About the relationship of the processing conditions, mechanical properties, and microstructure of a co-precipitated Fe/Cu prealloyed powder.

The sinterability of a commercial Fe-Cu pre-alloyed powder, designed to be used as a metallic bond in diamond impregnated tools, has been greatly analyzed by combining dilatometry, computational thermodynamic calculations, and microstructural analysis. The effect of sintering temperature and alloying elements such as graphite and iron phosphide have been taken into consideration in order to demonstrate the capability of tailoring final properties through different strategies, and dilatometry and microstructural analysis have been used to understand the densification process of the alloys. Solid phase sintering was the mechanism taking place during thermal cycle. In fact, a liquid phase appears but because of the high densification level at that time mechanisms associated with LPS do not contribute to densification. Discussion about mechanical properties has been related to key microstructural phenomena, i.e., grain growth, phase transformation, precipitation, and solid solution. Obtained hardness ranged from 83 HRB to 106 HRB with yield stresses between 450 MPa and 700 MPa and elongations above 3%, while final tensile properties similar to those obtained by cobalt-based powders processed by hot pressing were also obtained.

High EPHB2 mutation rate in gastric but not endometrial tumors with microsatellite instability.

The EPH/EFN family of receptor tyrosine kinases regulates cell adhesion and migration and has an important role in controlling cell positioning in the normal intestinal epithelium. Inactivation of EPHB2 has recently been shown to accelerate tumorigenesis in the colon and rectum, and we have previously demonstrated frequent frameshift mutations (41%) in an A9 coding microsatellite repeat in exon 17 of EPHB2 in colorectal tumors with microsatellite instability (MSI). In this study, we extended these analyses to extracolonic MSI cancers, and found frameshift EPHB2 mutations in 39% (25/64) of gastric tumors and 14% (8/56) of endometrial tumors. Regression analysis of these EPHB2 mutation data on the basis of our previously proposed statistical model identified EPHB2 as a selective target of frameshift mutations in MSI gastric cancers but not in MSI endometrial carcinomas. These results suggest a functional role for EPHB2 in gastric tumor progression, and emphasize the differences between the tumorigenic processes in MSI gastrointestinal and endometrial cancer.

The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.

BACKGROUND: The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed. OBJECTIVE: To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs. METHODS: A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent. STUDY PERSPECTIVE: Primary healthcare management of 4 public health areas. RESULTS: The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1). CONCLUSIONS: In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.

[Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipemia]. / Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia.

OBJECTIVES: The computer system for billing prescriptions (SIFAR in Spanish) enables indicators to be extracted for the study and follow-up of the use of medicines in the INSALUD primary care areas. Concretely, we studied the indicator referring to pensioners consumption of lipid-lowering drugs (PCLL), not validated, and whose value is expected to drop as quality increases. The objective was to calculate the correlation of the indicator of prescription of lipid-lowering drugs on the SIFAR with the proportion of lipid-lowerers prescribed correctly for pensioners (PCP). DESIGN: A descriptive study of correlation between two indicators of drug prescription. SETTING: Four health districts in Madrid. PARTICIPANTS: The prescriptions of 49 general practitioners, chosen at random on the basis of three strata defined by the value of the indicator, were studied. Each doctor filled out a protocol of data for each pensioner patient to whom he/she prescribed a lipid-lowerer during the study period. MEASUREMENTS AND MAIN RESULTS: The PCLL and PCP indicators were compared through the correlation of Spearman. 6,779 prescriptions for 1,125 patients were collected from the 49 participating doctors. The mean percentage of lipid-lowerers correctly prescribed was 31.9%, figure that rose to 77.5% when the LDL value was not specified. The correlation between the PCLL and the PCP was near zero. CONCLUSIONS: The PCLL indicator of the SIFAR does not discriminate quality in lipid-lowering drug prescription to people over 64.

Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia / Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipaemia

Objetivos. El sistema informático de facturación de recetas (SIFAR) permite la obtención de indicadores para el estudio y seguimiento de la utilización de medicamentos en las áreas de atención primaria del INSALUD. Concretamente, estudiamos el indicador referido al consumo de hipolipemiantes en población pensionista (CHPP), no validado y cuyo valor es esperable que disminuya al incrementarse la calidad. El objetivo es estimar la correlación del indicador de prescripción de hipolipemiantes del SIFAR con el porcentaje de hipolipemiantes correctamente prescritos en pensionistas (PCP). Diseño. Estudio descriptivo de correlación entre 2 indicadores de prescripción farmacológica. Emplazamiento. Cuatro áreas de salud de Madrid. Participantes. Se estudian las prescripciones de 49 médicos generales, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador. Cada médico rellena un protocolo de datos por cada paciente pensionista al que prescribe un hipolipemiante durante el período del estudio. Mediciones y resultados principales. Se comparan los indicadores CHPP y PCP mediante correlación de Spearman. Se han recogido 6.779 prescripciones correspondientes a 1.125 pacientes de los 49 médicos que participaron. El porcentaje medio de envases de hipolipemiantes correctamente prescritos es del 31,9 por ciento, cifra que asciende al 77,5 por ciento si no se exige tener constancia del valor LDL. Las correlaciones obtenidas entre el CHPP y el PCP son cercanas a cero. Conclusiones. El indicador CHPP del SIFAR no discrimina la calidad de prescripción de hipolipemiantes en mayores de 64 años (AU)

Prescripción farmacéutica en residencias de ancianos. Comparación con ancianos ambulatorios (2.ª parte) / Drug prescription for elderly living in nursing homes versus community-living elderly (2n d p a r t )

Fundamento: los ancianos ingresados en residencias (AR) utilizan más fármacos inadecuados y generan un gasto en dichos medicamentos superior a los ancianos ambulatorios (AA). El objetivo de es te estudio es comparar la prescripción de fármacos inadecuados y/o de baja utilidad terapéutica así co mo el gasto injustificado entre residencias de ancia nos sin intervención, residencias de ancianos con in tervención y AA.Métodos: estudio prospectivo observacional de tres grupos de pacientes de 65 o más años cuya ca racterística diferenciadora es el tipo de alojamiento: domicilio (AA), residencias privadas después de una intervención y residencia privada sin intervención . La estimación de las proporciones y del gasto por persona y mes en ambos grupos se realiza mediante el cálculo del intervalo de confianza al 95 por ciento (IC). Se calculan las razones relativas.Resultados: el porcentaje de pacientes que tie nen prescrito al menos un fármaco injustificado en el AR sin intervención es de 97 por ciento (IC, 92-103 por ciento), f rente a 51 por ciento (IC, 37-65 por ciento) en AR con intervención y 61 por ciento (IC, 49-72 por ciento) en AA. De igual forma, la ra zón relativa de envases prescritos injustificada mente es mayor en el AR sin intervención, tanto respecto a AR con intervención (3,0; 2,4

[The quality of the drug treatment in hyperlipemia patients from 4 health areas. The VICAF Group]. / Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud. Grupo VICAF.

OBJECTIVE: To calculate how suitable the lipid-lowering treatment prescribed for pensioners in primary care clinics in four health areas is. DESIGN: Cross-sectional descriptive study of quality of pharmacological treatment. SETTING: Four primary care health districts, INSALUD, Madrid. PARTICIPANTS: 1125 patients registered with 49 doctors, chosen at random on the basis of three strata defined by the value of the lipid-lowering drug indicator of prescription. For a year, each doctor filled in a protocol of variables for each pensioner to whom he/she prescribed a lipid-lowering drug. MEASUREMENTS AND MAIN RESULTS: An automated algorithm was designed to evaluate the suitability of the drugs treatment for each patient, according to scientific criteria including: cholesterol levels, LDL, age, and risk factors. Quality of prescription was finally measured for 1009 patients. The indication of the treatment was due to primary prevention in 65% of cases. 32% of patients were correctly treated. If LDL compliance was not demanded, the suitability figure rose to 77%. Drug treatment was more suitable when the doctor him/herself administered it (as against another doctor or a specialist; p = 0.001) or when the patient was on the list of the prescribing doctor (p < 0.0001). Proper indication was lower in patients over 74 (p < 0.0001). CONCLUSIONS: The quality of lipid-lowering drug prescription for pensioners in primary care clinics in four health districts, as a function of the criteria defined above, could be improved. LDL is the factor which most affects the procedure.

Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud / Quality of pharmacological treatment of patients with hyperlipaemia from four health districts

Objetivo.Estimar la adecuación del tratamiento hipolipemiante prescrito a pensionistas en consultas de atención primaria de 4 áreas de salud. Diseño. Estudio descriptivo transversal de calidad del tratamiento farmacológico. Emplazamiento. Cuatro áreas de salud de atención primaria. INSALUD. Madrid. Sujetos. Un total de 1.125 pacientes adscritos a 49 médicos, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador de prescripción de hipolipemiantes. Cada médico rellenó un protocolo de variables por cada pensionista al que indicó un hipolipemiante durante un año. Mediciones y resultados principales. Se elaboró un algoritmo automatizado para valorar la adecuación del tratamiento farmacológico de cada paciente, según criterios científicos teniendo en cuenta: niveles de colesterol, LDL, edad y existencia de factores de riesgo. La calidad de la prescripción se midió finalmente en 1.009 pacientes. La indicación del tratamiento se debió a prevención primaria en un 65 por ciento de los casos. El 32 por ciento de pacientes estaba correctamente tratado. Si no se exige la cumplimentación de LDL, el porcentaje de adecuación asciende al 77 por ciento. El porcentaje de tratamiento farmacológico adecuado fue superior cuando lo realizó el propio facultativo (frente a otro facultativo o al especialista; p = 0,001) y cuando el paciente pertenecía al propio cupo del médico prescriptor (p < 0,0001). La correcta indicación fue menor en pacientes mayores de 74 años (p < 0,0001). Conclusiones.La calidad de la indicación de hipolipemiantes a pensionistas en consultas de atención primaria de 4 áreas de salud, en función de los criterios previamente definidos, es mejorable, siendo la LDLel factor que más influye en el proceso (AU)