ABSTRACT
BACKGROUND: Headaches are common and often lead patients to seek advice from a pharmacist and consequently self-medicate for relief. Computerized pharmacy decision support systems (PDSSs) may be a valuable resource for health care professionals, particularly for community pharmacists when counseling patients with headache, to guide treatment with over-the-counter medications and recognize patients who require urgent or specialist care. OBJECTIVE: This observational pilot study aimed to evaluate a newly developed PDSS web app for the management of patients seeking advice from a pharmacy for headache. This study examined the use of the PDSS web app and if it had an impact on patient or pharmacy personnel counseling, pharmacy personnel perception, and patient perception. METHODS: The PDSS web app was developed according to Francophone des Sciences Pharmaceutiques Officinales (SFSPO) recommendations for headache management, and was made available to pharmacies in 2 regions of France: Hauts de France and New Aquitaine. Pharmacy personnel received 2 hours of training before using the PDSS web app. All people who visited the pharmacies for headache between June 29, 2020, and December 31, 2020, were offered an interview based on the PDSS web app and given information about the next steps in the management of headaches and advice on the proper use of their medication. Patients and pharmacy personnel reported satisfaction with the PDSS web app following consultations or during a follow-up period (January 18 to 25, 2021). RESULTS: Of the 44 pharmacies that received the PDSS web app, 38 pharmacies representing 179 pharmacy personnel used the PDSS web app, and 435 people visited these pharmacies for headache during the study period. Of these, 70.0% (305/435) asked for immediate over-the-counter analgesics for themselves and consulted with pharmacy personnel with the use of the PDSS web app. The majority of these patients were given advice and analgesics for self-medication (346/435, 79.5%); however, 17.0% (74/435) were given analgesics and referred to urgent medical services, and 3.5% (15/435) were given analgesics and referred to their general practitioner. All pharmacy personnel (n=45) were satisfied or very satisfied with the use of the PDSS web app, and a majority thought it improved the quality of their care (41/44, 93.2%). Most pharmacy personnel felt that the PDSS web app modified their approach to management of headache (29/45, 64.4%). Most patients were very satisfied with the PDSS web app during their consultation (96/119, 80.7%), and all felt mostly or completely reassured. CONCLUSIONS: Use of the PDSS web app for the management of patients with headache improved the perceived quality of care for pharmacy personnel and patients. The PDSS web app was well accepted and effectively identified patients who required specialist medical management. Further studies should identify additional "red flags" for more effective screening and management of patients via the PDSS web app. Larger studies can measure the impact of the PDSS web app on the lives of patients and how safe or appropriate pharmacy personnel recommendations are.
ABSTRACT
Fibropapillomatosis (FP) threatens the survival of green turtle (Chelonia mydas) populations at a global scale, and human activities are regularly pointed as causes of high FP prevalence. However, the association of ecological factors with the disease's severity in complex coastal systems has not been well established and requires further studies. Based on a set of 405 individuals caught over ten years, this preliminary study provides the first insight of FP in Martinique Island, which is a critical development area for immature green turtles. Our main results are: (i) 12.8% of the individuals were affected by FP, (ii) FP has different prevalence and temporal evolution between very close sites, (iii) green turtles are more frequently affected on the upper body part such as eyes (41.4%), fore flippers (21.9%), and the neck (9.4%), and (iv) high densities of individuals are observed on restricted areas. We hypothesise that turtle's aggregation enhances horizontal transmission of the disease. FP could represent a risk for immature green turtles' survival in the French West Indies, a critical development area, which replenishes the entire Atlantic population. Continuing scientific monitoring is required to identify which factors are implicated in this panzootic disease and ensure the conservation of the green turtle at an international scale.
Subject(s)
Turtles , Animals , Martinique/epidemiology , PrevalenceABSTRACT
PURPOSE: Opportunistic pharmacy-based screening of atrial fibrillation (AF) appears effective, but the proportion of detected citizens is unknown. The aim of our real-life study was to determine rates of screening in a community population according to age group and gender. METHODS: We conducted four community campaigns of pharmacy-based single-time point AF screening that involved individuals ≥65 years. We used a single-lead and hand-held device MyDiagnostick (6229 EV Maastricht, The Netherlands) that generates a 60-s ECG trace. All pharmacies of the communities (n = 54) were involved. Rates of screening were assessed on the base of the French National Institute for Statistics and Economic Studies data and were expressed as percentage and 95% Confidence interval (CI). RESULTS: We screened 4208 individuals (Mean age, 74.2 ± 6.6 years; females, 60.2%). The screening rate in citizens aged ≥65 years was 17.2% (16.6-17.7), and higher in females than in males (17.9% [17.3-18.6] versus 16.0 [15.3-16.8], p < 0.001). The 70-74 age group showed the highest rate (25.7% [24.4-27]) compared to other groups. After 74 years, screening rates decreased steadily with age and dropped to 4.8% [3.8-6.1] in very elderly (≥90). Among the 188 (4.47%) positive screening, 117 (2.78%) showed an AF that was unknown in 53 (1.26%). Increasing age (OR: 1.05 [1.00-1.09], p = 0.04), male sex (OR: 4.30 [2.33-7.92], p < 0.0001) and high CHA2DS2-Vasc (OR: 1.59 [1.21-2.09], p = 0.0008) were independent predictors of unknown AF. CONCLUSION: Single-lead AF detection performed in community pharmacies result in screening one in six elderly citizens. Although male sex and elderly predicted unknown AF diagnosis, they were less involved in such designed campaigns.
