El Papel del Bibliotecario Integrado en las Comisiones Clínicas, Docencia Postgraduada e Investigación en el Área Sanitaria Este de Málaga-Axarquía (ASEMA)

The concept of Library of the Health Sciences has noticeably changed during the last decade. The embedded librarian is a recently emerged figure, who works as a member of multidisciplinary groups with the mission of providing them with relevant literature as well as media for acquisition, exchange and dissemination of information. This figure has been gradually implanted in some committees of the ASEMA. The objective of the present work is to describe the functions of the embedded librarian and its results in our area.

Foto de familia, un estudio descriptivo de los recursos de información científica en las bibliotecas del Sistema Sanitario Público Español

G17+1 está integrado por: Elena Primo (Biblioteca Nacional de Ciencias de la Salud), Verónica Juan (BV Andalucía), Montserrat Salas (BV Aragón), Mercedes Corrales y Raquel Lavandera (BV Asturias), Virgili Paéz (BV Baleares), Beatriz Duque (BV Canarias), Fanny Ribes (BV Cantabria), Marisa Alonso (BV Castilla-La Mancha), Pilar Díaz Ruiz (BV Castilla y León), Pilar Roqué (BV Cataluña), Francisco Javier Moreno (BV Extremadura), Teresa Mejuto (BV Galicia), Mayra García Berges y José Manuel Estrada (BV Madrid), Enrique Aguinaga y Juan Antonio Sánchez Sánchez (BV Murcia), Idoia Gaminde (BV Navarra) y Ricardo Aróstegui y Mª Asunción García Martín (BV País Vasco).

El informe sanitario como instrumento para la protección de la salud ambiental

The difficult mission of monitoring environmental health requires that public authorities react by making decisions that safeguard public health. A health report is a tool developed by professionals who give technical advice and provide specialized knowledge to decision-making power bodies to support the management of environmental health risks. This article pays special attention to the main features that characterize the work of this type of administrative document and its functional value and describes some of the problems related to the use of the health report in public management in order to improve the effects of the administrative action. We provide an overview of the fields of intervention requiring the issuance of health reports in the environmental health sphere within the Andalusian public administration in order to present the most recent advances in environmental health protection.

Benzodiazepinas: riesgos y estrategias para su retirada

Benzodiazepines and hypnotic Z-drugs are indicated for the short-term treatment of insomnia and anxiety (4 weeks maximum) at the lowest dose possible. Despite the recommendations for short-term use and its unfavourable effects, the level of consumption of benzodiazepines in our context is high and it is continually rising. Prolonged medication usage is associated with adverse effects and significant risks, particularly in the elderly, and should, therefore, be avoided when approaching new treatment. If a previous treatment assessed is found to be inappropriate, its possible withdrawal must be considered. Benzodiazepines withdrawal is based on a gradual dose reduction and should be managed by establishing a doctor-patient relationship of trust to encourage and accomplish discontinuation.

Tratamiento farmacológico de la EPOC estable

Pharmacological treatment of patients with stable COPD should be individualised. Inhaled bronchodilators are the mainstay of pharmacological treatment for COPD. Long-acting medications (LABA or LAMA) are recommended over short-acting agents (SABA or SAMA). Short-acting bronchodilators are used on demand to rapidly control symptoms regardless of level of severity. Long-acting bronchodilators are used as maintenance therapy and are the mainstay of treatment in patients with permanent symptoms. Initial treatment for COPD is monotherapy with a long-acting bronchodilator. Clinical practice guidelines do not specify the best bronchodilator to use. The choice should be made on an individual basis, taking into account the patient’s preferences, response to treatment, its potential side effects and cost. When monotherapy fails to control symptoms, the first recommended step is to check medication adherence, inhaler technique and adequacy of inhalation device, and if these are correct but monotherapy is still insufficient, treatment should be intensified with combined inhaled therapies. Most clinical practice guidelines recommend the use of long-term therapy with LABA+inhaled corticosteroids in patients who experience frequent exacerbations and with FEV1 <50%. Long-term monotherapy with inhaled corticosteroids or oral corticosteroids is not recommended, and neither is the regular use of mucolytics nor the use of roflumilast.

Dapagliflozina

Dapagliflozin is a new oral antidiabetic agent whose mechanism of action increases renal glucose excretion, independently of insulin secretion or insulin action. The efficacy of dapagliflozin is dependent on renal function. The use of dapagliflozin has been licensed to improve glycaemic control in patients with type 2 diabetes mellitus as: - monotherapy when diet and exercise alone do not provide adequate glycaemic control in patients for whom the use of metformin is considered inappropriate due to intolerance. - Add-on combination therapy with other glucose-lowering agents including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. Funding has been restricted to the use of dapagliflozin, prior approval, as dual therapy in combination with metformin. This report aims to assess the efficacy and safety of dapagliflozin in the treatment of type 2 diabetes mellitus, rate the added therapeutic value of dapagliflozin in type 2 diabetes mellitus and identify its current place in therapy. A systematic literature search was carried out, for the purpose of this evaluation, using PubMed, Embase, Cochrane and IDIS databases as well as other secondary sources of evidence-based medicine, therapeutic bulletins and national and international drug agencies. Following the critical reading and analysis of the selected articles, a summary is made out of the scientific evidence available, using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Only one randomised clinical trial, out of the ten trials found, was considered to be a suitable comparison (versus a dual therapy in combination with the sulfonylurea glipizide in patients inadequately controlled with metformin, diet and exercise). No trials have evaluated variables of relevance to patients, except for safety variables. The main efficacy variable in the trials was the change from baseline in HbA1c, except for a study which evaluated the change from baseline in total body weight as main variable. Baseline characteristics of the patients enrolled in the trials significantly differ from those of the population with diabetes in our society which tend to be of an older age and have a longer history of type 2 diabetes mellitus. The major limitation of dapagliflozin derives from its mechanism of action, since its efficacy decreases as renal function declines. The use of dapagliflozin is not recommended in patients with moderate to severe renal impairment ((CrCl<60ml/min or GFG <60 ml/min/1.73 m2) nor in elderly patients, in which a decrease in renal function can be expected. The assessment of safety includes the incidence and rate of discontinuations due to adverse events, episodes of hypoglycaemia, signs or symptoms of genital and urinary tract infections, dehydration, hypovolaemia and hypotension. Further pharmacoepidemiological studies are to be carried out to clarify the long-term effects of dapagliflozin on renal function and the potential effect in the development of breast and bladder tumours. Dapagliflozin as monotherapy has not been evaluated against adequate comparators (sulfonylureas, pioglitazone, gliptins). In combination therapy with metformin, the efficacy of dapagliflozin was shown to be non-inferior to glipizide plus metformin, resulting in a mean reduction of 0.52% in HbA1c, with a difference of 0.00 among both groups (95% CI: -0.11 a 0.11). There are no comparative data against other second-line treatment options. As shown in the studies, the overall incidence of adverse events with dapagliflozin as monotherapy (21.5%) was similar to that observed with placebo, and greater to that observed with metformin (15.4%). Hypoglycaemia of any type was the adverse event more frequently reported. The incidence of severe hypoglycaemic events observed in most of the studies was low. The overall incidence of adverse events observed in the study that compared dapagliflozin+metformin against glipizide+metformin was similar for both groups (27%) and incidence of hypoglycaemic events with dapagliflozin (3.5%) was significantly lower to that observed with glipizide (40.8%). Reductions of body weight of about 2 to 3 kg and a slight decrease in blood pressure (1 to 5 mmHg) have been observed in all studies in the groups treated with dapagliflozin together with diet and exercise. Dosing scheme (every 24 hours) is similar to other oral antidiabetic agents and its cost is similar to that for gliptines and higher to that for sulfonylureas or generic pioglitazone. Funding has been limited to the use of dapagliflozin as dual therapy regimen in combination with metformin as an option for patients with contraindication or intolerance to sulfonylureas, such a those experiencing frequent hypoglycaemic events, weight loss associated risks, as long as they are under 75 years of age and have no moderate to severe renal impairment. In the light of the above, we consider dapagliflozin means no therapeutic innovation in the therapy of type 2 diabetes mellitus over other therapeutic alternatives available.

Acceso abierto y repositorios

Entre los ficheros se incluye la presentación realizada como introducción al grupo de trabajo durante las jornadas en mayo de 2014