https://sms.carm.es/ricsmur/handle/123456789/17184 2026-04-16T10:21:54Z https://sms.carm.es/ricsmur/handle/123456789/25389 Drawing as a learning tool for anatomy: design and implementation of a method Martínez, Elena; Fernández-Villacañas, Miguel-Ángel; Moreno, María-Matilde; Flores-Funes, Diego 2025-01-28T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/25156 Pharmacokinetics and Childhood Obesity: Pathophysiological Basis and Challenges in Choosing the Ideal Body Size Descriptor Hernández-Gago, Yolanda; Sánchez-Hernández, José-Germán; Alcalá-Minagorre, Pedro-J; Rodríguez-Marrodan, Belén; Hernández-Sabater, Laura; Cabanas-Poy, María-José; Rodríguez-Negrín, Ana-Cristina Despite the progressive increase in obesity and associated chronic diseases in children, there is limited evidence on the optimal dosage of most medications for obese children and adolescents. This review analyzes the influence of pathophysiological changes on pharmacokinetics and pharmacodynamics and evaluates the body size descriptors used in clinical practice. Patients with obesity present significant pathophysiological alterations, such as a substantial increase in fat/lean mass ratio, increased blood flow and cardiac output, and changes in plasma protein binding, which may affect the volume of distribution of drugs and the adjustment of the loading dose. In these patients, the distribution volume of hydrophilic drugs appears to slightly increase, while it varies widely-depending on the drug and other factors such as affinity for other tissues-for lipophilic drugs. On the other hand, a reduction in tissue perfusion, alterations to liver enzyme activity, and an increase in liver and kidney mass and blood flow have been reported, indicating a possible modification in drug clearance and necessitating adjustments to maintenance regimens. Furthermore, while there are multiple size descriptors, it is difficult to establish a single dosing strategy for the obese population, given the lack of studies confirming the extent of changes in pharmacokinetic processes, which will also depend on the properties of each drug, such as liposolubility and elimination pathways. New strategies need to be developed to characterize pharmacokinetic and pharmacodynamic changes in the obese pediatric population in order to optimize dosing regimens and improve the safety and efficacy of treatments. 2025-12-21T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/25046 Readability of Informed Consent Forms for Medical and Surgical Clinical Procedures: A Systematic Review García-Álvarez, José-Joaquín; García-Sánchez, Alfonso Background/Objectives: The wording of informed consent forms for medical or surgical clinical procedures can be difficult to read and comprehend, making it difficult for patients to make decisions. The objective of this study was to analyze the readability of informed consent forms for medical or surgical clinical procedures. Methods: A systematic review was performed according to the PRISMA statement using PubMed, Embase, and Google Scholar databases. Primary studies analyzing the readability of informed consent forms using mathematical formulas published in any country or language during the last 10 years were selected. The results were synthesized according to the degree of reading difficulty to allow for the comparison of the studies. Study selection was performed independently by the reviewers to avoid the risk of selection bias. Results: Of the 664 studies identified, 26 studies were selected that analyzed the legibility of 13,940 forms. Of these forms, 76.3% had poor readability. Of the six languages analyzed, only English, Spanish, and Turkish had adapted readability indexes. Flesch Reading Ease was the most widely used readability index, although it would be more reliable to use language-specific indices. Conclusions: Most of the analyzed informed consent forms had poor readability, which made them difficult for a large percentage of patients to read and comprehend. It is necessary to modify these forms to make them easier to read and comprehend, to adapt them to each specific language, and to carry out qualitative studies to find out the real legibility of each specific population. 2025-01-24T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/24642 Suicide in adults within 30 days of discharge from hospital emergency department Maestre-Orozco, Tamara; Soriano, Vicente; Sánchez-Gómez, Dolores-Elvira; Espinosa, Begoña; Blasco-Fontecilla, Hilario; Gallego, Lucía; Llorens, Pere; Ramos-Rincon, José-Manuel Suicide remains a frequent cause of death in adults, often overlooked despite known risk factors like mental disorders, older age, and chronic illness. Emergency department visits offer critical opportunities to identify suicidal ideation and provide preventive care. This study reviewed deaths within 30 days of discharge from the emergency department of a major public hospital in Alicante, Spain, focusing on deaths by suicide. Over five years, 529,312 emergency visits were recorded, with 453,599 patients (85.7%) discharged home. Of the 356 patients (0.078%) who died within 30 days post-discharge, 7 (1.97%) died by suicide. Among these, four had a psychiatric history, and one had a history of substance abuse, both established risk factors. The overall suicide rate among adults discharged from the emergency department was 1.54 per 100,000. Compared with those who died from other causes within 30 days of discharge, patients who died by suicide were younger (median age 72 vs. 83 years; p = 0.037, adjusted OR: 0.59, 95% CI: 0.34-1.03; p = 0.06), had a lower Charlson Comorbidity Index (median 3 vs. 6; p = 0.003), and were more often male (6/7 vs. 50.1%; p = 0.1). The presence of psychiatric history was the most significant risk factor for suicide within 30 days of discharge from the emergency department among patients aged 15 and older. Men were more likely than women to die by suicide, with the majority between the ages of 65 and 79. Notably, only one individual had a prior suicide attempt. 2025-11-01T00:00:00Z