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Con el objetivo de evaluar la seguridad, aceptabilidad galénica y eficacia del preparado GV-328, actualmente comercializado como complemento dietético, para el tratamiento de la lesión aftosa en los niños, se diseñó un estudio abierto prospectivo, aprobado por el Comité Ético de Investigación Clínica (ODP-ECL-2017-01) de la Universitat International de Catalunya (UIC) y registrado en ClinicalTrials.gov (Identificador: NCT04677062). Todos los padres o tutores de los niños que participaron en el estudio dieron su consentimiento informado de manera voluntaria y escrita. El estudio cumple con los principios éticos en investigación médica en seres humanos establecidos en la Declaración de Helsinki (última actualización octubre 2013). Se incluyeron niños de entre 3 y 13 años atendidos en el Servicio de Odontopediatría de la Clínica Universitaria de Odontología de la UIC afectados por aftas bucales con un máximo de 48 h de evolución (excluyendo las lesiones múltiples o traumáticas y pacientes que estuvieran tomando medicación concomitante y los pacientes diabéticos)1. Todos fueron tratados con el preparado GV-328, en pastillas con ácido hialurónico y cinc, y un soporte de plástico para evitar que se trague de golpe2. Se disuelve lentamente con la saliva como si fuera un caramelo bucal, y actúa tópicamente en la zona afectada. Tanto el contenido en ácido hialurónico (5 mg/pastilla) como en cinc (1 mg/pastilla) pueden considerarse muy seguros para su uso en la población infantil3, 4. El tratamiento en estudio (entre 4 y 6 pastillas al día según la edad) se realizó durante 4 días. info:eu-repo/semantics/publishedVersion

Despite that piperacillin-tazobactam combination is commonly used in critically ill children, increasing evidence suggests that the current dosing schedules are not optimal for these patients. The aim of this work is to develop a population pharmacokinetic model for piperacillin to evaluate the efficacy of standard dosing in children with and without continuous kidney replacement therapy (CKRT) and to propose alternative dosing schemes maximizing target attainment.Four hundred twenty-nine piperacillin concentrations measured in different matrices, obtained from 32 critically ill children (19 without CKRT, 13 with CKRT) receiving 100 mg/kg of piperacillin/tazobactam every 8 hours (increased to 12 hours after the fourth dose) were modelled simultaneously using the population approach with NONMEM 7.4. The percentage of patients with 90% fT MIC and target attainment (percentage of dosing interval above MIC) were estimated for different intermittent and continuous infusions in the studied population.Piperacillin pharmacokinetic was best described with a two-compartment model. Renal, nonrenal, and hemofilter clearances were found to be influenced by the glomerular filtration rate, height (renal clearance), weight (nonrenal clearance), and filter surface (hemofilter clearance). Only seven (37%) children without CKRT and seven (54%) with CKRT achieved 90% fT MIC with the current dosing schedule. Of the alternative regimens evaluated, a 24-hour continuous infusion of 200 mg/kg (CKRT) and 300 mg/kg (no CKRT) provided 100% fT MIC (percent of time free drug remains above the minimum inhibitory concentration) (≤16 mg/L) and target attainments ≥90% across all evaluated MICs.In children with and without CKRT, standard dosing failed to provide an adequate systemic exposure, while prolonged and continuous infusions showed an improved efficacy.

Continuous incisional lidocaine infusion has been proposed as an adjunctive therapy in the management of postoperative pain in adult patients. The aim of this study was to determine the efficacy and safety of a continuous subcutaneous lidocaine infusion in pediatric patients following open heart surgery. All patients receiving a subcutaneous lidocaine infusion in median sternotomy incisions after open heart surgery during 2 consecutive years were included in the study. A historical cohort of patients was used as a control group. Demographic variables (age, size, and surgical procedure), variables related to sedation and analgesia (COMFORT and analgesia scales, drug doses, and duration), and complications were registered. 106 patients in the lidocaine infusion group and 79 patients in the control group were included. Incisional analgesia was effective for the treatment of pain as it reduced the dose and duration of intravenous fentanyl (odds ratio (OR) 6.26, confidence interval (CI) 95%: 2.48-15.97, p = 0.001 ; OR 4.30, CI 95%: 2.09-8.84, p = 0.001 , respectively). The reduction in fentanyl use was more important in children over two years of age. Adverse effects were seen in three children (2.8%): they all had decreased level of consciousness, and one of them presented seizures as well. Two of these three patients had lidocaine levels over 2 mcg/ml. A continuous lidocaine incisional infusion is effective for the treatment of pain after open heart surgery. This procedure reduced intravenous analgesic drug requirements in pediatric patients undergoing a median sternotomy incision. Although the incidence of secondary effects is low, monitoring of neurologic status and lidocaine blood levels are recommended in all patients.

RESUMEN El objetivo fue analizar los cambios en el estado nutricional, presión arterial y patrones dietéticos de jóvenes evaluados durante la primera semana de inducción y seis meses posterior al ingreso a la Facultad de Ciencias de la Salud de una universidad pública de Valparaíso, Chile. Estudio comparativo, con diseño longitudinal de cohorte, análisis por-protocolo. Los patrones dietéticos se determinaron mediante una Encuesta de Tendencia de Consumo Cuantificado, la evaluación antropométrica incluyó mediciones estandarizadas de peso, estatura y perímetro de cintura, la composición corporal se determinó mediante impedancia bioeléctrica, y la presión arterial con esfigmomanómetro digital. Las mediciones se realizaron al inicio y término del primer semestre de 2017 (n= 76). En ambos sexos se observó una ganancia significativa de peso corporal, IMC, masa grasa e incremento de la presión arterial sistólica, además en hombres aumentó el perímetro de cintura y la presión arterial diastólica (p

Disparities persist in breast cancer outcomes between Latina survivors and non-Hispanic Whites. Identifying methods to ensure that Latinas participate in and benefit from translational behavioral medicine research is important to reduce disparities. We developed a “Social Network Research Registry” to enhance Latina survivors’ engagement in research and explored the social networks and research/cancer organization participation in this population. We initially recruited 30 Latina breast cancer survivors (“seeds”) from community organizations and identified other survivors through snowball sampling. Guided by Social Network Analysis, we assessed the structural (e.g., size) and functional (e.g., social support) characteristics of the network, willingness to join the registry, prior research participation, involvement in cancer organizations, and interest in different types of research and roles in research. The resulting network size was 98, including 53 women who enrolled in the study and 45 who were listed in the network but did not enroll. All enrolled participants (N = 53) agreed to be part of the registry. We identified 15 participants who occupied strategic positions as hubs and/or bridges. Women who were currently involved in cancer organizations were more likely to have participated in research (70.3% vs. 18.8%); χ(2) (1, 53) = 11.97, p = .001. Most were interested in surveys/interviews (98%), behavioral interventions (96%), and becoming health promoters (79%). The Social Network Research Registry is an acceptable and feasible strategy to engage underrepresented Latina survivors in research. Social network analysis can be useful to identify members who occupy key positions to enhance recruitment and translational efforts.

Aim The objective of this paper is to identify attribute patterns of influential individuals in intensive care units using unsupervised cluster analysis. Background Despite the acknowledgement that culture of an organisation is critical to improving patient safety, specific methods to shift culture have not been explicitly identified. Methods A social network analysis survey was conducted and an unsupervised cluster analysis was used. Results A total of 100 surveys were gathered. Unsupervised cluster analysis was used to group individuals with similar dimensions highlighting three general genres of influencers: well-rounded, knowledge and relational. Conclusions Culture is created locally by individual influencers. Cluster analysis is an effective way to identify common characteristics among members of an intensive care unit team that are noted as highly influential by their peers. To change culture, identifying and then integrating the influencers in intervention development and dissemination may create more sustainable and effective culture change. Additional studies are ongoing to test the effectiveness of utilising these influencers to disseminate patient safety interventions. Implications for nursing management This study offers an approach that can be helpful in both identifying and understanding influential team members and may be an important aspect of developing methods to change organisational culture.

El presente artículo tiene como objetivo evaluar la participación de las mujeres profesionales de la Universidad de Oriente y su acceso a cargos de dirección, precisando las inequidades de género que se manifiestan en este proceso. El primer resultado estuvo en la caracterización cuantitativa de la presencia de la mujer en las diferentes categorías docentes, científicas, áreas del conocimiento y otros estratos, así como en los diferentes niveles de cargos directivos. Por otra parte, se evaluaron las condiciones que influyen en el empoderamiento de las mujeres, especialmente de las directivas, atendiendo tanto a las condiciones de trabajo como a las estructuras patriarcales de género en que se desenvuelven.

Objective To design an experimental pediatric animal model of acute kidney injury induced by cisplatin. Methods Prospective comparative observational animal study in two different phases. Acute kidney injury was induced using three different doses of cisplatin (2, 3 and 5 mg/kg). The development of nephrotoxicity was assessed 2 to 4 days after cisplatin administration by estimating biochemical parameters, diuresis and renal morphology. Analytical values and renal morphology were compared between 15 piglets treated with cisplatin 3 mg/kg and 15 control piglets in the second phase of the study. Results 41 piglets were studied. The dose of 3 mg/kg administered 48 hours before the experience induced a significant increase in serum creatinine and urea without an increase in potassium levels. Piglets treated with cisplatin 3 mg/kg had significantly higher values of creatinine, urea, phosphate and amylase, less diuresis and lower values of potassium, sodium and bicarbonate than control piglets. Histological findings showed evidence of a dose-dependent increase in renal damage. Conclusions a dose of 3 mg/kg of cisplatin induces a significant alteration in renal function 48 hours after its administration, so it can be used as a pediatric animal model of non-oliguric acute kidney injury.

OBJECTIVE: Despite the benefits of hormonal therapy (HT) adherence remains suboptimal in ER positive breast cancer patients. Medication adherence is challenging to assess and tends to be overestimated. The Digital Health Feedback System (DHFS) consists of an ingestible sensor attached to a pill that sends intake date and time to a smart phone or computer. Patients can share this information with health care providers and other persons. The DHFS can also send reminders. This mixed methods study examined providers’ perceptions of HT medication adherence. The potential role of the DHFS in enhancing medication tracking and adherence was also explored. METHODS: We conducted semi-structured interviews with key informants (N=10). Questions examined perceptions about adherence barriers and facilitators, challenges tracking adherence, and views on the DHFS. Findings informed the development of a survey that was administered online (N=19). RESULTS: Providers emphasized the importance of fostering open and trustful communication around adherence. The most mentioned challenges to assessing adherence were the patient not disclosing discontinuation immediately (78.9%) and over-reporting adherence (57.9%). The perceived potential benefits of DHFS were the ability to track adherence better (94.7%) and reminders to take the medication (68.4%). Safety to ingest a sensor was as a major perceived barrier (8 4.2%). CONCLUSION: Interventions that target providers and doctor-patient communication are warranted to enhance adherence and reduce communication delays around HT discontinuation. PRACTICE IMPLICATIONS: DHFS has the potential to enhance HT adherence by directly targeting barriers. Future studies should also examine the feasibility of adopting the DHFS with cancer patients.

Las universidades tienen una responsabilidad social con la formación de profesionales. Mantener una estabilidad en su claustro constituye una necesidad, por cuanto garantiza los recursos humanos calificados para el logro de la calidad educacional e investigativa. En contradicción con esta condición, en América Latina y el Caribe se ha producido un incremento de la emigración calificada hacia países desarrollados, muchos de esos emigrantes procedentes de centros universitarios. Cuba no está exenta de este proceso, y ha sido incluida dentro de las corrientes de robo de cerebros. La Universidad de Oriente (UO), de Santiago de Cuba, presentó una movilidad creciente de su claustro entre los años 2004 y 2013, en la que las emigraciones al exterior tienen una incidencia considerable. Fue motivo de atención en el presente trabajo los factores que están asociados a este tipo de movilidad. Para la recogida de información se procesó estadísticamente la información contenida en las bases de datos de la universidad, al tiempo que se aplicaron entrevistas a informantes claves y a docentes de la misma que hayan emigrado. Se utilizaron, además, los datos recogidos en el cuestionario aplicado a docentes del claustro de dicha universidad por el proyecto donde se insertan las autoras. Se reveló la necesidad de prestar atención a factores que se relacionan con la emigración de profesionales en la UO tales como: condiciones socioeconómicas, políticas migratorias, sus insatisfacciones profesionales y condiciones laborales en su relación agente- estructura. Universities have a social responsibility with the formation of new professionals. Keeping stability on its staff is a must, since that guarantees the qualified human resources to achieve educational and research quality. In opposition to this condition, in Latin America and the Caribbean we found an increase in the emigration indicators of professionals to developed countries, many of them from the university centers. Cuba is not an exception, and it has been included inside the currents of brain robbery. The Oriente University, from Santiago de Cuba, showed an increasing staff mobility between the years 2004 and 2013, with a profound incidence of migration to other countries. A motive of attention in this work was the factors associated to that type mobility. For the collection of information that led to the theoretical analysis, we worked with the databases of the university, together with the application of key informant interviews and professors who have emigrated. Besides, we used the data gathered in the questionnaire prepared by the project in which the authors are inserted, answered by professors of the University. This investigation revealed the need to pay attention to factors relating to the migration of professionals in the UO such as: socioeconomic conditions, migratory policies, their professional dissatisfactions and working conditions in their agent-structure relation.

Desarrollar una Educación Ambiental (EA) sostenible constituyeuna necesidad para lograr cualquier transformación objetiva ysubjetiva en el medio ambiente. Las universidades tienen una gran responsabilidad respecto al tema, debido a su gran podertransformador y capacidad innovadora. Resulta necesaria, entonces, la búsqueda de soluciones a los problemas asociados a la carencia de una EA eficiente y sistemática en la Universidad de Oriente (UO), que repercute en la existencia de problemas ambientales en ella. Para ello, se realizó un análisis en la sede central Antonio Maceo, y su residencia estudiantil, que nos permitiera conocer en profundidad dicha problemática.

Valproic acid (VPA) is the most commonly used antiepileptic drug in pediatric patients, but its major drawback is its multiple pharmacological interactions. Objective To study children who had been simultaneously treated with carbapenems and valproic acid, considering drug levels, pharmacological interactions and clinical follow-up. Material and methods Retrospective study of children who simultaneously received treatment with VPA and carbapenems between January 2003 and December 2011. Demographic variables, indication of treatment, dose, VPA plasma levels, interactions, clinical manifestations and medical management were analyzed. Results 28 children with concomitant treatment with both drugs were included in the study. 64.3% were males. 78.6% of the interactions were observed in the Intensive Care Unit. 60.7% of children had been previously treated VPA and its major indication were generalized seizures. Basal plasma levels of VPA were recorded in 53% and at 24 h after admittance in 60%. “40% of basal VPA levels were below therapeutic range prior to the administration of carbapenem. After the introduction of carbapenem 88% of level determinations were below therapeutic range”. 54.5% of the patients that were chronically receiving VPA and had good control of epilepsy before admission had seizures during the coadministration. One patient that was on VPA before admission but with bad control of epilepsy worsened, and one patient that acutely received VPA did not achieve seizure freedom. In these cases it was necessary to either increase VPA dose or change to a different antiepileptic drug. Conclusions Little is known about the mechanism of pharmacologic interactions between carbapenems and VPA, but it leads to a reduction in plasma levels that may cause a loss of seizure control, so simultaneous use of both drugs should be avoided when possible. If not, VPA levels should be monitored.

Aim The aim of the study was to develop and implement a protocol for the prevention and treatment of catheter related intraluminal thrombosis in a paediatric intensive care unit Methods A computerised search was carried out on MEDLINE, through PubMed, using the medical subject heading ‘central venous catheter’, ‘central venous access device’, ‘central venous line’ associated with ‘occlusion’, ‘obstruction’, ‘catheter-related thrombosis’, ‘critically ill patients’ and ‘thrombolytic therapy’. References of reviewed articles were also searched for relevant titles as well as non-randomised controlled trials and series of cases when no information of higher level of evidence was available. Results With the information gathered, a protocol for the prevention and treatment of catheter related intraluminal thrombosis was elaborated and those recommendations that best suit our environment were included. They were agreed upon by a broad panel of professionals working in the Pediatric Intensive Care Unit and the Pharmacy Department. Conclusions Due to the variety of options available for the pharmacotherapeutic management of intraluminal catheter thrombosis, one measure to improve the quality of the therapy and to diminish the variability in the prescription could be the implementation of a protocol as described in this paper.

El presente artículo tiene como objetivo evaluar la participación de las mujeres profesionales de la Universidad de Oriente y su acceso a cargos de dirección, precisando las inequidades de género que se manifiestan en este proceso. El primer resultado estuvo en la caracterización cuantitativa de la presencia de la mujer en las diferentes categorías docentes, científicas, áreas del conocimiento y otros estratos, así como en los diferentes niveles de cargos directivos. Por otra parte, se evaluaron las condiciones que influyen en el empoderamiento de las mujeres, especialmente de las directivas, atendiendo tanto a las condiciones de trabajo como a las estructuras patriarcales de género en que se desenvuelven.

The aim of the study was to develop and implement a protocol for the prevention and treatment of catheter related intraluminal thrombosis in a paediatric intensive care unitA computerised search was carried out on MEDLINE, through PubMed, using the medical subject heading 'central venous catheter', 'central venous access device', 'central venous line' associated with 'occlusion', 'obstruction', 'catheter-related thrombosis', 'critically ill patients' and 'thrombolytic therapy'. References of reviewed articles were also searched for relevant titles as well as non-randomised controlled trials and series of cases when no information of higher level of evidence was available.With the information gathered, a protocol for the prevention and treatment of catheter related intraluminal thrombosis was elaborated and those recommendations that best suit our environment were included. They were agreed upon by a broad panel of professionals working in the Pediatric Intensive Care Unit and the Pharmacy Department.Due to the variety of options available for the pharmacotherapeutic management of intraluminal catheter thrombosis, one measure to improve the quality of the therapy and to diminish the variability in the prescription could be the implementation of a protocol as described in this paper.

Analysis of Social Networks may be further supported through the collection of ordinal data. Such data may help to determine potentially optimal teams extending across groups or departments through the use of Kruskal‘s Algorithm for the identification of Maximal Spanning Trees. Ordinal assessments of workers by those who have collaborated with them in the past may be aggregated into simple, stratified network visualizations to identify high performing members as well as those who may need re-training or reassignment. Contingency table analysis and the Gamma Test of Monotone Trend may provide further evidence supporting the identification of such individuals. Additionally, the Gamma Test offers a more powerful and informative alternative to the Chi-Squared Test of Independence. These methods stand out as an area for further research in practical settings and may be streamlined into existing research practices with great ease.