ABSTRACT
Effective health communication will not be possible if the messages directed to patients do not adapt to their health literacy skills. In this sense, if the Patient Information Leaflets (PILs) are not understood properly, they will not fulfill their purpose. Secondary education aims to develop students' fundamental skills, including reading comprehension, which should align with future patients. This study assesses reading comprehension of commonly used PILs among secondary education students. An observational cross-sectional study involved 590 Spanish secondary school students from March to June 2022. They read 3 original PILs and completed a questionnaire about medication use information. The European health literacy survey questionnaire (short version) and sociodemographic data were collected. The average correct answer rate was only 51%, with just 14.58% understanding when to take ibuprofen, results that fell significantly below the minimum 80% threshold required by the European Union. Age, gender, and cultural background didn't significantly impact comprehension. In conclusion, health literacy skills acquired in secondary education are insufficient for understanding current PILs. Educational reform is necessary to improve students' ability to comprehend medication instructions and enhance PILs for effective communication. At the same time, our work highlights that current PILs need to be redesigned to reduce the cognitive burden imposed on patients.
ABSTRACT
INTRODUCTION: Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS: A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS: Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION: The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.
Subject(s)
Comprehension , Drug Labeling , Health Literacy , Humans , Drug Packaging , Pharmaceutical PreparationsABSTRACT
BACKGROUND: Migratory pressure from sub-Saharan Africa on Europe must also be addressed from a health literacy perspective. Sub-Saharan migrants newly arriving in Europe generally have lower literacy skills compared to the host community's citizens and special learning needs. Pictograms give health professionals a means of communicating medication instructions to people with no common language or who are illiterate, or both. OBJECTIVE: This work aimed to explore the comprehension of a set of United States Pharmacopoeia (USP) pictograms by sub-Saharan migrants newly arriving in Europe. METHODS: A quantitative cross-sectional study was carried out. A voluntary survey was conducted among a population ≥ 18 years of age in a Temporary Stay Centre for Immigrants located in the Spanish city of Melilla (North Africa) in June 2022. The form included a selection of 10 USP pictograms to assess their comprehension. According to the International Organization for Standardization, a pictogram must receive 66.70% correct answers to be acceptable. RESULTS: Fifty-one sub-Saharan immigrants participated in this study. None of the pictograms reached comprehensibility threshold. CONCLUSION: Pharmaceutical pictograms are ineffective in practice when they are not designed in a culturally sensitive manner.
Subject(s)
Comprehension , Transients and Migrants , Humans , Cross-Sectional Studies , Europe , Pharmaceutical Preparations , Adolescent , AdultABSTRACT
Introducción: La Atención Farmacéutica requiere que los pacientes comprendan la información brindada. La inclusión de ayudas visuales podría mejorar la comprensión de textos complejos como son los prospectos de los medicamentos. Nuestro objetivo fue evaluar los efectos de la inclusión de pictogramas farmacéuticos sobre la comprensión de instrucciones elementales para el uso de medicamentos por estudiantes que finalizan la enseñanza básica. Método: De un total de 309 alumnos participantes, se aleatorizaron 160 para leer tres prospectos de medicamentos de uso frecuente (ibuprofeno, amoxicilina/ácido clavulánico y omeprazol), mientras que 149 recibieron pictogramas junto a los prospectos. La aleatorización fue alterna según la posición de los alumnos en el aula. La comprensión fue estimada mediante cuestiones básicas del uso de medicamentos. Resultados: En el grupo control solo el 38.75% de los alumnos contestaron correctamente cuándo tomar el ibuprofeno en relación a las comidas el 32.25% acertaron cual es la dosis habitual del antibiótico y el 61.88% identificó la indicación del omeprazol. En los tres casos, se encontraron diferencias significativas en favor de la comprensión en el grupo experimental (OR = 1.93; 95% IC, 1.23 3.05; p = 0.0041, OR = 3.87; 95% IC, 2.43 6.25; p = 10-7 y OR = 3.55; 95% IC, 2.07 6.29; p = 3.67x10-5 respectivamente). Conclusiones: La inclusión de pictogramas farmacéuticos en los prospectos es una estrategia sencilla que podría potencialmente favorecer el uso racional del medicamento. (AU)
Introduction: Pharmaceutical Care requires that patients understand the information provided. The inclusion of visual aids could improve the comprehension of complex texts such as drug package inserts. Our objective was to evaluate the effects of the inclusion of pharmaceutical pictograms on the comprehension of elementary instructions for the use of drugs by students completing basic education. Methods: Among a total of 309 participating students, 160 were randomized to read three frequently used drug package inserts (ibuprofen, amoxicillin/clavulanic acid and omeprazole), while 149 received pictographs together with the package inserts. Randomization was alternated according to the position of the students in the classroom. Comprehension was estimated by means of basic questions on the use of drugs. Results: In the control group only 38.75% of the students answered correctly when to take ibuprofen in relation to meals, 32.25% were right about the usual dose of the antibiotic and 61.88% identified the indication for omeprazole. In all three cases, significant differences in favor of understanding were found in the experimental group (OR = 1.93; 95% CI, 1.23 - 3.05; p = 0.0041, OR = 3.87; 95% CI, 2.43 - 6.25; p = 10-7 and OR = 3.55; 95% CI, 2.07 - 6.29; p = 3.67x10-5 respectively). Conclusions: The inclusion of pharmaceutical pictograms in package inserts is a simple strategy that could favor potentially the rational use of drugs. (AU)
Subject(s)
Humans , Adolescent , Health Literacy , Drug Labeling , Nonprescription Drugs , Audiovisual Aids/trendsABSTRACT
OBJECTIVES: This work aimed to explore the validity of South African pictograms to be comprehended by sub-Saharan migrant populations in Spain. METHODS: A quantitative cross-sectional study was carried out. A voluntary survey was conducted among a population ≥ 18 years of age in a Temporary Stay Centre for Immigrants located in Spain, in June 2022. The form included a culturally and linguistically validated version of the Health Literacy questionnaire (HLS-EU-Q16), a brief questionnaire of sociodemographic variables and 10 South African pictograms selected to assess the comprehension. According to the International Organization for Standardization, a pictogram must receive 66.70% correct answers to be acceptable. Mann-Whitney U or Kruskal-Wallis tests were used to assess differences between group variables. Statistical significance was set at P < 0.05. RESULTS: 55 sub-Saharan migrants who newly arrived in Europe voluntarily agreed to participate. None of the pictograms evaluated met the validity criterion. For the selected pictograms, the range of correct answers was between 52.50% and 20.00%. Neither sociodemographic variables nor Health Literacy level were significantly associated with pictogram comprehensibility. CONCLUSION: New culturally sensitive pictograms that are easily comprehended by sub-Saharan African population are needed. PRACTICE IMPLICATIONS: These results may serve as a starting point for future studies that aim to create and evaluate new pictograms or create new culturally adapted versions of existing pictograms involving the target population.
Subject(s)
Health Literacy , Humans , Cross-Sectional Studies , South Africa , Prospective Studies , Surveys and QuestionnairesSubject(s)
Health Literacy , Pharmaceutical Services , Pharmacy , Humans , Pharmaceutical Preparations , PharmacistsABSTRACT
Introducción: El material educativo para el uso del medicamento frecuentemente es poco legible para el paciente, especialmente si es poco Alfabetizado en Salud. Ello pone en relieve la necesidad de alternativas al prospecto tradicional. El objetivo de este trabajo fue revisar la evidencia disponible sobre los pictogramas como herramienta conducente al uso racional del medicamento. Método: Se realizó una búsqueda de los artículos que consistieran en estudios de la eficacia comunicativa de los pictogramas farmacéuticos en Scopus, Web of Science y Medline a través de PubMed. Resultados: Se identificaron 24 estudios con los criterios de inclusión aplicados. 10 de los 12 estudios controlados aleatorizados obtuvieron resultados favorables a la inclusión de pictogramas. Los estudios transversales exploraron la importancia del contexto cultural o educativo. Todos los estudios longitudinales obtuvieron resultados positivos tras el seguimiento, que podrían explicarse gracias a una explicación previa. Conclusiones: Los pictogramas son una herramienta simple, económica y con un elevado potencial para mejorar el uso del medicamento. (AU)
Introduction: Instructional material for the use of medicines is often unreadable by the patient, especially if he or she is poorly literate in Health. This alleviates the need for alternatives to the traditional leaflets. The aim of this work was to review the available evidence on the pictograms as a tool leading to the rational use of medicines. Method: A search was carried out for articles that considered studies of the communicative efficacy of pharmaceutical pictograms from Scopus, Web of Science and Medline through PubMed. Results: 24 studies were identified with the inclusion criteria applied. 10 of the 12 randomized controlled studies obtained results favorable to the inclusion of pictograms. Cross-sectional studies explored the importance of cultural or educational context. All longitudinal studies obtained positive results after follow-up, which could be explained by prior knowledge. Conclusions: Pictograms are a simple, economical tool with a high potential to improve the use of medication. (AU)
Subject(s)
History, 20th Century , History, 21st Century , Health Literacy , Health Education , Pharmacy , Databases as Topic , Databases, BibliographicABSTRACT
Introduction: Chondroitin sulfate was proposed as a more appropriate strategy for osteoarthritis long-term management than conventional treatment (nonsteroidal anti-inflammatory drugs and acetaminophen). However, its efficacy has been widely discussed and its public financing by the Spanish National Health System has been questioned. The aim of this paper was review on the clinical and economic aspects of chondroitin sulfate in osteoarthritis treatment. Method: A bibliographic search of recent literature was carried out until March 9th, 2022. The databases used were MEDLINE and Scopus. Results: According to the set of clinical studies identified in the search, chondroitin sulfate was effective in reducing cartilage volume loss, its clinical effects were estimated by objective (magnetic resonance or specific biomarkers) and subjective (visual analog pain scale or Lequesne index) outcome measures. In the set of studies reviewed, chondroitin sulfate proved to be an acceptable therapeutic option in clinical terms. Regarding economic aspects, only one study was identified, according to which, the prescription of chondroitin sulfate implies a lower cost per patient compared to non-steroidal anti-inflammatory drugs. Conclusion: From the clinical and economic points of view, the findings of this brief review justify the presence of chondroitin sulfate in osteoarthritis guidelines. (AU)
Introducción: El sulfato de condroitina fue propuesto como una estrategia más apropiada para el manejo de la artrosis a largo plazo que los tratamientos convencionales (antiinflamatorios no esteroideos y paracetamol). Sin embargo, su eficacia ha sido ampliamente discutida y su financiación por el Sistema Español de Salud cuestionado. El objetivo de este trabajo fue realizar revisar los aspectos clínicos y económicos en el manejo del sulfato de condroitina en el tratamiento de la artrosis. Método: Se llevo a cabo una búsqueda de la literatura reciente hasta el 9 de marzo de 2022. Las bases de datos consultadas fueron MEDLINE y Scopus. Resultados: Según el conjunto de los estudios identificados, el sulfato de condroitina fue efectivo en la reducción de pérdida de volumen de cartílago causante del dolor y la rigidez articular. Sus efectos clínicos fueron estimados mediante medidas de resultado objetivas (resonancias magnéticas o biomarcadores específicos) y subjetivas (escala visual analógica de dolor o índice de Lequesne). El sulfato de condroitina mostró ser una opción terapéutica aceptable en términos clínicos. Respecto a los aspectos económicos, solo se identificó un estudio, según el cual, la prescripción de sulfato de condroitina implica un menor coste por paciente comparado con antiinflamatorios no esteroideos. Conclusión: Desde los puntos de vista clínico y económico, los hallazgos de esta breve revisión justifican la presencia del sulfato de condroitina en las guías medicas del manejo de la artrosis. (AU)
Subject(s)
History, 21st Century , Economics, Pharmaceutical , Chondroitin Sulfates , Joint Diseases , Databases, Bibliographic , Databases as Topic , Magnetic Resonance SpectroscopyABSTRACT
Introducción: En los últimos años ha habido un incremento de la participación de farmacias comunitarias en proyectos de investigación. El reclutamiento de pacientes juega un papel clave en el éxito de las investigaciones. Se han identificado barreras y facilitadores que promueven dicho reclutamiento por parte de los farmacéuticos, pero poco es sabido sobre la influencia de factores relacionados con los proyectos de investigación. El objetivo de este trabajo es observar la participación en diferentes investigaciones llevadas a cabo en farmacias comunitarias e identificar las variables propias de los estudios que puedan estar asociadas con la participación.Método:Se realizó un estudio multicéntrico experimental en 12 farmacias comunitarias que formaron parte de 4 proyectos de investigación. Se registró el número de pacientes que aceptaron/rechazaron participar. Se recogieron variables relacionadas con el estudio ofrecido y las farmacias. Se realizó un análisis bivariante mediante la prueba Chi-Cuadrado de Pearson y un análisis de los riesgos. Resultados: La participación total fue del 90,44% (n=558). El tipo de estudio (OR=2,64; 95%IC=1,47-4,75; transversal vs pragmático), el tipo de medida aplicada (OR=2,47; 95%IC=1,43-4,36), la aplicación de zona de atención personalizada (ZAP) (OR=2,49; 95%IC=1,44-4,39), y la solicitud de datos personales (OR=2,53; 95%IC=1,47-4,42) mostraron asociación con la participación en los PI (p<0,05). Conclusiones: La participación por parte de los pacientes en proyectos de investigación es elevado y parece depender de factores propios del estudio aplicado (AU)
Introduction: Over the last years there has been an increase in community pharmacy participation in research projects. Patient recruitment plays a key role in the research project success. Pharmacists barriers and enablers of recruitment have been identified, but little is known about the influence of research project-related factors. The aim of this paper is to explore patient participation in different studies conducted in community pharmacies and to identify study-specific factors that may be associated with it. Method: An experimental multicenter study was performed in 12 community pharmacies participating in 4 research projects. The number of patients who accepted/refused to participate was recorded. Variables related to each offered study and the project were collected. A bivariate analysis using Pearsons Chi-Square test and a risk analysis were performed. Results: Participation rate was 90.44% (n=558). Study type (OR=2.64; 95%IC=1.47-4.75; cross-sectional vs pragmatic), the type of measurement applied (OR=2.47; 95%CI=1.43-4.36), the use of a personalized care area (PCA) (OR=2.49; 95%CI=1.44-4.39), and personal data request (OR=2.53; 95%CI=1.47-4.42) showed association with participation in the RP (p<0.05). Conclusions: Patient participation in research projects is high and appears to rely on study-specific factors
Subject(s)
Humans , Community Pharmacy Services , Patient Participation , Pharmacy ResearchABSTRACT
Introducción: La incidencia de eventos cardiovasculares fatales es muy elevada y el tratamiento con estatinas es vital para reducir este riesgo en muchos pacientes, sin embargo, sus efectos adversos sobre el músculo esquelético dificultan la adherencia o la continuación del mismo. Se ha propuesto la suplementación de coenzima Q10 para revertir mialgias asociadas a el empleo de estatinas. Los ensayos clínicos que se realizaron en los últimos 10 años obtuvieron resultados contrapuestos. El objetivo de este trabajo es revisar la evidencia sobre la eficacia del empleo de suplementos de coenzima Q10 en para mitigar las miopatías causadas por las estatinas. Metodología: Se realizó una búsqueda sistemática de la literatura publicada hasta Julio de 2020. Las bases de datos consultadas fueron MEDLINE y SCOPUS. También se consultaron instituciones como la Agencia Española del Medicamento y Productos Sanitarios (AEMPS), la European Medicines Agency (EMA) y la Food and Drug Administration (FDA). Resultados: La etiología de las mialgias asociadas a estatinas sigue siendo desconocida y la evidencia encontrada en los ensayos clínicos y metaanalisis obtuvieron conclusiones dispares. La European Medicine Agency (EMA) solo considera el empleo de suplementos en síndrome de deficiencia primaria de coenzima Q10, mientras en Reino Unido el National Institute for Health and Care Excellence (NICE) y el National Institute of Health (NIH) no recomiendan el empleo de estos suplementos para tratar mialgias asociadas al empleo de estatinas. Conclusiones: El conjunto de los estudios analizados no consiguió una evidencia unánime para poder recomendar este empleo de suplementos de coenzima Q10 de modo confiable. Se necesitan estudios mejor diseñados que aporten reproducibilidad y robustez a futuros ensayos clínicos. (AU)
Introduction: The incidence of fatal cardiovascular events is very high and statin treatment is vital to reduce this risk in many patients, however, its adverse effects on skeletal muscle make it difficult to adhere or continue it. Coenzyme Q10 supplementation has been proposed to reverse myalgia associated with the use of statins. The clinical trials carried out in the last 10 years obtained conflicting results. The aim of the present work is to review the evidence on the efficacy of the use of coenzyme Q10 supplements in mitigating myopathies caused by statins. Methodology: A systematic review of the published literature until July 2020 was undertaken. The searched databases were MEDLINE and SCOPUS. Institutions such as the Agencia Española del Medicamento y productos Sanitarios (AEMPS), European Medicines Agency (EMA) and Food and Drug Administration were also consulted. Results: The etiology of statin-associated myalgias remains unknown, and the evidence found in clinical trials and meta-analysis drew disparate conclusions. The European Medicine Agency (EMA) only considers the use of supplements in primary coenzyme Q10 deficiency syndrome, while in the United Kingdom the National Institute for Health and Care Excellence (NICE) and the National Institute of Health (NIH) do not recommend the use of these supplements to treat myalgias associated with the use of statins. Conclusions: The set of studies analyzed did not obtain unanimous evidence to be able to reliably recommend this use of coenzyme Q10 supplements. Better designed studies that provide reproducibility and robustness to future clinical trials are needed. (AU)
Subject(s)
Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Ubiquinone , Muscular Diseases/drug therapy , Muscular Diseases/etiology , Muscle, SkeletalABSTRACT
Introducción: El empleo de los condroprotectores se presentó como una estrategia mejor encaminada al tratamiento de la artrosis por su efecto modulador y mayor seguridad. Sin embargo, su empleo es discutido y serán retirados de la financiación por el Sistema Nacional de salud (SNS). El objetivo fue revisar y comparar los condroprotectores en términos de eficacia (sobre dolor, función y estrechamiento articular), seguridad y rentabilidad en el manejo de la artrosis. Metodología: Se ha realizado una búsqueda bibliográfica de la literatura. Las bases de datos utilizadas fueron Medline y Scopus. Se revisó guía médica de la ESCEO (European Society for Clinical and Economic Aspects of Osteoarthritis), estudio epidemiológico de la Sociedad Española de Reumatología y fichas técnicas de medicamentos de la Agencia Española del Medicamento. Resultados: Se identificaron un total de 152 artículos con los algoritmos de búsqueda utilizados y los criterios de inclusión/exclusión aplicados. Después de leer títulos y resúmenes, 79 fueron excluidos porque no adecuarse a la calidad metodológica requerida o tratar otras aplicaciones diferentes a la artrosis. Tras la lectura íntegra del resto de artículos, se seleccionaron 36 artículos que se adaptaban al objetivo de este trabajo. Conclusiones: Los ensayos clínicos que evaluaron la diacereína y el condroitín sulfato tuvieron diseños muy variables que podrían justificar la variabilidad de los resultados obtenidos. Con la desfinanciación de estos fármacos por el SNS, el ahorro esperado podría revertirse por el empleo de recursos sanitarios más costosos en el futuro dado el enfoque a corto plazo de las terapias permanentes. (AU)
Introduction: The use of chondroprotectives was presented as a better strategy aimed at the treatment of osteoar-thritis due to its attributed chondromodulatory effect and greater safety. However, their use is disputed.The aim of the present work was to review and compare the chondroprotectives in terms of efficacy (on pain, func-tion and joint narrowing), safety and economic profitability in the management of osteoarthritis. Methodology: A bibliographic search of the literature published has been carried out. The databases used were Medline and Scopus. The medical guide of the ESCEO (European Society for Clinical and Economic Aspects of Osteo-athritis), the epidemiological study of the Spanish Society of Rheumatology and the technical sheets of medicines of the Spanish Agency of Medicines were reviewed. Results: A total of 152 articles were identified with the search algorithms used and the inclusion/exclusion criteria applied. After having read titles and abstracts, 79 were excluded because they did not conform to the required meth-odological quality or to treat other applications other than osteoarthritis. After reading the rest of the articles in their entirety, 36 articles were finally selected that were adapted to the objective of this work. Conclusions: The clinical trials that evaluated diacerein and chondroitin sulfate had highly variable designs that could justify the variability of the results obtained. With the underfunding of these drugs by the SNS, the expected savings could be reversed by the use of more expensive healthcare resources in the future given the short-term focus of permanent therapies. (AU)
Subject(s)
Humans , Joint Diseases/drug therapy , Chondroitin , Drug Costs , Glucosamine , Treatment OutcomeABSTRACT
Introducción: Más de la mitad de los pacientes con Enfermedad Inflamatoria Intestinal (EII) presenta al menos una manifestación extraintestinal, principal-mente articular, con interferencias en la calidad de vida. Además, los mecanismos patogénicos que explican el vínculo entre las patologías intestinal y la articular aún no están bien definidos. El objetivo del presente trabajo es revisar el arsenal farmaco-terapéutico actual frente a artropatías asociadas a EII.Método: Se realizó una búsqueda bibliográfica de la literatura, las bases de datos consultadas fueron Medline a través de PubMed y Scopus desde el 14 hasta el 22 de diciembre. Se seleccionaron estudios realizados en los últimos 15 años. Las palabras clave empleadas fueron: Spondyloarthritis, inflammatory bowel disease and pharmacologic therapy. También se consultó la European Crohn's and Colitis Organisation (ECCO) y la European Me-dicines Agency (EMA).Resultados: Existen diferencias entre el abordaje terapéutico de las espondiloartritis axial y periféri-ca. El manejo farmacológico ha consistido princi-palmente en aminosalicilatos, corticoides, inmu-nosupresores, metotrexato y agentes biológicos entre los que destaca el infliximab por su acción dual sobre las afecciones intestinales y articulares. Recientemente han surgido terapias mejor dirigi-das, en busca de tratamientos más personalizados como el vedolizumab, ustekinumab e inhibidores selectivos de la tirosina quinasas asociadas a JANUS (JAK).Conclusión: Los protocolos son muy dispares entre las fuentes consultadas, lo que pone de manifiesto la necesidad de un manejo de las patologías de manera integral multidisciplinar que mejoraría la calidad de vida del paciente. Consensuar el abor-daje óptimo para cada caso se presenta como un desafío tanto para el gastroenterólogo como para el reumatólogo.(AU)
Introduction: More than half of the patients with Inflammatory Bowel Disease (IBD) present, at least, one extraintestinal manifestation, mainly articular, with interference in their quality of life. Furthermore, the pathogenic mechanisms that explain the link between intestinal and joint pathologies are not well defined yet. The aim of this work is to review the current pharmacotherapeutical arsenal against arthropathies associated with IBD.Method: A bibliographic search of the literature was undertaken, the databases consulted were Medline through PubMed and Scopus from December 14 to 22. Only studies carried out in the last 15 years were selected. The keywords used were: Spon-dyloarthritis, inflammatory bowel disease and pharmacologic therapy. The European Crohn's and Colitis Organization (ECCO) and the European Medicines Agency (EMA) were also consulted.Results: There are differences between the ther-apeutic approach to axial and peripheral spon-dyloarthritis. Pharmacological management has included mainly of aminosalicylates, corticoste-roids, immunosuppressants, methotrexate and biological agents, among which infliximab stands out due to its dual action on intestinal and joint conditions. Better targeted therapies such as vedolizumab, ustekinumab, and selective inhibitors of JANUS-associated tyrosine kinases (JAK) have recently emerged in search of more personalized treatments.Conclusion: The algorithms are very disparate among the consulted sources, which highlights the need for a comprehensive multidisciplinary management that would improve the quality of life of the patient. Reaching consensus on the optimal approach for each case is a challenge for both the gastroenterologist and the rheumatologist.(AU)
Subject(s)
Humans , Joint Diseases , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/drug therapy , Spondylarthritis , Pharmaceutical ServicesABSTRACT
Introducción: Las estatinas han mostrado ser una herramienta esencial en la prevención de eventos cardiovasculares, sin embargo, sus efectos adversos sobre el músculo esquelético conocidos como SAMS (Statin-Associated Muscle Symptoms) son frecuentes y motivan la falta de adherencia al tratamiento. Es necesario superar esta barrera con nuevas estrategias, se ha sugerido en diferentes estudios que la suplementación de vitamina D o de coenzima Q10 (CoQ10) podrían revertir este inconveniente. El objetivo de este trabajo es revisar y comparar la evidencia disponible sobre CoQ10 y la vitamina D como posibles candidatos para el manejo de las SAMS. Método: Se ha realizado una búsqueda bibliográfica de la literatura, las bases de datos consultadas fueron Medline a través de PubMed y Scopus. Resultados: Los ensayos clínicos que evaluaron la suplementación de CoQ10 con este fin obtuvieron conclusiones dispares, la suplementación oral aumentó las concentraciones séricas, pero no se ha confirmado con claridad que este incremento se transfiera al tejido musculo-esquelético ya que pocos ensayos emplearon biopsias, además, cuando se emplearon arrojaron resultados contrapuestos. Respecto a la vitamina D, destacaron estudios transversales y retrospectivos en los que se evidenció que la hipovitaminosis D se asocia a exacerbación de estas miopatías asociadas, en cambio, los ensayos que valoraron la suplementación no obtuvieron una evidencia unánime. Conclusión: No se pueden recomendar suplementos de CoQ10 de modo confiable para tratar SAMS. El estatus de vitamina D al inicio de la terapia con estatinas es un buen marcador de riesgo y mejora el pronóstico de las miopatías asociadas, en cambio, se necesitan más ensayos clínicos controlados con placebo para contrastar la utilidad en suplementación.(AU)
Introduction: Statins have shown to be an essential tool in the prevention of cardiovascular events. However, their adverse effects on skeletal muscle are common and lead to lack of adherence to treatment. Different studies suggest that vitamin D or coenzyme Q10 supplementation could reverse this problem. The aimof this work is to review and compare the available evidence on coenzyme Q10and vitamin D as possible candidates for the management of statin-related myalgias. Method: A bibliographic search of literature was conducted, databases consulted were Medline through Pubmed and Scopus. Results: Clinical trials that evaluated coenzyme Q10 supplementation obtained disparate results. Oral supplementation increased coenzyme Q10 serum concentrations, but it has not been confirmed clearly that this increase is transferred to muscular-skeletal tissue, since few trials used biopsies, and when applied, opposing results were obtained. With regard to vitamin D, some cross-sectional and retrospective studies stand out. They showed hypovitaminosis D is associated with statin-related myalgias exacerbation. However, trials that assessed its supplementation did not obtain unanimous evidence. Conclusion: Coenzyme Q10 supplements cannot be recommended reliably to treat statin-related myalgias. Vitamin D status at the beginning of statin therapy is a good risk marker and improves statin-related myalgias prognosis, but more placebo-controlled clinical trials are needed to prove its supplementation usefulness.(AU)
Subject(s)
Humans , Vitamin D , Coenzymes , Ubiquinone , Myalgia , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Muscle, Skeletal , Pharmaceutical Services , Clinical Trials as TopicABSTRACT
Objetivo: Revisar la evidencia reciente sobre las aplicaciones potenciales de los suplementos farmacológicos de la vitamina D (VD) que pudieran justificar el incremento de su gasto farmacéutico, así como las dificultades que presenta estimar su utilidad terapéutica en la práctica clínica. Metodología: Se ha realizado una búsqueda bibliográfica de la literatura publicada en los últimos 5 años. Las bases de datos consultadas fueron Medline y Scopus. También se consultaron fichas técnicas de la Agencia Española de Medicamentos y Productos Sanitarios, la Sociedad Española de Reumatología, la Sociedad Española de Endocrinología y Nutrición, el Colegio Americano de Reumatología y el Grupo de Trabajo de Servicios Preventivos de Estados Unidos. Resultados: Se han detectado nuevas localizaciones de receptores específicos de VD como en enterocitos, islotes pancreáticos o túbulos distales renales, que parecen tener un papel central en funciones no relacionadas con el metabolismo del calcio. Estudios recientes relacionanel estado en VD con beneficios en procesos inmunitarios, inflamatorios de carácter crónico, infecciosos o sobre la salud cardiovascular o neurológica. Las peculiaridades metabólicas de la VD actualmente son una limitación para establecer un consenso sobrequé rango analítico en suero es más adecuado y representan una debilidad en los ensayos clínicos que valoran nuevas terapias basadas en la VD. Conclusión: No se ha alcanzado una relación causal consistente entre la suplementación con VD y sus beneficios recientemente atribuidos. Es necesario superar las barreras analíticas para conferir mayor confianza a las recomendaciones sobre su valores óptimos y mayor evidencia a sus ensayos clínicos.(AU)
Aim: To review recent evidence in relation to the potential applications of vitamin D (VD) pharmacological supplements, that could justify the increase in their pharmaceutical spending, as well as the difficulties in estimating their therapeutic utility in clinical practice. Methods: A bibliographic search of clinical trials, observational studies, reviews and meta-analysis published inthe last 5 years, in Medline and Scopus has been carried out. Data sheets from the Spanish Agency of Medicines and Health Products, Spanish Society of Rheumatology, Spanish Society of Endocrinology and Nutrition, the American College of Rheumatology and the U.S. Preventive Task Force, were also consulted. Results: New locations of specific VD receptors have been detected in enterocytes, pancreatic islets, and distal renal tubules, which appear to play a central role in functions unrelated to calcium metabolism. Recent studies, associate VD status with benefits in immune, chronic inflammatory or infectious processes, and in cardiovascular or neurological health.Metabolic peculiarities of VD currently represent a limitation for the establishment of a therapeutic serum analytical range consensus, and also appears to be a weakness in clinical trials that evaluate potential new VD-based therapies. Conclusion: A consistent causal relationship between VD supplementation and its newly attributed therapeutic benefits has not been achieved. Analytical barriers need to be overcome in order to give greater confidence to recommendations of VD optimal values and to ensure a higher level of evidence for future clinical trials.(AU)
Subject(s)
Humans , Vitamin D , Biomarkers , Nervous System Diseases , Cardiovascular Diseases , Pharmaceutical Services , Pharmaceutical PreparationsABSTRACT
OBJETIVO: Revisar la evidencia reciente disponible sobre la eficacia del empleo de los SYSADOA (Symptomatic Slow Acting Drugsfor Osteoarthritis) en artrosis, como estrategia terapéutica que pudiera adaptarse mejor a la etiología de la enfermedad como al paciente por su elevada seguridad y tolerabilidad. Metodología: Se ha realizado una búsqueda bibliográfica de la literatura publicada hasta 30 de agosto de 2019 en PubMed, las palabras clave empleadas en la búsqueda fueron:"evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" y "glucosamine". Se revisaron guías médicas internacionales, estudios epidemiológicos y fichas técnicas de medicamentos de la Agencia Española del Medicamento y Productos Sanitarios. RESULTADO: Se identificaron un total de154 artículos con los algoritmos de búsqueda empleados orientados a valorar la evidencia de este grupo terapéutico como el impacto económico y sanitario generado por la artrosis. Tras la lectura de títulos y resúmenes se procedió al descarte de 82 artículos por no adaptarse al objetivo del presente trabajo. Se realizó una segunda selección valorando la calidad metodológica y contenido. Finalmente se escogieron 8 artículos. También se consultaron las fichas técnicas de los fármacos involucrados como guías médicas y estudios epidemiológicos como el EPISER. Los últimos estudios muestran una tendencia favorable a los SYSADOA como alternativa al consumo continuado de AINE (Antiinflamatorios No Esteroideos), mostrándose una eficacia comparable al celecoxib, tanto en combinación en el estudio MOVES, como por separado en el estudio CONCEPT, ambos en 2017. CONCLUSIÓN: La elevada prevalencia de la artrosis y los inconvenientes derivados de su manejo tradicional hacen necesario el empleo de alternativas terapéuticas. Los SYSADOA se postulan como una herramienta que pudiera adaptarse mejor a la enfermedad por su carácter crónico, y al tipo de paciente al que frecuentemente van dirigidas estas terapias. Sin embargo, la disparidad obtenida en los ensayos clínicos dificulta alcanzar un consenso y ponen de manifiesto la necesidad de aclarar la confianza depositada en ellos
OBJECTIVE: To review the available recent evidence about the effectiveness of the usage of SYSADOA (Symptomatic Acting Drugsfor Osteoarthritis) in osteoarthritis, as a therapeutic strategy that could evolve with the etiology of the disease and the patient thanks toits high security and tolerability. METHODS: It was carried out a bibliographical research of the published literature until 30th August 2019 in PubMed. The key words employed in the search were: "evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" and "glucosamide". International medical guides, epidemiologic studies and data sheets of drugs from The Spanish Agency for Medication and Healthcare Products (AEMPS) were examined. RESULTS: A total of 154 articles were identified with the search algorithms used, orientated to evaluate the evidence of this therapeutic group as well as the economic and health impact generated by the osteoarthritis. After having read titles and abstracts, 82 articles were dismissed because they did not fit in the objective of the present work. A second selection was done taking into account the methodological quality and the content. In the end, 8 articles were chosen. The data sheets of the involved drugs together with the medical guides, the epidemiology studies and the EPISER were checked. The last studies show a favorable tendency to the SYSADOA as an alternative to the continued consume of non-steroidal anti-inflammatories. It was shown effectiveness comparable to celecoxib in combination with the study MOVES but also separately in the study CONCEPT, both in 2017. CONCLUSION: The high prevalence of osteoarthritis and the disadvantages derived from its traditional management make the usage of therapeutic alternatives necessary. The SYSADOA postulate as a key that could adapt better to the disease because of its chronic character and the kind of patient to whom are commonly targeted these therapies. Nevertheless, the disparity obtained in the clinical trials makes difficult to reach a consensus and reveals the necessity of clarifying the confidence placed in them
Subject(s)
Humans , Joint Diseases/drug therapy , Glucosamine/therapeutic use , Chondroitin Sulfates/therapeutic use , Anthraquinones/therapeutic use , Disease Management , Treatment Outcome , Reproducibility of ResultsABSTRACT
No disponible
Subject(s)
Humans , Alcoholism/epidemiology , Education, Pharmacy/methods , Education, Pharmacy/organization & administration , Alcohol-Related Disorders/epidemiology , Alcohol-Related Disorders/prevention & control , Behavior, Addictive/epidemiology , Behavior, Addictive/prevention & controlABSTRACT
No disponible
Subject(s)
Humans , Heart Failure/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/pharmacology , Drug-Related Side Effects and Adverse Reactions/prevention & control , Patient Safety/standardsABSTRACT
No disponible
Subject(s)
Humans , Potassium/blood , Diuretics , Adrenergic beta-Antagonists , Renal Insufficiency, Chronic/physiopathology , Myocardial Ischemia/physiopathologyABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Stroke/complications , Stroke/drug therapy , Diabetes Mellitus/drug therapy , Prognosis , Hyperglycemia/complications , Hyperglycemia/drug therapy , Medication Adherence , Pharmacists/standards , Pharmaceutical Services/organization & administration , Aspirin/therapeutic use , Professional RoleABSTRACT
Objetivo: El objetivo de esta revisión es proporcionar a los farmacéuticos comunitarios información práctica para orientar a los pacientes con DM2 en tratamiento con plantas medicinales. Material y método: Se realizó una búsqueda exhaustiva de la literatura publicada en las principales bases de datos hasta el 31 de marzo de 2014. Las revisiones y estudios seleccionados fueron sometidos a lectura crítica y a la evaluación de su calidad metodológica. Resultados: Los pacientes, a menudo, solicitan asesoramiento farmacéutico para el empleo de estas plantas en el tratamiento de DM2; sin embargo, no existen estudios robustos que ayuden a los farmacéuticos a ofrecer consejos con fiabilidad. Los estudios existentes incluyen pocos pacientes, están mal diseñados y los resultados son heterogéneos. Conclusión: El fenogreco o alholva posee un efecto hipoglucemiante con una fuerte evidencia científica. También existe buena evidencia en el caso de ivy gourd y gymnema en el manejo de la hiperglucemia (AU)
Objective: The aim of this review is to provide pharmacists a practical information to guide consumers in their choices of herbal products for the management of DM2. Material and Methods: An exhaustive search of the published literature in referencial data recourses was performed, up to March 31nd 2015. Revisions and selected studies were subjected to critical reading and assessment of methodological quality. Results: Pharmacist advice is often requested on the use of these agents for the management of type 2 diabetes mellitus (DM2); however, this is an area that has insufficient evidence to support confident recommendations. Many published studies involving herbal agents are small and poorly designed, with heterogeneous results. Conclusion: The strongest scientific evidence for blood glucose lowering effect is associated with fenugreek. There is also good evidence supporting the use of ivy gourd and gymnema for management of hyperglycemia (AU)