In vitro anti-inflammatory, anti-arthritic and anti- proliferative activity of green synthesized silver nanoparticles - Phoenix dactylifera (Rothan dates)

Abstract Traditionally dates is consumed as a rich source of iron supplement and the current research discuss the synthesis of silver nanoparticles (AgNPs) using methanolic seed extract of Rothan date and its application over in vitro anti-arthritic, anti-inflammatory and antiproliferative activity against lung cancer cell line (A549). FTIR result of synthesised AgNPs reveals the presence of functional group OH as capping agent. XRD pattern confirms the crystalline nature of the AgNPs with peaks at 38º, 44º, 64º and 81º, indexed by (111), (200), (220) and (222) in the 2θ range of 10-90, indicating the face centered cubic (fcc) structure of metallic Ag. HR- TEM results confirm the morphology of AgNPs as almost spherical with high surface areas and average size of 42 ± 9nm. EDX spectra confirmed that Ag is only the major element present and the Dynamic light scattering (DLS) assisted that the Z-average size was 203nm and 1.0 of PdI value. Zeta potential showed − 26.5mv with a single peak. The results of the biological activities of AgNPs exhibited dose dependent activity with 68.44% for arthritic, antiinflammatory with 63.32% inhibition and anti-proliferative activity illustrated IC50 value of 59.66 µg/mL expressing the potential of AgNPs to combat cancer

A network pharmacology approach to assess Reno-protective and -curative effects of methanolic extract of Malva neglecta Wallr in gentamicin induced renal toxicity rat model

Abstract The aim of present study was to explore protective and curative effects of Malve neglecta on kidneys. In silco study with network pharmacology was performed to find out potential target organs, genes and cellular cell lines which confirmed kidneys as target organ of phyto-constituents present in Malva neglecta extract. Gentamicin (40 mg/kg, i.p) was given to induce renal toxicity. Prophylactic study was performed with 300-, 600- and 900 mg/kg doses to find out nephro-protective and -curative effects and curative potential was evaluated at 900 mg/kg dose. Renal function biomarkers, blood urea, BUN, serum creatinine and uric acid, and oxidative stress measuring biomarkers, SOD, CAT, GSH and MDA levels in kidney homogenate were quantified at the end of study. Treatment groups showed decrease in blood urea, BUN, serum creatinine and uric acid levels dose dependently and curative group also showed decline in these biomarkers. SOD, CAT, GSH levels were increased and MDA level decreased in treatment groups significantly as compared to toxic control which revealed the role of oxidative stress in renal damage and anti-oxidant power of MN. Data suggested that use of MN along with drugs causing renal toxicity may prove beneficial due to its nephro- protective and curative effects.

Dosage adjustment recommendations of drugs in non-nephrology units with kidney disease / Recomendaciones de ajuste posológico de fármacos para enfermedad renal en unidades no nefrológicas

Purpose: Kidney disease (KD) is defined as an abnormality of the kidney in the structure or function with implications for the health, which can occur abruptly, and either resolve or become chronic. This status use to require medication dosage adjustment. Inappropriate prescribing is a common drug-related problem. The aim of this study is to evaluate the acceptance rate through pharmaceutical interventions with implementation of a daily cross-validation procedure in electronic prescription in patients with KD, susceptible to suffer a drug-related problem (DRP). Methods: A nine month-prospective study, in renal insufficiency inpatients (serum creatinine >1.7 mg/dl) treated with drugs that require dosage adjustment.Results: 539 patients with renal failure were identified, 135 of them needed any adjust in their prescription. We performed 179 dosage recommendations, 104 of which were accepted. Most of the recommendations were done in patients with G4 renal damage. Dose modification was the adjustment most widely required. 25 active ingredients were analyzed and the drugs with higher number of interventions were spironolactone, ranitidine, meropenem and allopurinol. General Internal Medicine was the unit with most interventions and acceptance rate. Conclusions: Pharmaceutical intervention stands out as a strategy to improve the population’s pharmacotherapeutic quality taking into account the integration of assisted electronic prescription systems to facilitate a fast and immediate intervention in decision-making in these situations. (AU)

Objetivos: Evaluar la tasa de aceptación de las intervenciones farmacéuticas con la implementación de un procedimiento diario de validación cruzada en prescripción electrónica de pacientes con IR susceptibles de sufrir un problema relacionado con la medicación (PRM). Material y método: Se trata de un estudio prospectivo de nueve meses de duración realizado en un hospital general universitario de 400 camas en pacientes con insuficiencia renal (creatinina sérica >1,7mg/dl) tratados con medicamentos que pueden requerir un ajuste posológico. La variable principal fue la tasa de aceptaación de las intervenciones farmacéuticas.Resultados: Se identificaron 539 pacientes con insuficiencia renal durante el período de estudio, 135 de ellos necesitaron algún ajuste en su prescripción. Se realizaron 179 recomendaciones farmacéuticas, 104 de las cuales fueron aceptadas. La mayoría de las recomendaciones se realizaron en pacientes con insuficiencia renal G4. Se analizaron 25 principios activos y los fármacos con mayor número de intervenciones fueron: espironolactona, ranitidina, meropenem y alopurinol. El servicio con más intervenciones y tasa de aceptación fue Medicina Interna. (AU)

Dosis de carbón activado en la intoxicación medicamentosa aguda / Activated charcoal dose in acute drug poisoning

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Antimicrobial defined daily dose adjusted by weight: A proposal for antibiotic consumption measurement in children / Dosis diaria definida ajustada por peso: una propuesta para la medición de consumo antimicrobiano en pediatría

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In reply to: "Antimicrobial defined daily dose adjusted by weight: A proposal for antibiotic consumption measurement in children" / En respuesta a: "Dosis diaria definida ajustada por peso: una propuesta para la medición de consumo antimicrobiano en pediatría"

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Sistemas personalizados de dosificación en atención primaria: un estudio multidisciplinar / Dose dispensing service in a prymary health care area: A multidisciplinary study

Introducción: los sistemas personalizados de dosificación (SPD) preparados en farmacias son una opción para mejorar la adherencia terapéutica. Objetivo: describir las características y grado de implantación de los SPD bajo la perspectiva de profesionales sanitarios de un centro de salud, farmacéuticos comunitarios y pacientes adscritos a ese centro. Método: estudio descriptivo transversal en la zona de influencia del centro de salud Daroca (Madrid). Participaron 64 profesionales del centro de salud, 37 farmacéuticos comunitarios y 29 usuarios de SPD. Se utilizaron cuestionarios para cada una de las categorías con preguntas sobre conocimientos y opiniones de los SPD, gestión, preparación y satisfacción con el servicio. Resultado: conocen los SPD el 61,4 % de los profesionales del centro de salud y el 94 % creen que son útiles. Trece farmacias ofrecen los SPD: el 55,6 % considera que hay que contactar con el médico, el 41,7 % pone precio al servicio y el 92,3 % lo hace manualmente. Cinco farmacias preparan SPD a 18 pacientes de la zona. Criterios de inclusión más utilizados: edad, polimedicación y sospecha de mal cumplimiento. Perfil de paciente usuario de SPD: mujer octogenaria con estudios primarios polimedicada que vive sola. El 66,7 % de los pacientes encuestados tomaba los medicamentos directamente de la caja y al 88,9 % de ellos les recomendó el SPD el farmacéutico. El cien por cien de los usuarios de SPD está muy satisfecho con el servicio. Conclusión: aunque todos los colectivos estudiados creen que los SPD son útiles para mejorar la adherencia, existe una baja implantación de los SPD en nuestra zona

Introduction: Dose Dispensing Service (SPD) prepared in pharmacies are an option to improve therapeutic adherence. Objective: to describe the characteristics and implantation of SPD from the perspective of professionals of a health center, community pharmacists and patients attached to that center. Methods: Descriptive cross-sectional study in the area of influence of Daroca health center (Madrid). 64 health center professionals, 37 community pharmacists and 29 SPD users participated. Questionnaires were used for each of the categories with questions about knowledge and opinions of SPDs, management, preparation and satisfaction with the service. Results: 61.4% of health center professionals know SPD and 94% believe they are useful. 13 pharmacies offer SPD: 55.6% consider that they should contact the doctor, 41.7% charge for the service and 92.3% do so manually. 5 pharmacies prepare SPD for 18 patients in our local zone. Most used inclusion criteria: age, polymedication and suspicion of poor compliance. Patient profile using SPD: octogenarian woman polymedicated with primary studies living alone. 66.7% of the patients took the medications directly from the box. Pharmacists recommended SPD to 88.9% of patients. 100% of SPD users are very satisfied with the service. Conclusion: Although all the groups studied believe that SPDs are useful for improving adherence, SPDs have a low implementation in our area

Programa para la adecuación del uso de paracetamol a dosis menores y más seguras: implantación y resultados / Program for the adaptation of the use of paracetamol to lower and safer doses: Implementation and results

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Antimicrobial defined daily dose adjusted by weight: a proposal for antibiotic consumption measurement in children / Dosis diaria definida ajustada por peso: una propuesta para la medición de consumo antimicrobiano en pediatría

INTRODUCTION: Antimicrobial defined daily dose (DDD), has limitations for antimicrobial consumption measurement in paediatrics. An alternative DDD design applicable for children is proposed. METHODS: Children (< 16 years-old) from 10 Spanish hospitals during a 12-months period were included. Weight for age (50th percentile) was calculated for the median age of the cohort using standardized World Health Organization tables. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication. RESULTS: A total of 40,575 children were included. Median age was 4.17 (IQR: 1.36-8.98) and 4.81 (IQR: 1.42-9.60) years for boys and girls, respectively. Mean weight for this age was 17.08 kg. Standardized DDD for representative antimicrobials were calculated. CONCLUSIONS: A useful method for antimicrobial DDD measurement in paediatrics has been proposed and should be validated in future studies for its use in paediatric antimicrobial stewardship programmes

INTRODUCCIÓN: La dosis diaria definida (DDD), tiene limitaciones para la medición del consumo antimicrobiano en pediatría. Se propone un diseño aplicable en niños. MÉTODOS: Se incluyeron niños (< 16 años) de 10 hospitales españoles durante un periodo de 12 meses. A partir de la mediana de edad de la cohorte, utilizando tablas estandarizadas de la OMS, se obtuvo el peso correspondiente al percentil P50 de esa edad. Se calculó la DDD (gr) multiplicando el peso obtenido por la dosis recomendada (mg/kg) de cada antimicrobiano para su indicación más común. RESULTADOS: Un total de 40575 niños fueron incluidos. La mediana de edad fue 4,17 (RIQ: 1,36-8,98) y 4,81 (RIQ: 1,42-9,60) años para niños y niñas, respectivamente. Peso medio para la edad: 17,08 kg. DDD estandarizadas fueron calculadas para antimicrobianos representativos. CONCLUSIONES: Se ha propuesto un método útil para monitorizar consumo antimicrobiano en pediatría utilizando DDD adaptadas, que deberá validarse en futuros estudios

Development of the Anticholinergic Burden Calculator Web Tool / Desarrollo de la herramienta web Anticholinergic Burden Calculator

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Parámetros mamográficos: compresión, dosis y disconfort / Mammography parameters: compression, dose, and discomfort

Objetivo: Confirmar la importancia de la compresión en mamografía, y relacionarla con el disconfort manifestado por las pacientes. Materiales y métodos: Se emplearon 2 muestras de 402 y 268 mamografías, obtenidas en dos centros de diagnóstico que poseen el mismo equipo mamográfico pero diferentes técnicas de compresión. Las edades variaron entre los 21 y los 50 años. Resultados: Se observó una sensible disminución en la dosis recibida a mayor compresión. Sin embargo, no se obtuvo una diferencia significativa en lo que respecta a los reclamos de las pacientes en relación con el disconfort experimentado. Discusión y Conclusión: La compresión en mamografía, siguiendo los estándares internacionales de una fuerza entre 80-120 N, es efectiva en cuanto a la reducción de dosis, sin por eso ser insoportable para la paciente. Este disconfort tampoco está relacionado con la glandularidad de la mama.

Objective: To confirm the importance of compression in mammography and relate it to the discomfort expressed by the patients. Materials and methods: Two samples of 402 and 268 mammographies were obtained from two diagnostic centres that use the same mammographic equipment, but different compression techniques. The patient age range was from 21 to 50 years old. Results: A significant decrease in the dose received was observed at higher compression. However, there was no significant difference as regards patients complaining about the discomfort experienced. Discussion and Conclusion: Compression in mammography, following the international standards of a pressure between 80-120 N, is effective in reducing the dose without being unbearable for the patient. This discomfort is also unrelated to the glandularity of the breast.

Oral immunotherapy for food allergy: a Spanish Guideline. Egg and milk immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosig schedules. Models of dosing Schedules of OIT with CM and egg

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg (AU)

Introducción: El huevo y la leche de vaca son la causa más frecuente de alergia alimentaria en los primeros años de vida. Como alternativa terapéutica a la dieta de eliminación se han investigado otras formas de tratamiento como la inmunoterapia oral (ITO). Actualmente no existen guías de práctica clínica para el manejo de la ITO con leche y huevo. Objetivos: Elaborar una guía clínica para el tratamiento con ITO basada en la evidencia científica disponible y en la opinión de expertos. Métodos: Revisión de estudios publicados desde el año 1984 hasta junio de 2016, tesis doctorales publicadas en España, resúmenes de comunicaciones en congresos (SEAIC, SEICAP, EAACI, AAAAI) y consenso de opinión de un grupo de expertos de las sociedades científicas SEICAP y SEAIC. Resultados: Se establecen recomendaciones acerca de la indicación, requerimientos, aspectos prácticos del tratamiento en las diferentes fases de la ITO, y pautas especiales para pacientes de alto riesgo de reacciones adversas. Conclusiones: Se presenta una guía con las directrices para el manejo en la práctica clínica de la ITO con leche y huevo que aúna la opinión consensuada de expertos españoles (AU)

Assessment of the rates and characteristics of the short-term supply of medication (Tider) from an integrated healthcare delivery system in the United States

Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider), patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM) cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80%) medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8%) and 134,815 (99.2%) patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable since the benefits of providing patients with needed medications likely outweigh the cost. Future studies should be performed to assess the impact of tider dispensing on health outcomes (AU)

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Cambio en la dosificación de colistimetato sódico en el paciente crítico / Changes in the dosing of colistimethate sodium in critically ill patients

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El reto de la administración de antituberculosos en lactantes y preescolares. Proyecto Magistral de pTBred / The challenge of administering anti-tuberculosis treatment in infants and pre-school children. pTBred Magistral Project

INTRODUCCIÓN: En España no existen presentaciones pediátricas de fármacos antituberculosos, salvo para rifampicina. Algunos pediatras prescriben fórmulas magistrales (FM), mientras que otros administran comprimidos triturados. No existe consenso al respecto, ni estudios de farmacocinética que avalen estos procedimientos. Ante esta situación, la Red Española de Estudio de la Tuberculosis Pediátrica (pTBred) desarrolla el Proyecto Magistral, con el objetivo de analizar, en su primera fase, la conveniencia de desarrollar formas farmacéuticas específicas para niños, así como estudiar otros aspectos relacionados con la administración de antituberculosos en niños. MATERIAL Y MÉTODOS: Estudio transversal, multicéntrico y de ámbito nacional, mediante encuesta on-line enviada por correo electrónico a los instituciones pertenecientes a pTBred entre febrero y marzo del 2015 RESULTADOS: Se recibieron 54 respuestas de 67 instituciones consultadas. La mayoría de los centros trituran los comprimidos. Un porcentaje elevado, aunque menor, administra FM, cuya disponibilidad es variable entre las instituciones. El 83% responde que sería ideal disponer de combinaciones fijas de antituberculosos, adaptadas a las dosis pediátricas y administradas mediante FM o en un comprimido. Entre las instituciones encuestadas existen diferencias en el tratamiento de la infección tuberculosa latente, el uso de la terapia directamente observada y la monitorización de efectos adversos. CONCLUSIONES: Nuestra encuesta revela gran heterogeneidad en la prescripción de antituberculosos en niños debido a la falta de formulaciones específicas para esta edad, que podría tener implicaciones en la adherencia al tratamiento y evolución. pTBred propone elaborar un pionero y útil documento de consenso sobre la administración de medicación antituberculosa en niños

INTRODUCTION: There are no paediatric formulations of anti-tuberculous drugs in Spain, with the only exception being rifampicin. Some paediatricians often prescribe composite formulations (CF), while others prefer to give crushed tablets. Nevertheless, there is no consensus in this regard, or any pharmacokinetic studies validating these procedures. In this situation, the Spanish Network for the Study of Paediatric Tuberculosis (pTBred) has launched the Magistral Project, which has as its first phase aims to analyse the desirability of developing child-friendly pharmaceutical formulations and other aspects regarding the anti-tuberculous drug prescription in children. MATERIAL AND METHODS: A cross-sectional, multicentre, nationwide study was conducted, based on an online questionnaire sent to members of pTBred between February and March 2015. RESULTS: Fifty-four responses from 67 consulted institutions were received. Most of the respondents reported prescribing crushed tablets. A significant number of those surveyed, although being fewer, prescribe CF, for which availability varies widely among institutions. Eighty-three percent replied that it would be essential to have fixed dose combinations of anti-tuberculous drugs, specifically adapted to paediatric doses and administered by CF or tablets. Among the surveyed institutions, differences were found in the management of latent tuberculosis infection, in the use of directly observed therapy, and in the monitoring of adverse events. CONCLUSIONS: Our survey reveals great diversity in anti-tuberculous drug prescription in children, due to the lack of suitable infant formulations, which could have an impact on treatment adherence and outcomes. pTBred intends to develop a pioneering and useful consensus document on the management of anti-tuberculous medication in children

Individualización posológica de enoxaparina en un obeso extremo mediante la monitorización del factor anti-Xa / Enoxaparin dosage in extreme obesity by monitoring anti-Xa factor

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Recomendaciones para el uso de metotrexato en pacientes con artritis idiopática juvenil / Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis

OBJETIVOS: Elaborar un documento de recomendaciones consensuadas para el uso de metotrexato (MTX) en pacientes con artritis idiopática juvenil (AIJ). MATERIAL Y MÉTODO: Un grupo de 11 expertos planteó diversos interrogantes clínicos en el uso de MTX en pacientes con AIJ. Se realizó una revisión sistemática y se extrajeron las evidencias y recomendaciones para cada pregunta. Los resultados fueron valorados y consensuados por los expertos en una sesión presencial para establecer las recomendaciones finales. RESULTADOS: Se recomienda el MTX como primer fármaco inductor de remisión en AIJ, cuya indicación se realizará según la categoría clínica del paciente. Previo al tratamiento se recomienda evaluar un hemograma que incluya recuento leucocitario, niveles de enzimas hepáticas y creatinina sérica, así como otros parámetros analíticos conforme a factores de riesgo específicos. El tratamiento se iniciará con dosis de 10-15mg/m2/semana. En casos de uveítis o poliartritis se valorará una dosis inicial de 15mg/m2/semana. Para una mejor biodisponibilidad y tolerabilidad, se administrará preferentemente por vía parenteral si la dosis es≥15mg/m2/semana. Se deberá realizar un seguimiento analítico del paciente periódicamente y evaluar posibles alteraciones en enzimas hepáticas para realizar cambios si fuera preciso. La combinación con biológicos puede ser necesaria, además del uso concomitante de ácido fólico o folínico. CONCLUSIONES: Este documento recoge las principales recomendaciones para el empleo adecuado de MTX en pacientes con AIJ, de acuerdo a la evidencia científica y a la experiencia clínica

OBJECTIVES: To develop a consensus document of recommendations for the use of methotrexate (MTX) in patients with juvenile idiopathic arthritis (JIA). MATERIAL AND METHOD: A group of eleven experts proposed several clinical questions on the use of MTX in patients with JIA. A systematic review was conducted and the evidence and recommendations for each question were extracted. The results were discussed and validated by the experts in a work session to establish the final recommendations. RESULTS: MTX is recommended as the first drug for inducing remission in JIA, and its indication should be made according to the clinical category of the patient. Prior to treatment, it is recommended to perform a complete blood count, including white cells, levels of liver enzymes, serum creatinine, and other analytical parameters according to specific risk factors. Treatment should be initiated with a dose of 10-15mg/m2/week. In cases of uveitis or polyarthritis, an initial dose of 15mg/m2/week should be considered. For a better bioavailability and tolerability, it is preferable to administer MTX parenterally if the dose is ≥15mg/m2/week. It is necessary to periodically perform an analytical monitoring of the patient and to assess possible alterations in liver enzymes to make changes if necessary. Combinations with biological agents may be necessary, as well as the concomitant addition of folic or folinic acid. CONCLUSIONS: This document describes the main recommendations for the appropriate use of MTX in JIA patients, according to scientific evidence and clinical experience

El dilema de la reducción de tratamiento en pacientes con asma moderado-grave controlados / The dilemma of reducing treatment for patients with moderate-severe controlled asthma

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Comparación del tratamiento con infusión subcutánea continua de insulina frente a la terapia con múltiples dosis de insulina con calculador de bolus en pacientes con diabetes tipo 1 / Comparison of treatment with continuous subcutaneous insulin infusion versus multiple daily insulin injections with bolus calculator in patients with type 1 diabetes

OBJETIVOS: Comparar el control glucémico, la calidad de vida, así como el miedo y percepción de las hipoglucemias en el grupo de infusión subcutánea continua de insulina (ISCI) frente a la terapia con múltiples dosis de insulina (MDI) con calculador de bolus. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo con seguimiento durante los 12 primeros meses desde que el grupo ISCI (n = 30) comienza a utilizar el «bolus ayuda» y el grupo MDI-calculador (n = 30), comienza a utilizar el calculador de bolus (Accu-Chek® Aviva Expert). Variable de desenlace primaria: HbA1c (3, 6 y 12 meses). Cuestionarios empleados: EsDQOL (calidad de vida), FH-15 (miedo a las hipoglucemias), Clarke (percepción de las hipoglucemias). Análisis estadístico: T de Student y pruebas no paramétricas. RESULTADOS: El descenso medio de HbA1c a lo largo del estudio fue significativamente mayor en el grupo ISCI (−0,56 ± 0,84%) que en el grupo MDI (0,097 ± 0,94%), p = 0,028. La dosis media de insulina basal fue significativamente mayor en el grupo MDI (al inicio, 6 y 12 meses). No se encontraron diferencias significativas entre ambos grupos de tratamiento en los cuestionarios EsDQOL, FH-15 y Clarke. La calidad de vida percibida por los pacientes, valorada mediante el cuestionario EsDQOL, en el grupo ISCI fue significativamente mejor al final del estudio que al inicio de la utilización de la bomba de insulina. CONCLUSIONES: El descenso medio de HbA1c fue significativamente mayor en el grupo ISCI. Se objetivó una mejor calidad de vida en el grupo ISCI al final del estudio que al inicio

OBJECTIVES: A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily inyections (MDI) with bolus calculator group. MATERIAL AND METHODS: This is a retrospective cohort study with following up during the first 12 months that CSII group (n = 30) begins the use of "bolus wizard" and the MDI-calculator (n = 30) group begins the use of the bolus calculator (Accu-Chek® Aviva Expert). Primary outcome: HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia). Statistical analysis: T Student and nonparametric tests. RESULTS: The average reduction in HbA1c during the study was significantly higher in CSII group (−0.56 ± 0.84%) compared with the MDI group (0.097 ± 0.94%), P = .028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences were found between the 2 treatment groups after analyzing the EsDQOL, FH-15 and Clarke questionnaires. In the CSII group, perceived quality of life assessed by the EsDQOL questionnaire was found to be better at the end of the study than at the beginning of using the insulin pump. CONCLUSIONS: The average reduction in HbA1c was significantly higher in the CSII group. In the CSII group, perceived quality of life was better at the end of the study than at the beginning

Revisión de medicación según criterios STOPP/START en pacientes mayores del servicio de sistema personalizado de dosificación de medicamentos de una farmacia comunitaria / Medication review according to STOPP-START criteria in older patients from the dose administration aids service of a community pharmacy

Objetivos: Detectar de forma sistemática según los criterios STOPP-START la medicación inadecuada y los fármacos necesarios no prescritos en pacientes del servicio del sistema personalizado de administración de medicamentos (SPD) de una farmacia comunitaria. Métodos: Estudio cuasi experimental pre-post sin grupo control realizado en una farmacia comunitaria de Málaga durante 4 meses (noviembre 2013-febrero 2014). Los sujetos de estudio seleccionados son 84 pacientes mayores de 65 años inscritos en el servicio de SPD. Se registraron los siguientes datos: edad, sexo, medicamentos, criterios STOPP-START identificados. La identificación de los criterios se realizó con la herramienta informática CheckTheMeds®. Resultados: Se revisaron las historias farmacoterapéuticas de 84 pacientes. Un 54,8% de los pacientes presentaron como mínimo un criterio STOPP-START, con una media de 1,07 (DE=1,3) criterios por paciente. De estos pacientes, un 36,9% solo presentaban criterios STOPP, un 32,6% criterios START y un 30,5% criterios STOPP-START. En los criterios START la situación más prevalente corresponde al sistema endocrino (Antiagregantes plaquetarios en la diabetes mellitus si coexisten uno o más factores mayores de riesgo cardiovascular) con un 15,6%. Respecto a los criterios STOPP se ha detectado como la situación más frecuente el sistema nervioso central y psicofármacos con un 14,4% (Uso prolongado de benzodiacepinas de vida media larga o benzodiacepinas con metabolitos de larga acción). Conclusiones: La revisión sistemática de la medicación según criterios STOPP-START en pacientes del servicio de SPD mediante el programa informático CheckTheMeds® puede constituirse en una buena herramienta para mejorar el seguimiento de pacientes ancianos, polimedicados y/o con patologías crónicas. Es necesario mejorar las intervenciones farmacéuticas dirigidas a aumentar la calidad de la prescripción derivando al médico este tipo de situaciones (AU)

Objectives: To detect systematically according to the STOPP-START criteria inappropriate prescribing and necessary drugs not prescribed in patients of the Dose Administration Aids (DAAs) of a community pharmacy. Methods: A pre-post quasi-experimental study without a control group was performed in a community pharmacy in Malaga for 4 months (November 2013-february 2014). The subjects of the study are 84 patients over 65 years old in the PDS service. The following data were recorded: age, sex, medications and STOPP-START criteria identified. The identification of the criteria was performed with the software tool CheckTheMeds®. Results: Pharmacotherapeutic histories of 84 patients were reviewed. 54.8% of patients had at least one STOPP-START criteria, with an average of 1.07 criteria per patient. Of these patients, 36.9% only presents STOPP criteria, START criteria 32.6% and 30.5% STOPP-START criteria. In the START criteria the most prevalent situation corresponds to the endocrine system (Antiplatelet therapy in diabetes mellitus with co-existing major cardiovascular risk factors) with 15.6%. Regarding the STOPP criteria was detected as the most frequent situation the central nervous system and psychotropic drugs with 14.4% (Long-term, long-acting benzodiazepines and benzodiazepines with long-acting metabolites). Conclusions: The systematic review of the medication according to STOPP-START criteria in patients from the PDS service using the CheckTheMeds® software can become a good tool to improve the monitoring of elderly, polymedicated and/or patients with chronic diseases. Pharmaceutical interventions should be improved in order to increase the quality of prescribing by deriving to the physician such situations (AU)