BACKGROUND:National data on clinical pharmacy implementation can inform health policy, resource allocation, workforce planning, and academic development. In Chile, such data are limited, particularly for therapeutic drug monitoring (TDM). The objective of this study was to characterize the clinical pharmacy workforce in Chilean hospitals and describe the implementation of core clinical activities, with an emphasis on TDM. METHODS:A national cross-sectional survey was conducted among pharmacists performing clinical functions in Chilean hospitals, using the 2024 registry of the Clinical Pharmacy Division of the Chilean Society of Intensive Care Medicine as the sampling frame. Descriptive analyses were performed; workforce capacity was expressed as full-time equivalents (FTEs) and regional density per 10 000 inhabitants. RESULTS:Of 220 invited pharmacists, 181 responded (82.3%), representing 83 institutions across 15 of 16 administrative regions. Median age was 35 years (interquartile range [IQR] 31-39); 28.2% were registered Clinical Pharmacy Specialists, and 77.1% worked in public hospitals. The highest density was in the Metropolitan Region (0.12 FTE/10000 inhabitants), followed by Tarapacá and Antofagasta (0.09 each). Deployment was most frequent in Infectious Diseases (36.5%) and intensive care units (34.8%). Pharmacotherapy follow-up and medication therapy review were each reported by 94.5%, adverse drug reaction reporting by 87.3%, and involvement in TDM by 85.1%. Teaching and research were reported by 44.8% and 30.4%, respectively, but 95.5% reported no formally protected time. TDM was available in 81.9% of centers, most commonly for vancomycin (80.7%), valproic acid (63.9%), amikacin (60.2%), and phenytoin (57.8%); pharmacokinetic software to support dose individualization was used in 61.4% of centers. CONCLUSION:Clinical pharmacy services in Chile are broadly integrated into hospital care-particularly in infectious diseases, critical care, and TDM-while gaps persist in formal credentialing, regional workforce distribution, and institutional structures supporting academic activities.
OBJECTIVE:To present a standardized and reproducible ten-step approach to ileocolonic anastomosis with natural orifice specimen extraction (NOSE) in the context of laparoscopic or robotic surgery for deep endometriosis. DESIGN:Surgical video article demonstrating a step-by-step technique. SETTING:Tertiary referral center for advanced minimally invasive surgery for deep endometriosis. INTERVENTIONS:Bowel endometriosis involves rectum and sigmoid in 90% of cases [1,2]. NOSE during these procedures have proven to be safe, better cosmesis, lower risk of incisión complications and faster recovery. [3,4]. Excision of deep endometriosis of the distal ileum or cecum can be performed in 10 successive steps [1]. (1) Cecum Mobilization: The lateral peritoneum is incised along the line of Toldt. (2) Dissection of Ileal Mesentery: The mesentery of the terminal ileum is divided up to the planned transection point. (3) Transection of the Ileum: The ileum is transected with a linear stapler at a disease-free segment (4) Removal of Pericecal and Pericolonic Fat: Fat surrounding the cecum and ascending colon is cleared to improve exposure of the bowel wall and facilitate further dissection. (5) Section of the Cecum: The cecum is transected distal to the lesion using a stapler. (6) Approximation of Ileum and Ascending Colon: The ileum and ascending colon are brought together in an isoperistaltic orientation, aligned without tension. (7) Incision of Ileum and Ascending Colon: Enterotomies are performed on the antimesenteric borders of both segments, adequately sized for stapler insertion. (8) Stapling of the Ileum and Colon: A side-to-side intracorporeal anastomosis is constructed using a linear stapler. (9) Suture of the Bowel Wall: The common enterotomy is closed with absorbable sutures, either continuous or interrupted. (10) Natural Orifice Specimen Extraction (NOSE): The specimen may be extracted transvaginally if a posterior colpotomy or hysterectomy has been performed, or transrectally following segmental rectal resection. CONCLUSION:The ten-step technique presented in this video article provides a standardized method for performing ileocolonic anastomosis with natural orifice specimen extraction in selected cases of deep endometriosis. Dividing the procedure into systematic steps facilitates teaching and improves reproducibility. VIDEO ABSTRACT.
OBJECTIVE:The comprehensive birth model (CBM) seeks to promote humanized care, maternal autonomy, and emotional bonding. However, its application in high-complexity hospitals presents inconsistencies depending on the mode of delivery. The aim of the present study was to evaluate postpartum women's experience with the CBM and identify quality perception differences based on the mode of delivery in a Chilean high-complexity public hospital. METHODS:A concurrent exploratory mixed-methods study (QUAN + QUAL) was conducted at a high-complexity reference hospital in Viña del Mar, Chile. The quantitative phase included 345 postpartum women (184 vaginal births, 158 cesarean sections and 3 forceps) who completed the BMSP2 scale; data were analyzed using Mann-Whitney U test, rank-biserial correlation ( r ) for effect size, and robust linear regression (Huber's M-estimator). The qualitative phase involved a different cohort of 26 postpartum women participating in in-depth interviews analyzed via thematic analysis, validated with Cohen's kappa (κ = 0.86; 95% confidence interval [CI]: 0.78-0.92). Integration followed GRAMMS guidelines. RESULTS:Women reported high overall satisfaction, particularly in relational care. However, cesarean sections yielded significantly lower scores in self-care and comfort ( r = 0.33 , P < 0.001 ), and mother-child contact ( r = 0.37 , P < 0.001 ). Interviews suggested perceived discontinuities in autonomy, comfort, and early bonding within surgical care contexts. CONCLUSION:CBM implementation demonstrates positive relational care experiences but also suggests the presence of structural and operational challenges within cesarean care processes. Midwifery leaders and managers should prioritize the standardization of humanization strategies in surgical settings to support early post-cesarean bonding and promote continuity of relational care throughout the postpartum period.
Heart failure (HF) affects over 64 million people worldwide, with prevalence projected to reach 3
OBJECTIVE:To determine the effects of exercise programs on exercise-induced hypoalgesia in people with chronic musculoskeletal pain. LITERATURE SURVEY:This systematic review and meta-analysis included a search of MEDLINE, Web of Science, CINAHL, SCOPUS, and EMBASE databases from inception until May 18, 2025. Randomized controlled trials that examined aerobic or anaerobic exercise interventions in patients with chronic musculoskeletal pain and that assessed pressure pain thresholds were considered. METHODOLOGY:The Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects method, depending on the heterogeneity, was applied to estimate the effects of exercise-induced hypoalgesia. The risk of bias was assessed with the risk of bias 2 tool and the certainty of the evidence was evaluated with Grading of Recommendations Assessment, Development, and Evaluation. SYNTHESIS:Nineteen articles were included. The meta-analysis found a small statistically significant difference in favor of other physical therapy treatments compared with isolated exercise for pressure pain thresholds in both individuals with chronic neck-shoulder pain and those with chronic low back pain pain, with low and very low certainty of the evidence, respectively. For the overall risk of bias, 2 studies had a low risk, 6 had some concerns, and 11 had a high risk. CONCLUSIONS:Isolated exercise in people with chronic neck and shoulder pain and those with chronic low back pain is not superior to other therapeutic modalities for improving pressure pain thresholds. Other physical therapy modalities generate higher pressure pain thresholds than isolated exercise with small effect size. These findings should be interpreted with caution due to the limited certainty of the evidence.
