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Papers by Miriam Ramos Heredia
Clínica e Investigación en Ginecología y Obstetricia, 2013
Infertilidad masculina; Calidad seminal; Técnicas de reproducción asistida Resumen Objetivo: es c... more Infertilidad masculina; Calidad seminal; Técnicas de reproducción asistida Resumen Objetivo: es comprobar los cambios en calidad seminal y los factores asociados en pacientes que se someten a técnicas de reproducción asistida del área de influencia del hospital de la Mancha-Centro Método: Los datos se obtuvieron a partir de las historias clínicas de las pacientes. Se incluyeron aquellos pacientes en tratamiento con reproducción asistida en el área del hospital de la Mancha-Centro entre 25 de julio de 2005 y 1 de febrero de 2010. Resultados: Se incluyeron 252 pacientes. Se observó una relación estadísticamente significativa entre bajo volumen espermático y bajo número de espermatozoides. Las gráficas de la evolución de los parámetros de calidad seminal a lo largo de los años de estudio indican una disminución de la calidad seminal. La edad media de los pacientes fue algo superior en pacientes con mayor volumen seminal. Los pacientes con mayor número de espermatozoides eran más jóvenes. En el medio no urbano hubo mayor porcentaje de pacientes con mejores parámetros de REM y número de espermatozoides. Sin embargo, las cifras de volumen espermático dentro de la normalidad fueron más favorables para el grupo urbano. Conclusión: En los pacientes del estudio ha aumentado las alteraciones en las cifras de parámetros seminales. Esto no implica disminución de la calidad en la región puesto que el estudio no está diseñado para extraer este tipo de conclusiones, pero sí se puede afirmar que los pacientes que solicitan técnicas de reproducción asistida en el área presentan una calidad seminal con tendencia descendente en los últimos 5 años. Este estudio está realizado en un área en concreto pero podría emplearse como punto de partida para su comparación con otras regiones
Atencion Farmaceutica
Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperati... more Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperative nausea and vomiting (PONV) in a General Hospital. Method: A bibliographic research was performed through the main databases. limiting with MesH terms, adult population. Results: Risk stratification Apfel model is one of the easiest to employ. Ondansetron, droperidol and dexamethasone have shown their efficacy in prophylaxis and treatment of PONV. in prophylaxis, it is recommended ondansetron 4 mg at the end of the surgery, dexamethasone 4 mg before anesthetic induction and droperidol 0.625-1.25 mg at the end of the surgery. Multimodal prophylaxis is recommended for moderate-high risk patients. For rescue treatment it should be employed a different drug from the used in prophylaxis. Discussion: The establishment of protocols for PONV could reduce incidents of associated patient complications, medical variability and related costs.
Atencion Farmaceutica
Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperati... more Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperative nausea and vomiting (PONV) in a General Hospital. Method: A bibliographic research was performed through the main databases. limiting with MesH terms, adult population. Results: Risk stratification Apfel model is one of the easiest to employ. Ondansetron, droperidol and dexamethasone have shown their efficacy in prophylaxis and treatment of PONV. in prophylaxis, it is recommended ondansetron 4 mg at the end of the surgery, dexamethasone 4 mg before anesthetic induction and droperidol 0.625-1.25 mg at the end of the surgery. Multimodal prophylaxis is recommended for moderate-high risk patients. For rescue treatment it should be employed a different drug from the used in prophylaxis. Discussion: The establishment of protocols for PONV could reduce incidents of associated patient complications, medical variability and related costs
Farmacia Hospitalaria (English Edition), 2008
ABSTRACT Determine the nutritional status of patients with colorectal cancer undergoing chemother... more ABSTRACT Determine the nutritional status of patients with colorectal cancer undergoing chemotherapy and assess how many patients could benefit from nutrition facts. Patients of both sexes aged over the age of 18 with colorectal cancer who were receiving chemotherapy between March and April 2005 were included. The nutritional status of these patients was evaluated using the method "Patient-Generated Subjective Global Assessment" (PG-SGA). According to this questionnaire, the patients were classified in one of four levels of intervention (a) no intervention required; b) nutrition education; c) nutritional intervention; d) critical intervention) and into one of three nutritional status (well-nourished, moderately malnourished or severely malnourished). All the patients with colorectal cancer receiving chemotherapy during the two months indicated (33 patients): 9.1% were in stage II of the disease, 21.2% in stage III and 69.7% in stage IV. The 69.7% was receiving cytostatics associated with moderate risk of malnutrition while 30.3% received low-risk chemotherapy. 57.6% of the patients were well-nourished. However, the intervention was critical in 42.4% of the patients. The majority of the patients studied require some type of nutritional act, although not all of them suffer from malnutrition.
Farmacia Hospitalaria, 2008
European Journal of Hospital Pharmacy, 2012
ABSTRACT Objective The aim of this study was to quantify the level of knowledge of patients treat... more ABSTRACT Objective The aim of this study was to quantify the level of knowledge of patients treated with fertility drugs before and after information was provided by a hospital pharmacist, the acceptability of this counselling, and patient treatment adherence. Materials and methods Infertile couples undergoing assisted reproduction techniques lasting 12 months were followed up through review of the patient's medical notes, a personal patient interview and a structured questionnaire. Consecutive couples were enrolled. Clinical patient data were collected from the patient's medical notes and patient medication knowledge was assessed by personal interview before and after pharmacy counselling. Acceptability by patients was evaluated using a questionnaire and adherence to treatment using hospital dispensing information. Results 61 patients were included and 22 (36.06%) completed the acceptability questionnaire. The global satisfaction rate was 92.4% (4.62 points out of 5). There was 100% patient adherence to treatment. The percentage of medication knowledge was 60.9% before pharmacist counselling and 90% (increase of 29.2%) after counselling. Conclusions This study provides reassurance of the high adherence to treatment of these patients. Patients are receptive to counselling and satisfied with pharmaceutical care. Information received and ease of staff contact were rated highest and pharmacy opening hours were rated lowest. The difference in knowledge before and after pharmaceutical counselling implies such care is beneficial.
European Journal of Hospital Pharmacy: Science and Practice, 2013
Objectives The aim of the present work was to establish a specialised pharmaceutical care program... more Objectives The aim of the present work was to establish a specialised pharmaceutical care programme for patients with multiple sclerosis in order to analyse its effects on patient satisfaction, the detection of drug-related problems, and the identification and resolution of negative outcomes associated with medication. Methods This was a prospective, longitudinal study with a pre/post-exposure design regarding the pharmaceutical care programme implemented: in bimonthly visits the pharmacist identified, detected and resolved drug-related problems and negative outcomes, and also provided information about the treatment. All patients with multiple sclerosis treated with immunomodulatory drugs from 1 June to 31 December 2011 were included in the study. A Likert scale questionnaire was used before and 6 months after the implementation to assess its impact on perceived patient satisfaction. Results In all, 32 patients (20 women and 12 men), with an age of 39.7±8.3 years were included. A total of 26 were receiving treatment with interferon β and 6 with glatiramer acetate. All items assessing the pharmacist's skills and interest in the patient along with those assessing the information received by the patient showed significant improvement (p<0.001). Overall satisfaction also improved significantly (p=0.016). Of the 13 negative outcomes associated with medication identified, 9 were resolved. Eight negative outcomes were classified as ‘non-quantitative safety problems’ and two as ‘untreated health problems’ were due to the drug-related problem ‘probability of adverse effects’. Three classified as ‘quantitative ineffectiveness’ were due to an ‘insufficiently treated health problem’. Conclusions The implementation of a specialised pharmaceutical care programme led to a significant improvement in perceived patient satisfaction. It has also allowed for better detection of drug-related problems and identification and resolution of negative outcomes associated with medication.
Clínica e Investigación en Ginecología y Obstetricia, 2012
Estudio de los fármacos asociados con esterilidad. Material y métodos: Se realizó una búsqueda si... more Estudio de los fármacos asociados con esterilidad. Material y métodos: Se realizó una búsqueda sistemática bibliográfica. Resultados: Antiinflamatorios, quimioterápicos, hormonas, antibióticos y otros como cafeína, clortetracoclina, dapsona, fenotiazinas, nifedipino, cimetidina, ciclosporina o espironolactona. Discusión: Se podría recomendar intentar evitar su uso en pacientes con dificultad para concebir a no ser que sea estrictamente necesario
Systems Biology in Reproductive Medicine, 2012
A longitudinal, observational prospective panel cohort study of 61 patients lasting one year was ... more A longitudinal, observational prospective panel cohort study of 61 patients lasting one year was undertaken. Explanatory variables included sociodemographic factors along with factors related to the underlying pathology as well as the protocol used and the type of treatment received. These variables were analyzed both individually and in combination to account for confounding effects and model interactions. A generalized estimating equation (GEE) model was constructed for each adverse effect. Associations were calculated as odds ratios (OR). Confounding variables related to drug tolerability were identified. Follitropin-alpha and cetrorelix exhibited the poorest safety profile. With respect to local adverse drug reactions (ADEs), the results obtained in our study point to statistically significant tolerability improvements for menotropin when administered in insemination. For gastrointestinal ADEs, ganirelix was the drug that showed the highest tolerability in in vitro treatments whereas follitropin-alpha showed the lowest tolerability in insemination treatments. Diverse factors related to assisted reproduction techniques (ART) influence the incidence of adverse effects. Each drug has a different safety profile with possible interactions depending on the type of assisted reproduction therapy used.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013
This was a prospective study among a cohort of women undergoing ART. Subjects receiving infertili... more This was a prospective study among a cohort of women undergoing ART. Subjects receiving infertility drugs from a public
Clínica e Investigación en Ginecología y Obstetricia, 2013
Infertilidad masculina; Calidad seminal; Técnicas de reproducción asistida Resumen Objetivo: es c... more Infertilidad masculina; Calidad seminal; Técnicas de reproducción asistida Resumen Objetivo: es comprobar los cambios en calidad seminal y los factores asociados en pacientes que se someten a técnicas de reproducción asistida del área de influencia del hospital de la Mancha-Centro Método: Los datos se obtuvieron a partir de las historias clínicas de las pacientes. Se incluyeron aquellos pacientes en tratamiento con reproducción asistida en el área del hospital de la Mancha-Centro entre 25 de julio de 2005 y 1 de febrero de 2010. Resultados: Se incluyeron 252 pacientes. Se observó una relación estadísticamente significativa entre bajo volumen espermático y bajo número de espermatozoides. Las gráficas de la evolución de los parámetros de calidad seminal a lo largo de los años de estudio indican una disminución de la calidad seminal. La edad media de los pacientes fue algo superior en pacientes con mayor volumen seminal. Los pacientes con mayor número de espermatozoides eran más jóvenes. En el medio no urbano hubo mayor porcentaje de pacientes con mejores parámetros de REM y número de espermatozoides. Sin embargo, las cifras de volumen espermático dentro de la normalidad fueron más favorables para el grupo urbano. Conclusión: En los pacientes del estudio ha aumentado las alteraciones en las cifras de parámetros seminales. Esto no implica disminución de la calidad en la región puesto que el estudio no está diseñado para extraer este tipo de conclusiones, pero sí se puede afirmar que los pacientes que solicitan técnicas de reproducción asistida en el área presentan una calidad seminal con tendencia descendente en los últimos 5 años. Este estudio está realizado en un área en concreto pero podría emplearse como punto de partida para su comparación con otras regiones
Atencion Farmaceutica
Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperati... more Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperative nausea and vomiting (PONV) in a General Hospital. Method: A bibliographic research was performed through the main databases. limiting with MesH terms, adult population. Results: Risk stratification Apfel model is one of the easiest to employ. Ondansetron, droperidol and dexamethasone have shown their efficacy in prophylaxis and treatment of PONV. in prophylaxis, it is recommended ondansetron 4 mg at the end of the surgery, dexamethasone 4 mg before anesthetic induction and droperidol 0.625-1.25 mg at the end of the surgery. Multimodal prophylaxis is recommended for moderate-high risk patients. For rescue treatment it should be employed a different drug from the used in prophylaxis. Discussion: The establishment of protocols for PONV could reduce incidents of associated patient complications, medical variability and related costs.
Atencion Farmaceutica
Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperati... more Introduction: The aim is to establish recommendations on prophylaxis and treatment of postoperative nausea and vomiting (PONV) in a General Hospital. Method: A bibliographic research was performed through the main databases. limiting with MesH terms, adult population. Results: Risk stratification Apfel model is one of the easiest to employ. Ondansetron, droperidol and dexamethasone have shown their efficacy in prophylaxis and treatment of PONV. in prophylaxis, it is recommended ondansetron 4 mg at the end of the surgery, dexamethasone 4 mg before anesthetic induction and droperidol 0.625-1.25 mg at the end of the surgery. Multimodal prophylaxis is recommended for moderate-high risk patients. For rescue treatment it should be employed a different drug from the used in prophylaxis. Discussion: The establishment of protocols for PONV could reduce incidents of associated patient complications, medical variability and related costs
Farmacia Hospitalaria (English Edition), 2008
ABSTRACT Determine the nutritional status of patients with colorectal cancer undergoing chemother... more ABSTRACT Determine the nutritional status of patients with colorectal cancer undergoing chemotherapy and assess how many patients could benefit from nutrition facts. Patients of both sexes aged over the age of 18 with colorectal cancer who were receiving chemotherapy between March and April 2005 were included. The nutritional status of these patients was evaluated using the method "Patient-Generated Subjective Global Assessment" (PG-SGA). According to this questionnaire, the patients were classified in one of four levels of intervention (a) no intervention required; b) nutrition education; c) nutritional intervention; d) critical intervention) and into one of three nutritional status (well-nourished, moderately malnourished or severely malnourished). All the patients with colorectal cancer receiving chemotherapy during the two months indicated (33 patients): 9.1% were in stage II of the disease, 21.2% in stage III and 69.7% in stage IV. The 69.7% was receiving cytostatics associated with moderate risk of malnutrition while 30.3% received low-risk chemotherapy. 57.6% of the patients were well-nourished. However, the intervention was critical in 42.4% of the patients. The majority of the patients studied require some type of nutritional act, although not all of them suffer from malnutrition.
Farmacia Hospitalaria, 2008
European Journal of Hospital Pharmacy, 2012
ABSTRACT Objective The aim of this study was to quantify the level of knowledge of patients treat... more ABSTRACT Objective The aim of this study was to quantify the level of knowledge of patients treated with fertility drugs before and after information was provided by a hospital pharmacist, the acceptability of this counselling, and patient treatment adherence. Materials and methods Infertile couples undergoing assisted reproduction techniques lasting 12 months were followed up through review of the patient's medical notes, a personal patient interview and a structured questionnaire. Consecutive couples were enrolled. Clinical patient data were collected from the patient's medical notes and patient medication knowledge was assessed by personal interview before and after pharmacy counselling. Acceptability by patients was evaluated using a questionnaire and adherence to treatment using hospital dispensing information. Results 61 patients were included and 22 (36.06%) completed the acceptability questionnaire. The global satisfaction rate was 92.4% (4.62 points out of 5). There was 100% patient adherence to treatment. The percentage of medication knowledge was 60.9% before pharmacist counselling and 90% (increase of 29.2%) after counselling. Conclusions This study provides reassurance of the high adherence to treatment of these patients. Patients are receptive to counselling and satisfied with pharmaceutical care. Information received and ease of staff contact were rated highest and pharmacy opening hours were rated lowest. The difference in knowledge before and after pharmaceutical counselling implies such care is beneficial.
European Journal of Hospital Pharmacy: Science and Practice, 2013
Objectives The aim of the present work was to establish a specialised pharmaceutical care program... more Objectives The aim of the present work was to establish a specialised pharmaceutical care programme for patients with multiple sclerosis in order to analyse its effects on patient satisfaction, the detection of drug-related problems, and the identification and resolution of negative outcomes associated with medication. Methods This was a prospective, longitudinal study with a pre/post-exposure design regarding the pharmaceutical care programme implemented: in bimonthly visits the pharmacist identified, detected and resolved drug-related problems and negative outcomes, and also provided information about the treatment. All patients with multiple sclerosis treated with immunomodulatory drugs from 1 June to 31 December 2011 were included in the study. A Likert scale questionnaire was used before and 6 months after the implementation to assess its impact on perceived patient satisfaction. Results In all, 32 patients (20 women and 12 men), with an age of 39.7±8.3 years were included. A total of 26 were receiving treatment with interferon β and 6 with glatiramer acetate. All items assessing the pharmacist's skills and interest in the patient along with those assessing the information received by the patient showed significant improvement (p<0.001). Overall satisfaction also improved significantly (p=0.016). Of the 13 negative outcomes associated with medication identified, 9 were resolved. Eight negative outcomes were classified as ‘non-quantitative safety problems’ and two as ‘untreated health problems’ were due to the drug-related problem ‘probability of adverse effects’. Three classified as ‘quantitative ineffectiveness’ were due to an ‘insufficiently treated health problem’. Conclusions The implementation of a specialised pharmaceutical care programme led to a significant improvement in perceived patient satisfaction. It has also allowed for better detection of drug-related problems and identification and resolution of negative outcomes associated with medication.
Clínica e Investigación en Ginecología y Obstetricia, 2012
Estudio de los fármacos asociados con esterilidad. Material y métodos: Se realizó una búsqueda si... more Estudio de los fármacos asociados con esterilidad. Material y métodos: Se realizó una búsqueda sistemática bibliográfica. Resultados: Antiinflamatorios, quimioterápicos, hormonas, antibióticos y otros como cafeína, clortetracoclina, dapsona, fenotiazinas, nifedipino, cimetidina, ciclosporina o espironolactona. Discusión: Se podría recomendar intentar evitar su uso en pacientes con dificultad para concebir a no ser que sea estrictamente necesario
Systems Biology in Reproductive Medicine, 2012
A longitudinal, observational prospective panel cohort study of 61 patients lasting one year was ... more A longitudinal, observational prospective panel cohort study of 61 patients lasting one year was undertaken. Explanatory variables included sociodemographic factors along with factors related to the underlying pathology as well as the protocol used and the type of treatment received. These variables were analyzed both individually and in combination to account for confounding effects and model interactions. A generalized estimating equation (GEE) model was constructed for each adverse effect. Associations were calculated as odds ratios (OR). Confounding variables related to drug tolerability were identified. Follitropin-alpha and cetrorelix exhibited the poorest safety profile. With respect to local adverse drug reactions (ADEs), the results obtained in our study point to statistically significant tolerability improvements for menotropin when administered in insemination. For gastrointestinal ADEs, ganirelix was the drug that showed the highest tolerability in in vitro treatments whereas follitropin-alpha showed the lowest tolerability in insemination treatments. Diverse factors related to assisted reproduction techniques (ART) influence the incidence of adverse effects. Each drug has a different safety profile with possible interactions depending on the type of assisted reproduction therapy used.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013
This was a prospective study among a cohort of women undergoing ART. Subjects receiving infertili... more This was a prospective study among a cohort of women undergoing ART. Subjects receiving infertility drugs from a public