BACKGROUND:In 2010, the World Health Organization (WHO) called for global implementation of Patient Blood Management (PBM) programs to optimize transfusion practices and reduce variability in blood utilization. This study examines the evolution of red cell, platelet, and plasma consumption in Iberia (Spain and Portugal), comparing trends within the region and with European benchmarks like the United Kingdom, Germany, and Italy. METHODS:National transfusion activity reports from Spain, Portugal, the United Kingdom (2011-2023) were analyzed. Key metrics included transfusion rates per 1,000 inhabitants for red cells, platelets, and fresh frozen plasma. Statistical analyses were performed using Kruskal-Wallis tests and ANOVA to identify differences between countries and over time. RESULTS:From 2011 to 2023, red cell transfusion rates decreased by 30% in the UK, 6% in Spain, and 15% in Portugal. Germany showed a modest decline, while Italy maintained stable rates exceeding 40 units per 1,000 inhabitants. Platelet and plasma consumption exhibited distinct patterns, with Portugal showing a steeper decline compared to Spain, and the UK maintaining the lowest overall rates. Platelet consume is clearly increasing. CONCLUSIONS:The analysis reveals significant differences in blood component utilization across Iberia and Europe, reflecting varying levels of PBM adoption. Despite WHO and Council of Europe recommendations, Iberian countries lag behind the UK in reducing red cell transfusion rates. These findings underscore the need for uniform PBM implementation to harmonize practices and optimize resource use, not only Red Cell Concentrates. The creation of the Iberian task-force (section of the Ibero-American PBM Society (SIAPBM) could be an opportunity to create the necessary awareness in our countries and become a meeting point between America and Europe.
BACKGROUND:Standard dosing of linezolid regimen frequently results in suboptimal exposure in critically ill patients. This study aimed to analyze the association between dosing regimens (total daily dose and infusion duration) and the probability of achieving pharmacokinetic/pharmacodynamic targets, as well as their microbiological and clinical impact. METHODS:A retrospective observational study was conducted in critically ill patients admitted to intensive care units who underwent therapeutic drug monitoring of linezolid between May 2021 and December 2023. Achievement of pharmacokinetic/pharmacodynamic targets (Cmin: 2-7 mg/L, AUC: 0-24/MIC: 80-120 mg*h/L, and T>MIC =85%) was evaluated according to the initial regimens (1,200 or 1,800 mg/day) and infusion duration (1 or 3 hours). Risk subgroups included obesity, augmented creatinine clearance, renal replacement therapy, and age <65 years. RESULTS:Seventy patients were included. At the first monitoring, only 18.6% achieved all three pharmacokinetic/pharmacodynamic targets and 40% achieved the Cmin target. No statistically significant differences were observed in target attainment according to dose or infusion duration, including within risk subgroups. However, the 1,800 mg/day regime showed a numerically higher proportion of patients achieving the Cmin target (54.5% vs. 37.3%). No significant differences in microbiological or clinical outcomes were observed between patients with Cmin within the target range and those outside it. CONCLUSIONS:Fewer than 20% of critically ill patients achieve all pharmacokinetic/pharmacodynamic targets with the initial regimen. These findings support the need for individualized dosing and therapeutic drug monitoring to optimize linezolid treatment in this population, particularly in high-risk patients.
This paper presents the Ulysses Framework, a navigational approach to forensic psychiatric practice developed through clinical work with gender violence survivors in Spain’s specialised legal system. I argue that forensic psychiatry at the intersection of law, culture, and clinical care requires navigation between incommensurable frameworks rather than synthesis. Like Odysseus choosing between Scylla and Charybdis, the forensic psychiatrist must make strategic, conscious choices about what to sacrifice while maintaining orientation toward healing and justice even when these conflict. The framework draws on criminal law theory, phenomenological psychiatry, cultural psychiatry, and feminist epistemology—particularly Fricker’s account of testimonial and hermeneutical injustice and Beauvoir’s ethics of ambiguity. A composite clinical case shows how conventional diagnostic approaches fail to capture the entanglement of trauma, cultural meaning, legal demands, and contested credibility characterising gender violence cases. Three principles structure the framework: primacy of movement, framework plurality, and conscious sacrifice. The concept of métis—cunning practical wisdom that operates in ambiguous situations—is the central competence for forensic practice, distinct from cultural competence, evidence-based practice, and clinical intuition. The framework’s distinctive contribution is its refusal of consoling syntheses: it provides tools for navigating conflicts between perspectives while acknowledging the costs. For gender violence survivors, it holds simultaneously trauma and agency, injury and resilience; for forensic clinicians, it makes explicit the navigation occurring, often implicitly, in complex clinical-legal encounters.
El envejecimiento poblacional en las zonas rurales de Navarra plantea la necesidad de abordar la fragilidad como un estado reversible antes de la llegada de la dependencia. El presente trabajo monográfico analiza las intervenciones de enfermería comunitaria en la Zona Básica de Salud de Caparroso, con especial énfasis en las localidades de Beire y Pitillas. Se describe la importancia de la Valoración Geriátrica Integral mediante el uso de escalas validadas (SPPB, Barthel, Lawton-Brody y Yesavage) y se evalúa el impacto de activos de salud como la "Escuela de la Experiencia". Los resultados sugieren que, aunque las intervenciones grupales y multifactoriales son las más eficaces según la evidencia, su éxito en el entorno rural depende de la cohesión social local. Se concluye que la prevención de la fragilidad requiere un enfoque que trascienda la consulta clínica, integrando la dinamización comunitaria para garantizar un envejecimiento activo en núcleos rurales dispersos.
Objetivo Explorar la experiencia del paciente/persona con pluripatología (PPP) en relación con la atención recibida y la experiencia de los/as profesionales implicados/as. Diseño Estudio cualitativo con orientación fenomenológica. Emplazamiento Desarrollado en el País Vasco (Osakidetza) entre septiembre de 2023 y marzo de 2024. Participantes Incluidos 12 pacientes y 19 profesionales. Método Entrevistas realizadas en profundidad a pacientes y grupos focales con profesionales de Atención Primaria y hospitalaria. Realizado muestreo teórico-intencional buscando la máxima heterogeneidad de perfiles tanto en pacientes (sexo, edad, ingresos hospitalarios…) como en profesionales (medicina, enfermería, años de experiencia...). Análisis cualitativo del contenido mediante el método de comparaciones constantes con el programa Atlas-ti a. Resultados El análisis del contenido aporta ocho categorías (556 citas) transversales que reflejan elementos clave para avanzar hacia una atención centrada en la persona como son: atención longitudinal, enfoque integral, humanista e individualizado; accesibilidad; coordinación y trabajo en equipo; gestión de tiempos en Atención Primaria; soporte social clave para la gestión del cuidado; el afrontamiento de la comorbilidad y un plan terapéutico complejo y formación de profesionales y aprovechamiento de competencias. Conclusiones El modelo de atención centrada en la persona busca incorporar las percepciones de los pacientes sobre su salud. Este estudio hace hincapié en integrar procesos, recursos sociales y educación y empoderamiento del paciente. Enfatiza la necesidad de un profesional de referencia, asegurar la accesibilidad, incorporar soporte social y toma de decisiones compartida, subrayando como clave para su incorporación en la práctica la formación continua y aprovechamiento de competencias en el sistema de salud.
