;time dedicated to the consultation;overall satisfaction.Answers of b), c) and d) were scored as follows: 1=very bad, 2=bad, 3=normal, 4=good, 5=very good. There were several free text boxes to add observations. A mathematical adjustment was made for the transformation of the scale from 1–5 to 1–10.Over the 3 years, improvements were made, such as an appointment calendar, staff identification cards and a parking area for patients.ResultsOne-hundred and eight, 104 and 84 surveys were completed in 2015, 2016 and 2017, respectively. Average scores for each question in 2015, 2016 and 2017 respectively were: b. 1) 6.84; 7.10; 6.67; b. 2) 8.31; 8.37; 8.19; b. 3) 7.80; 8.98; 8.32; b. 4) 7.17; 8.99; 5.57; b. 5) 9.11; 9.53; 8.84; c. 1) 7.70; 9.03; 8.51; c. 2) 8.00; 9.44; 8.91; c. 3) 8.58; 9.58; 9.17; c. 4) 7.45; 9.12; 8.42;and d) 8.29; 9.08; 8.67.Observations were excessive waiting times, opening hours and location.The results of six other OPS were reviewed.ConclusionSatisfaction surveys are useful tools to gain knowledge about patients’ preferences and needs, and implementing future actions to improve the service. A good maintained score was observed for the services and care given by pharmacy technicians and pharmacists. Waiting times obtained the worst score consecutively. The worst-rated aspects were waiting times and opening hours, coinciding with the results reviewed of other OPS.References and/or acknowledgementsNo conflict of interest.
The Vapor Pressure Deficit (VPD) is one of the most relevant surface meteorological variables; with important implications in ecology, hydrology, and atmosphere. By understanding the processes ...involved in the variability and trend of the VPD, it is possible to assess the possible impacts and implications related to both physical and human environments, like plant function, water use efficiency, net ecosystem production, atmospheric CO2 growth rate, etc. This study analysed recent temporal variability and trends in VPD in Spain between 1980 and 2020 using a recently developed high-quality dataset. Also, the connection between VPD and soil moisture and other key climate variables (e.g. air temperature, precipitation, and relative humidity) was assessed on different time scales varying from weekly to annual. The objective was to determine if changes in land-atmosphere feedbacks connected with soil moisture and evapotranspiration anomalies have been relevant to assess the interannual variability and trends in VPD. Results demonstrate that VPD exhibited a clear seasonality and dominant positive trends on both the seasonal (mainly spring and summer) and annual scales. Rather, trends were statistically non-significant (p > 0.05) during winter and autumn. Spatially, VPD positive trends were more pronounced in southern and eastern of Spain. Also, results suggest that recent trends of VPD shows low contribution of variables that drive land-atmosphere feedbacks (e.g. evapotranspiration, and soil moisture) in comparison to the role of global warming processes. Notably, the variability of VPD seems to be less coupled with soil moisture variability during summertime, while it is better interrelated during winter, indicating that VPD variability would be mostly related to climate variability mechanisms that control temperature and relative humidity than to land-atmosohere feedbacks. Overall, our findings highlight the importance of assessing driving forces and physical mechanisms that control VPD variability using high-quality climate datasets, especially, in semiarid and sub-humid regions of the world.
•Increase of Vapor Pressure Deficit in Spain in the last decades, particularly in summer season.•The increase of Vapor Pressure Deficit is principally related to warming processes.•There is not connection between Vapor Pressure Deficit and soil moisture variability an important role of land atmosphere feedbacks.
BackgroundFentanyl sublingual tablets are indicated for the management of breakthrough pain in cancer patients who are already receiving, and tolerant to, around-the-clock opioid therapy for ...persistent cancer pain.PurposeTo evaluate the use of fentanyl sublingual tablets in our hospital.Material and methodsRetrospective observational study from June 2017 to February 2018 where all hospitalised patients who were receiving sublingual fentanyl tablets were included.A database was developed in which demographical data (age and sex), service of the prescribing doctor, prescribed doses and indication of sublingual fentanyl were collected.ResultsWe studied 164 patients in total, 80 (48.78%) were males and 84 (51.22%) were females with a median age of 60.25 years’ old.Ninety-six (58.54%) were cancer patients of which 79 (82.30%) were patients with breakthrough pain who were already in treatment with other opioids, eight (8.33%) had an established dose without condition of the pain the patient was suffering and nine (9.38%) did not have the prescription in their computerised clinical history.The most diagnosed cancers in these patients were: 17 lung (17.70%), 11 colon (11.46%), eight pancreas (8.33%) and six mammary gland (6.25%).The remaining 68 (41.46%) patients were not cancer patients. The most common pains for which sublingual fentanyl was used were: 13 (19.12%) postoperatory pain, 10 (14.71%) rheumatoid pain, six (8.82%) diabetic foot disease, six (8.82%) ischaemias due to a vascular disease, five (7.35%) uncontrolled postpartum pain and four uncontrolled pain after a traumatism. Three (4.41%) of the non-cancer patients used sublingual fentanyl tablets with an established dose without a breakthrough pain.In total, the prescription of fentanyl sublingual tablets in the computerised clinical history of the patients was not found 18 times (10.98%). The maximun number of tablets were not specified in 55 patients (33.54%).The most common services that prescribed the medication were: 20 (29.41%) anaesthesia, 12 (17.65%) vascular angiology and 11 (16.18%) rheumatology.ConclusionThere are several patients in treatment with sublingual fentanyl that do not fit in its approved indication in our hospital.Pharmacists must participate in the development of guidelines to ensure the indication of fentanyl sublingual tablets is correct and to try to decrease the drug dependence related to its uncontrolled use.References and/or acknowledgementsI would like to express my gratitude to my co-workers for helping with this research.No conflict of interest.
BackgroundIn post-PA studies in the use of erlotoinib, it was observed that the favourable clinical situation benefited the response to treatment.PurposeTo compare the effectiveness and safety of ...erlotinib, according to the Eastern Cooperative Oncology Group (ECOG), in pancreatic cancer.Material and methodsRetrospective observational study with pancreatic cancer patients treated with erlotinib, in a third-level care hospital from January 2009 to March 2017. A database was developed with demographic, clinical (Selene®) and pharmacotherapeutic data (Savac®). The data were analysed with SPSS® (version23). The level of statistical significance was p≤0.05.ResultsWe obtained 34 patients, excluding one patient due to insufficiente clinical data. The remaining 33 patients: 57.58% males with a median age of 60.8 years (IQR :54–67). Eighteen patients (54.55%) were smokers. In 28 patients (84.85%), the disease was metastatic and and in five, locally advanced. Erlotinib was used in 15 patients such as the first line (with gemcitabine in 14 of them). Erlotinib in the second line was used in 11 (nine with gemcitabine and one with capecitabine) and seven in the third line (six with gemcitabine).The median progression-free survival (PFS) of the 33 patients was 2.4 months (RI: 1.57–5) and the median overall survival (OS) was 6 months (RI: 2.17–12.17).Subgroup analysis according to ECOG at the start of treatment: characteristics were: a) ECOG <2 (n=17) (ECOG 0 (n=4; 12.12%) and ECOG 1 (n=13; 39.39%)). 58.82% were males with a median age of 59 years (RI: 50–66). Eleven of these patients were smokers and 14 had metastatic disease. Erlotinib was used in the first line in 12 (70.59%) patients, two patients in the second line and 3 in the third line.b) ECOG ≥2 (n=6) (ECOG 2 (n=13; 39.39%) and ECOG 3 (n=3; 9.09%)). 56.25% males with a median age of 61 years (RI: 57–68.25). Seven patientswere smokers and 14 had metastatic disease. Erlotinib was used in the first line in three patients, in 9 in the third line second line and four in the third line.The median PFS of subgruop ECOG <2 was 4.1 months (RI: 1.83–7) versus subgruop ECOG ≥2 with 1.93 months (RI: 1–2.91) (p=0.116). Median OS was 11.67 months (RI: 6–20.17) versus 3.45 months (RI:1.47–6. 02) (p=0.049), respectively. Two patients with ECOG <2 discontinued erlotinib for cutaneous toxicity and renal failure, respectively. The remaining patients discontinued treatment due to disease progression and/or death.ConclusionPatients’ conditions before starting treatment is a determining factor in OS results, however it is not a determinant for PFS. The toxicity was frequent with ECOG <2 but we have not studied the dose influence.Pharmacists must participate in the development of guidelines where patients who will benefit most were selected for treatment with erlotinib.References and/or AcknowledgementsPA. 3 studyNo conflict of interest
Zoonosis in Colombia is a subject of high epidemiological importance due to the transmission of pathogens to humans. T. gondii is an intracellular parasite (transmitted to human population) that ...causes various congenital diseases; including chorioretinitis, microcephaly, hydrocephaly, encephalomyelitis, mental retardation and hepatosplenomegaly, among others. The parasite affects also immunocompromissed patients that suffer from any type of cancer, organ transplantation and HIV. A deeper study on toxoplasmosis requires analysis of the developmental stages of the parasite, including the cyst stage, which allows it to evade the immune system and to get established in the host organism permanently. The goal of this work was to develop a digital image processing algorithm based on texture recognition to allow automatic detection of the cysts associated to pathogen T. gondii from isolated Colombian native strains in meat samples for human consumption, using computational software Matlab 2013, specifically through the Image Processing Toolbox. This algorithm allowed to segment the biological images, highlighting typical features of the cysts for calculate its eccentricity as a circularity criterion and finally to validate the efficiency of the algorithm.
The scattering through a Josephson junction interrupting a superconducting line is revisited including power leakage. We discuss also how to make tunable and broadband resonant mirrors by ...concatenating junctions. As an application, we show how to construct cavities using these mirrors, thus connecting two research fields: JJ quantum metamaterials and coupled cavity arrays. We finish by discussing the first non-linear corrections to the scattering and their measurable effects.
We searched for new components that are involved in the positive regulation of nuclear gene expression by light by extending a screen for Arabidopsis cue (chlorophyll a/b-binding CAB ...protein-underexpressed) mutants (H.-M. Li, K. Culligan, R.A. Dixon, J. Chory 1995 Plant Cell 7: 1599-1610). cue mutants display reduced expression of the CAB3 gene, which encodes light-harvesting chlorophyll protein, the main chloroplast antenna. The new mutants can be divided into (a) phytochrome-deficient mutants (hy1 and phyB), (b) virescent or delayed-greening mutants (cue3, cue6, and cue8), and (c) uniformly pale mutants (cue4 and cue9). For each of the mutants, the reduction in CAB expression correlates with the visible phenotype, defective chloroplast development, and reduced abundance of the light-harvesting chlorophyll protein. Levels of protochlorophyllide oxidoreductase (POR) were reduced to varying degrees in etiolated mutant seedlings. In the dark, whereas the virescent mutants displayed reduced CAB expression and the lowest levels of POR protein, the other mutants expressed CAB and accumulated POR at near wild-type levels. All of the mutants, with the exception of cue6, were compromised in their ability to derepress CAB expression in response to phytochrome activation. Based on these results, we propose that the previously postulated plastid-derived signal is closely involved in the pathway through which phytochrome regulates the expression of nuclear genes encoding plastid proteins
Le droit des données, pierre angulaire de la transition d’une société industrielle à une société numérique, joue un rôle particulièrement important pour promouvoir la gouvernance mondiale de ...l’Internet et bâtir une communauté de destin dans le cyberespace. Dans la continuité de l’ouvrage Loi sur les droits numériques 1.0 : Fondements théoriques, le Droit des données 2.0 : Construction du système de droits propose de manière innovante le postulat de l’homo numericus, qui élargit le champ de recherche juridique et enrichit la notion de l’homme dans une perspective juridique. L’ouvrage offre une analyse de trois principaux types de droits en matière de données : droits sur les données, droit de partage et souveraineté des données. Il répond aux instructions du président chinois Xi Jinping présentées dans sa lettre de félicitation au « Big Data Expo 2019 », dans laquelle il a souligné que « nous devrions saisir les opportunités du développement numérique, connecté et intelligent, bien gérer les défis juridiques, de sécurité et de gouvernance liés au développement des mégadonnées ».
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