El proceso de institucionalización de la enfermera gestora de casos en España. Análisis comparativo entre los sistemas autonómicos de salud

Care of chronicity is a pressing issue for health systems because of its high prevalence and the organisational challenges that it generates. Different countries solve the complexity of the care of chronicity through case management by the nursing profession, obtaining good results.This paper analyses the status of institutionalisation of the case management nurse in Spain through the design of a reference standard to compare between the autonomous communities in their approach to chronicity. Thus, we sought to monitor the degree of progress of the institutional structure of the policies for the care of chronicity in our country through this healthcare professional. Our results showed that no autonomous community has reached the maximum standard of implementation and that the situation is very heterogeneous, confirming a weak and erratic degree of institutionalisation of the case management nurse in Spain despite the formal recognition of their role in patient care.     

注射用两性霉素B治疗艾滋病/HIV感染合并深部真菌感染的不良反应及防护

目的:为临床合理应用注射用两性霉素B(AMB)治疗人类免疫缺陷病毒(HIV)感染或艾滋病(AIDS)合并深部真菌感染提供参考。方法:收集某院2010年1月至2012年2月期间住院治疗的3 202例HIV/AIDS患者的临床资料,分析其中使用AMB治疗深部真菌感染患者的不良反应(ADR)发生及防护。结果:HIV/AIDS合并深部真菌感染患者948例,感染率为29.61%;899例使用AMB,其中18例出现ADR,发生率为2.00%。AMB静脉滴注的ADR主要表现为发热、腹泻、瘙痒、肝功能异常及血液系统毒性。及时停药或减量,同时对症治疗,可有效地减少、减轻药物的ADR。结论:AMB虽ADR多见,但其疗效确切,是治疗HIV/AIDS合并深部真菌感染比较安全、有效、经济的选择。只要合理用药,严密监测用药后患者病情进展,尽早发现ADR,及时采取有效措施,并将心理护理贯穿治疗始终,就能保证患者治疗的顺利进行。     

Psychopharmacology of the negative symptoms: Current status and prospects for progress

The past decade has witnessed a resurgence of interest in the development of novel pharmacological agents to treat the negative symptoms of schizophrenia. This review provides an overview of pharmacological approaches that have been evaluated as potential treatments and describes the emergence of several promising new approaches. First, we briefly describe recent methodological developments, including consensus-based clinical trial guidelines for patient selection criteria, symptom assessment, and trial duration. Next, we overview mono- and adjunctive-therapies that have been evaluated, including first- and second-generation antipsychotics, antidepressants, psychostimulants, molecules targeting cholinergic and glutamatergic systems, and hormones. We highlight the most promising pharmacological agents on the horizon, including glycine transporter-1 inhibitors, α7-nicotinic receptor positive allosteric modulators, and oxytocin, as well as non-pharmacological electromagnetic stimulation approaches. Further investigations, using optimal clinical trial design, hold considerable promise for discovering effective treatments for these functionally disabling symptoms in the near future.     

In vitro and in vivo correlation for lipid-based formulations: Current status and future perspectives

Lipid-based formulations (LBFs) have demonstrated a great potential in enhancing the oral absorption of poorly water-soluble drugs. However, construction of in vitro and in vivo correlations (IVIVCs) for LBFs is quite challenging, owing to a complex in vivo processing of these formulations. In this paper, we start with a brief introduction on the gastrointestinal digestion of lipid/LBFs and its relation to enhanced oral drug absorption; based on the concept of IVIVCs, the current status of in vitro models to establish IVIVCs for LBFs is reviewed, while future perspectives in this field are discussed. In vitro tests, which facilitate the understanding and prediction of the in vivo performance of solid dosage forms, frequently fail to mimic the in vivo processing of LBFs, leading to inconsistent results. In vitro digestion models, which more closely simulate gastrointestinal physiology, are a more promising option. Despite some successes in IVIVC modeling, the accuracy and consistency of these models are yet to be validated, particularly for human data. A reliable IVIVC model can not only reduce the risk, time, and cost of formulation development but can also contribute to the formulation design and optimization, thus promoting the clinical translation of LBFs.     

Vitamin D supplementation and lipid profile: What does the best available evidence show?

Vitamin D supplements have increasingly been used for the treatment and prevention of osteoporosis. Historically, effects of the vitamin on the cardiovascular (CV) system have been proposed and demonstrated in the literature, including benefits on serum lipids. Although observational studies support an association between increased serum vitamin D levels and a favorable lipid profile, interventional studies have shown no effects.