Clinical Performance Evaluation of a Rapid Real-Time PCR Assay for Monkeypox Diagnosis: a Retrospective and Comparative Study.

In an increasingly globalized and interconnected world, the outbreak of an infectious disease in one country can become a worrying health emergency for the whole world. A current example is the 2022 monkeypox virus (mpox) outbreak affecting multiple areas across the world. In this context, strategies to interrupt transmission as soon as possible by identifying cases, clusters, and sources of infection should be developed around the world to prevent these crises. The aim of this retrospective and collaborative study was to perform external clinical validation of the VIASURE monkeypox virus real-time PCR detection kit (CerTest Biotec, Spain) with ready-to-use reagents designed for the rapid detection of mpox. A total of 165 samples with suspected infection were used for this analysis. The standard procedures of the clinical microbiology laboratory of the Miguel Servet University Hospital, using the RealStar Orthopoxvirus PCR kit v1.0 (Altona Diagnostics) and bidirectional Sanger sequencing (STAB VIDA, Caparica, Portugal), were considered reference techniques. Furthermore, a subset of 67 mpox-negative samples and 13 mpox-positive samples were routinely tested for clinical diagnosis of other rash/ulcerative pathologies. Accuracy testing resulted in appropriate clinical validation values, as follows: sensitivity, 1 (95% confidence interval [CI], 0.97 to 1); specificity, 1 (95% CI, 0.98 to 1); positive predictive value, 1 (95% CI, 0.93 to 1); negative predictive value, 1 (95% CI, 0.95 to 1). The strength of agreement between assays was almost perfect. The added value is the useful support for the specific diagnosis of mpox infections due to the diagnostic specificity data obtained. IMPORTANCE Given that a large number of mpox outbreaks have been reported worldwide since 2022 in countries in which the disease is not endemic, the main concern for clinicians and global health systems should be to develop effective, available, and easy-to-implement diagnostic strategies to interrupt mpox transmission as soon as possible. This retrospective study demonstrates the satisfactory clinical parameters of a commercially available molecular diagnostic kit for routine testing for mpox in clinical diagnostic laboratories.

Retrospective and Comparative Study of Three Molecular Assays for the Macrolide Resistance Detection in Mycoplasma genitalium Positive Urogenital Specimens.

The capacity of Mycoplasma genitalium to develop resistance to macrolides makes detection of macrolide resistance genes by rapid real-time PCR assays increasingly necessary in clinical diagnostic laboratories so as to initiate appropriate treatment as rapidly as possible. The aim of this retrospective and comparative study was to conduct the clinical evaluation of three commercially available kits for macrolide resistance detection. A total of 111 M. genitalium positive samples analyzed in the Clinical Microbiology Laboratory of the Miguel Servet University Hospital, Zaragoza (Spain) were used. After M. genitalium molecular confirmation, the three assays under study were evaluated and discrepant results were resolved via sequencing. The clinical sensitivity for resistance detection was 83% (95% confidence interval, 69% to 93%) for the ResistancePlus® MG panel kit (SpeeDx Pty Ltd., Sydney, Australia), 95% (84% to 99%) for AllplexTM MG & AziR Assay (Seegene®, Seoul, Korea), and 97% (88% to 99%) for the VIASURE macrolide resistance-associated mutations (23SrRNA) Real time PCR detection kit (Certest Biotec, Zaragoza, Spain). The clinical specificity was 100% (94% to 100%) for Allplex and VIASURE assays and 95% (86% to 99%) for SpeeDx assay. The results arising from this study are cause for strong consideration for the implementation of rapid real-time PCR assays in clinical diagnosis laboratories to eliminate treatment failure and transmission as soon as possible.

Pathways regulating decreased soil respiration with warming in a biocrust-dominated dryland.

A positive soil carbon (C)-climate feedback is embedded into the climatic models of the IPCC. However, recent global syntheses indicate that the temperature sensitivity of soil respiration (RS ) in drylands, the largest biome on Earth, is actually lower in warmed than in control plots. Consequently, soil C losses with future warming are expected to be low compared with other biomes. Nevertheless, the empirical basis for these global extrapolations is still poor in drylands, due to the low number of field experiments testing the pathways behind the long-term responses of soil respiration (RS ) to warming. Importantly, global drylands are covered with biocrusts (communities formed by bryophytes, lichens, cyanobacteria, fungi, and bacteria), and thus, RS responses to warming may be driven by both autotrophic and heterotrophic pathways. Here, we evaluated the effects of 8-year experimental warming on RS , and the different pathways involved, in a biocrust-dominated dryland in southern Spain. We also assessed the overall impacts on soil organic C (SOC) accumulation over time. Across the years and biocrust cover levels, warming reduced RS by 0.30 µmol CO2  m-2  s-1 (95% CI = -0.24 to 0.84), although the negative warming effects were only significant after 3 years of elevated temperatures in areas with low initial biocrust cover. We found support for different pathways regulating the warming-induced reduction in RS at areas with low (microbial thermal acclimation via reduced soil mass-specific respiration and ß-glucosidase enzymatic activity) vs. high (microbial thermal acclimation jointly with a reduction in autotrophic respiration from decreased lichen cover) initial biocrust cover. Our 8-year experimental study shows a reduction in soil respiration with warming and highlights that biocrusts should be explicitly included in modeling efforts aimed to quantify the soil C-climate feedback in drylands.

Antimicrobial Resistance Profiles of Listeria monocytogenes and Listeria innocua Isolated from Ready-to-Eat Products of Animal Origin in Spain.

The objective of this work was to investigate the antimicrobial resistance in Listeria spp. isolated from food of animal origin. A total of 50 Listeria strains isolated from meat and dairy products, consisting of 7 Listeria monocytogenes and 43 Listeria innocua strains, were characterized for antimicrobial susceptibility against nine antimicrobials. The strains were screened by real-time PCR for the presence of antimicrobial resistance genes: tet M, tet L, mef A, msr A, erm A, erm B, lnu A, and lnu B. Multidrug resistance was identified in 27 Listeria strains, 4 belonging to L. monocytogenes. Resistance to clindamycin was the most common resistance phenotype and was identified in 45 Listeria strains; the mechanisms of resistance are still unknown. A medium prevalence of resistance to tetracycline (15 and 9 resistant and intermediate strains) and ciprofloxacin (13 resistant strains) was also found. Tet M was detected in Listeria strains with reduced susceptibility to tetracycline, providing evidence that both L. innocua and L. monocytogenes displayed acquired resistance. The presence of antimicrobial resistance genes in L. innocua and L. monocytogenes indicates that these genes may be transferred to commensal and pathogenic bacteria via the food chain; besides this, antibiotic resistance in L. monocytogenes could compromise the effective treatment of listeriosis in humans.

Warming reduces the cover and diversity of biocrust-forming mosses and lichens, and increases the physiological stress of soil microbial communities in a semi-arid Pinus halepensis plantation.

Soil communities dominated by lichens and mosses (biocrusts) play key roles in maintaining ecosystem structure and functioning in drylands worldwide. However, few studies have explicitly evaluated how climate change-induced impacts on biocrusts affect associated soil microbial communities. We report results from a field experiment conducted in a semiarid Pinus halepensis plantation, where we setup an experiment with two factors: cover of biocrusts (low [<15%] versus high [>50%]), and warming (control versus a ∼2°C temperature increase). Warming reduced the richness and cover (∼45%) of high biocrust cover areas 53 months after the onset of the experiment. This treatment did not change the ratios between the major microbial groups, as measured by phospholipid fatty acid analysis. Warming increased the physiological stress of the Gram negative bacterial community, as indicated by the cy17:0/16:1ω7 ratio. This response was modulated by the initial biocrust cover, as the increase in this ratio with warming was higher in areas with low cover. Our findings suggest that biocrusts can slow down the negative effects of warming on the physiological status of the Gram negative bacterial community. However, as warming will likely reduce the cover and diversity of biocrusts, these positive effects will be reduced under climate change.

Biocrusts modulate warming and rainfall exclusion effects on soil respiration in a semi-arid grassland.

Soil surface communities composed of cyanobacteria, algae, mosses, liverworts, fungi, bacteria and lichens (biocrusts) largely affect soil respiration in dryland ecosystems. Climate change is expected to have large effects on biocrusts and associated ecosystem processes. However, few studies so far have experimentally assessed how expected changes in temperature and rainfall will affect soil respiration in biocrust-dominated ecosystems. We evaluated the impacts of biocrust development, increased air temperature and decreased precipitation on soil respiration dynamics during dry (2009) and wet (2010) years, and investigated the relative importance of soil temperature and moisture as environmental drivers of soil respiration, in a semiarid grassland from central Spain. Soil respiration rates were significantly lower in the dry than during the wet year, regardless of biocrust cover. Warming increased soil respiration rates, but this response was only significant in biocrust-dominated areas (> 50% biocrust cover). Warming also increased the temperature sensitivity (Q10 values) of soil respiration in biocrust-dominated areas, particularly during the wet year. The combination of warming and rainfall exclusion had similar effects in low biocrust cover areas. Our results highlight the importance of biocrusts as a modulator of soil respiration responses to both warming and rainfall exclusion, and indicate that they must be explicitly considered when evaluating soil respiration responses to climate change in drylands.

Climate and soil attributes determine plant species turnover in global drylands.

AIM: Geographic, climatic, and soil factors are major drivers of plant beta diversity, but their importance for dryland plant communities is poorly known. This study aims to: i) characterize patterns of beta diversity in global drylands, ii) detect common environmental drivers of beta diversity, and iii) test for thresholds in environmental conditions driving potential shifts in plant species composition. LOCATION: 224 sites in diverse dryland plant communities from 22 geographical regions in six continents. METHODS: Beta diversity was quantified with four complementary measures: the percentage of singletons (species occurring at only one site), Whittake's beta diversity (ß(W)), a directional beta diversity metric based on the correlation in species occurrences among spatially contiguous sites (ß(R2)), and a multivariate abundance-based metric (ß(MV)). We used linear modelling to quantify the relationships between these metrics of beta diversity and geographic, climatic, and soil variables. RESULTS: Soil fertility and variability in temperature and rainfall, and to a lesser extent latitude, were the most important environmental predictors of beta diversity. Metrics related to species identity (percentage of singletons and ß(W)) were most sensitive to soil fertility, whereas those metrics related to environmental gradients and abundance ((ß(R2)) and ß(MV)) were more associated with climate variability. Interactions among soil variables, climatic factors, and plant cover were not important determinants of beta diversity. Sites receiving less than 178 mm of annual rainfall differed sharply in species composition from more mesic sites (> 200 mm). MAIN CONCLUSIONS: Soil fertility and variability in temperature and rainfall are the most important environmental predictors of variation in plant beta diversity in global drylands. Our results suggest that those sites annually receiving ~ 178 mm of rainfall will be especially sensitive to future climate changes. These findings may help to define appropriate conservation strategies for mitigating effects of climate change on dryland vegetation.

Functional traits determine plant co-occurrence more than environment or evolutionary relatedness in global drylands.

Plant-plant interactions are driven by environmental conditions, evolutionary relationships (ER) and the functional traits of the plants involved. However, studies addressing the relative importance of these drivers are rare, but crucial to improve our predictions of the effects of plant-plant interactions on plant communities and of how they respond to differing environmental conditions. To analyze the relative importance of -and interrelationships among- these factors as drivers of plant-plant interactions, we analyzed perennial plant co-occurrence at 106 dryland plant communities established across rainfall gradients in nine countries. We used structural equation modeling to disentangle the relationships between environmental conditions (aridity and soil fertility), functional traits extracted from the literature, and ER, and to assess their relative importance as drivers of the 929 pairwise plant-plant co-occurrence levels measured. Functional traits, specifically facilitated plants' height and nurse growth form, were of primary importance, and modulated the effect of the environment and ER on plant-plant interactions. Environmental conditions and ER were important mainly for those interactions involving woody and graminoid nurses, respectively. The relative importance of different plant-plant interaction drivers (ER, functional traits, and the environment) varied depending on the region considered, illustrating the difficulty of predicting the outcome of plant-plant interactions at broader spatial scales. In our global-scale study on drylands, plant-plant interactions were more strongly related to functional traits of the species involved than to the environmental variables considered. Thus, moving to a trait-based facilitation/competition approach help to predict that: 1) positive plant-plant interactions are more likely to occur for taller facilitated species in drylands, and 2) plant-plant interactions within woody-dominated ecosystems might be more sensitive to changing environmental conditions than those within grasslands. By providing insights on which species are likely to better perform beneath a given neighbour, our results will also help to succeed in restoration practices involving the use of nurse plants.

Decoupling of soil nutrient cycles as a function of aridity in global drylands.

The biogeochemical cycles of carbon (C), nitrogen (N) and phosphorus (P) are interlinked by primary production, respiration and decomposition in terrestrial ecosystems. It has been suggested that the C, N and P cycles could become uncoupled under rapid climate change because of the different degrees of control exerted on the supply of these elements by biological and geochemical processes. Climatic controls on biogeochemical cycles are particularly relevant in arid, semi-arid and dry sub-humid ecosystems (drylands) because their biological activity is mainly driven by water availability. The increase in aridity predicted for the twenty-first century in many drylands worldwide may therefore threaten the balance between these cycles, differentially affecting the availability of essential nutrients. Here we evaluate how aridity affects the balance between C, N and P in soils collected from 224 dryland sites from all continents except Antarctica. We find a negative effect of aridity on the concentration of soil organic C and total N, but a positive effect on the concentration of inorganic P. Aridity is negatively related to plant cover, which may favour the dominance of physical processes such as rock weathering, a major source of P to ecosystems, over biological processes that provide more C and N, such as litter decomposition. Our findings suggest that any predicted increase in aridity with climate change will probably reduce the concentrations of N and C in global drylands, but increase that of P. These changes would uncouple the C, N and P cycles in drylands and could negatively affect the provision of key services provided by these ecosystems.

Changes in biocrust cover drive carbon cycle responses to climate change in drylands.

Dryland ecosystems account for ca. 27% of global soil organic carbon (C) reserves, yet it is largely unknown how climate change will impact C cycling and storage in these areas. In drylands, soil C concentrates at the surface, making it particularly sensitive to the activity of organisms inhabiting the soil uppermost levels, such as communities dominated by lichens, mosses, bacteria and fungi (biocrusts). We conducted a full factorial warming and rainfall exclusion experiment at two semiarid sites in Spain to show how an average increase of air temperature of 2-3 °C promoted a drastic reduction in biocrust cover (ca. 44% in 4 years). Warming significantly increased soil CO2 efflux, and reduced soil net CO2 uptake, in biocrust-dominated microsites. Losses of biocrust cover with warming through time were paralleled by increases in recalcitrant C sources, such as aromatic compounds, and in the abundance of fungi relative to bacteria. The dramatic reduction in biocrust cover with warming will lessen the capacity of drylands to sequester atmospheric CO2 . This decrease may act synergistically with other warming-induced effects, such as the increase in soil CO2 efflux and the changes in microbial communities to alter C cycling in drylands, and to reduce soil C stocks in the mid to long term.

Aridity modulates N availability in arid and semiarid Mediterranean grasslands.

While much is known about the factors that control each component of the terrestrial nitrogen (N) cycle, it is less clear how these factors affect total N availability, the sum of organic and inorganic forms potentially available to microorganisms and plants. This is particularly true for N-poor ecosystems such as drylands, which are highly sensitive to climate change and desertification processes that can lead to the loss of soil nutrients such as N. We evaluated how different climatic, abiotic, plant and nutrient related factors correlate with N availability in semiarid Stipa tenacissima grasslands along a broad aridity gradient from Spain to Tunisia. Aridity had the strongest relationship with N availability, suggesting the importance of abiotic controls on the N cycle in drylands. Aridity appeared to modulate the effects of pH, plant cover and organic C (OC) on N availability. Our results suggest that N transformation rates, which are largely driven by variations in soil moisture, are not the direct drivers of N availability in the studied grasslands. Rather, the strong relationship between aridity and N availability could be driven by indirect effects that operate over long time scales (decades to millennia), including both biotic (e.g. plant cover) and abiotic (e.g. soil OC and pH). If these factors are in fact more important than short-term effects of precipitation on N transformation rates, then we might expect to observe a lagged decrease in N availability in response to increasing aridity. Nevertheless, our results suggest that the increase in aridity predicted with ongoing climate change will reduce N availability in the Mediterranean basin, impacting plant nutrient uptake and net primary production in semiarid grasslands throughout this region.

Warming reduces the growth and diversity of biological soil crusts in a semi-arid environment: implications for ecosystem structure and functioning.

Biological soil crusts (BSCs) are key biotic components of dryland ecosystems worldwide that control many functional processes, including carbon and nitrogen cycling, soil stabilization and infiltration. Regardless of their ecological importance and prevalence in drylands, very few studies have explicitly evaluated how climate change will affect the structure and composition of BSCs, and the functioning of their constituents. Using a manipulative experiment conducted over 3 years in a semi-arid site from central Spain, we evaluated how the composition, structure and performance of lichen-dominated BSCs respond to a 2.4°C increase in temperature, and to an approximately 30 per cent reduction of total annual rainfall. In areas with well-developed BSCs, warming promoted a significant decrease in the richness and diversity of the whole BSC community. This was accompanied by important compositional changes, as the cover of lichens suffered a substantial decrease with warming (from 70 to 40% on average), while that of mosses increased slightly (from 0.3 to 7% on average). The physiological performance of the BSC community, evaluated using chlorophyll fluorescence, increased with warming during the first year of the experiment, but did not respond to rainfall reduction. Our results indicate that ongoing climate change will strongly affect the diversity and composition of BSC communities, as well as their recovery after disturbances. The expected changes in richness and composition under warming could reduce or even reverse the positive effects of BSCs on important soil processes. Thus, these changes are likely to promote an overall reduction in ecosystem processes that sustain and control nutrient cycling, soil stabilization and water dynamics.

Plant species richness and ecosystem multifunctionality in global drylands.

Experiments suggest that biodiversity enhances the ability of ecosystems to maintain multiple functions, such as carbon storage, productivity, and the buildup of nutrient pools (multifunctionality). However, the relationship between biodiversity and multifunctionality has never been assessed globally in natural ecosystems. We report here on a global empirical study relating plant species richness and abiotic factors to multifunctionality in drylands, which collectively cover 41% of Earth's land surface and support over 38% of the human population. Multifunctionality was positively and significantly related to species richness. The best-fitting models accounted for over 55% of the variation in multifunctionality and always included species richness as a predictor variable. Our results suggest that the preservation of plant biodiversity is crucial to buffer negative effects of climate change and desertification in drylands.

Ecology and functional roles of biological soil crusts in semi-arid ecosystems of Spain.

Biological soil crusts (BSCs), composed of lichens, cyanobacteria, mosses, liverworts and microorganisms, are key biotic components of arid and semi-arid ecosystems worldwide. Despite they are widespread in Spain, these organisms have been historically understudied in this country. This trend is beginning to change as a recent wave of research has been identifying BSCs as a model ecological system. Many studies and research projects carried out in Spain have explored the role of BSCs on water, carbon and nitrogen fluxes, the interactions between BSCs and vascular plants, their dynamics after disturbances, and their response to global change, among other topics. In this article we review the growing body of research on BSCs available from semi-arid areas of Spain, highlighting its importance for increasing our knowledge on this group of organisms. We also discuss how it is breaking new ground in emerging research areas on the ecology of BSCs, and how it can be use to guide management and restoration efforts. Finally, we provide directions for future research on the ecology of BSCs in Spain and abroad.

Do biotic interactions modulate ecosystem functioning along stress gradients? Insights from semi-arid plant and biological soil crust communities.

Climate change will exacerbate the degree of abiotic stress experienced by semi-arid ecosystems. While abiotic stress profoundly affects biotic interactions, their potential role as modulators of ecosystem responses to climate change is largely unknown. Using plants and biological soil crusts, we tested the relative importance of facilitative-competitive interactions and other community attributes (cover, species richness and species evenness) as drivers of ecosystem functioning along stress gradients in semi-arid Mediterranean ecosystems. Biotic interactions shifted from facilitation to competition along stress gradients driven by water availability and temperature. These changes were, however, dependent on the spatial scale and the community considered. We found little evidence to suggest that biotic interactions are a major direct influence upon indicators of ecosystem functioning (soil respiration, organic carbon, water-holding capacity, compaction and the activity of enzymes related to the carbon, nitrogen and phosphorus cycles) along stress gradients. However, attributes such as cover and species richness showed a direct effect on ecosystem functioning. Our results do not agree with predictions emphasizing that the importance of plant-plant interactions will be increased under climate change in dry environments, and indicate that reductions in the cover of plant and biological soil crust communities will negatively impact ecosystems under future climatic conditions.

[Impact of new therapeutic products for the treatment of chronic obstructive pulmonary disease and asthma in primary care in Madrid between 1996 and 2005]. / Impacto de las novedades terapéuticas para el tratamiento de la enfermedad pulmonar obstructiva crónica y el asma en atención primaria de Madrid, entre 1996 y 2005.

OBJECTIVES: To analyze the trend of use of new drugs for the treatment of chronic obstructive pulmonary disease in primary care of Madrid (Spain) between 1996 and 2005, and to evaluate its impact in terms of supply, use and costs. METHODS: Drug utilization study of new products of the R03 group (Anatomical Therapeutic Chemical Classificaction System: drugs for obstructive airway diseases) prescribed by doctors of primary care of Madrid, during 1996 and 2005. Information on drug utilization and cost was obtained from the prescription database. Date was expressed in daily doses defined by 1,000 inhabitants and day. RESULTS: The supply experiences few quantitative variations although of great qualitative interest, when disappearing drugs without therapeutic utility and commercializing 6 therapeutic new products. In 2005, the use of the 6 new products generates 28.03% of the total of the consumption and 79% of the costs. The new drugs of greater impact are salmeterol/fluticasone and tiotropio. CONCLUSIONS: The supply of medicines qualitatively improves when disappearing drugs without therapeutic utility. The consumption of therapeutic new products has a great impact on the total consumption of the R03 group and, mainly, in the costs by its elevated price, in spite of contributing only limited therapeutic advantages. The new drugs have been gotten up at great speed to the prescription.

Impacto de las novedades terapéuticas para el tratamiento de la enfermedad pulmonar obstructiva crónica y el asma en atención primaria de Madrid, entre 1996 y 2005 / Impact of new therapeutic products for the treatment of chronic obstructive pulmonary disease and asthma in primary care in Madrid between 1996 and 2005

Objetivos: Analizar la tendencia de utilización de nuevos medicamentos para el tratamiento de las enfermedades obstructivas de las vías aéreas en atención primaria de Madrid entre 1996 y 2005, y evaluar su impacto en términos de oferta, consumo y costes. Métodos: Estudio de utilización de medicamentos de novedades terapéuticas del grupo R03 («medicamentos para enfermedades obstructivas de las vías aéreas») prescritos por médicos de atención primaria de Madrid, durante 1996 y 2005. Los datos de consumo y gasto a PVP provienen de la facturación de recetas. El consumo se expresa en dosis diarias definidas por 1.000 habitantes y día. Resultados: La oferta experimenta pocas variaciones cuantitativas aunque de gran interés cualitativo, al desaparecer fármacos sin utilidad terapéutica y comercializarse 6 novedades terapéuticas. En el año 2005, la utilización de estas últimas genera el 28,03% del total del consumo y el 79% de los costes. Las novedades de mayor impacto son salmeterol/fluticasona y tiotropio. Conclusiones: La oferta de medicamentos mejora cualitativamente al desaparecer los fármacos sin utilidad terapéutica. La prescripción de novedades terapéuticas tiene un gran impacto sobre el consumo total de los medicamentos del grupo R03 y, sobre todo, en los costes generados, dado su elevado su precio; sin embargo, aportan limitadas ventajas terapéuticas. Los nuevos medicamentos se han incorporado a gran velocidad a la prescripción (AU)

Objectives: To analyze the trend of use of new drugs for the treatment of chronic obstructive pulmonary disease in primary care of Madrid (Spain) between 1996 and 2005, and to evaluate its impact in terms of supply, use and costs. Methods: Drug utilization study of new products of the R03 group (Anatomical Therapeutic Chemical Classificaction System: drugs for obstructive airway diseases) prescribed by doctors of primary care of Madrid, during 1996 and 2005. Information on drug utilization and cost was obtained from the prescription database. Date was expressed in daily doses defined by 1,000 inhabitants and day. Results: The supply experiences few quantitative variations although of great qualitative interest, when disappearing drugs without therapeutic utility and commercializing 6 therapeutic new products. In 2005, the use of the 6 new products generates 28.03% of the total of the consumption and 79% of the costs. The new drugs of greater impact are salmeterol/fluticasone and tiotropio. Conclusions: The supply of medicines qualitatively improves when disappearing drugs without therapeutic utility. The consumption of therapeutic new products has a great impact on the total consumption of the R03 group and, mainly, in the costs by its elevated price, in spite of contributing only limited therapeutic advantages. The new drugs have been gotten up at great speed to the prescription (AU)

Coordinación de servicios sociosanitarios para la mejora de la prescripción y dispensación farmacológica en una residencia de ancianos / Coordination of geriatric care to improve drug prescription and dispensation in a nursing home

Objetivo: implementar un programa de coordinación entre un centro de salud (CS), un centro residencial geriátrico (CRG) y una oficina de farmacia (OF) como estrategia de mejora de la gestión clínica-asistencial de pacientes residentes en centros geriátricos y evaluar su impacto en términos de eficiencia en la utilización de recursos sanitarios y seguridad del paciente. Material y método: estudio descriptivo y de intervención antes-después con 3 fases: evaluación de la situación, intervención y medida de resultados en el CRG. Se determinan indicadores en relación con la organización, protocolización de proceso, calidad de prescripción farmacéutica y seguimiento farmacoterapéutico en la OF. Se realizó un análisis de situación identificando 6 áreas de mejora en relación con la asistencia sanitaria prestada a los pacientes del CRG: coordinación entre unidades gestoras y asistenciales, prescripción de medicamentos y productos sanitarios, circuito para la realización de pruebas analíticas, suministro de material sanitario, control de pacientes en tratamiento con anticoagulación oral y seguimiento farmacoterapéutico en la OF. Se instauraron acciones correctivas en relación con la coordinación así como con la protocolización de 5 de los procesos clínico-asistenciales descritos anteriormente. La OF inició un programa para el seguimiento farmacoterapéutico de los pacientes del CRG. Resultados: de los indicadores propuestos se observa una disminución del importe medio por envases en un 24%, y mejoran los indicadores de calidad de prescripción seleccionados (especialidades farmacéuticas genéricas [%], antagonistas de receptores de angiotensina II [%], antidiabéticos de elección [%] e inhibidores de la enzima conversiva de angiotensina de elección [%]). Se ha realizado seguimiento farmacoterapéutico en la OF a 82 pacientes detectando 61 problemas relacionados con medicamentos. Conclusiones: los resultados de este programa de intervención se muestran útiles para mejorar la calidad de la prescripción farmacéutica y utilización de los recursos sanitarios en pacientes geriátricos de una residencia. La metodología se ha mostrado apropiada para promover un uso eficiente de los recursos sanitarios y potenciar la seguridad de los pacientes

Objective: to implement a coordination program among a health center, a nursing home, and a community pharmacy as a strategy to improve the management of nursing home residents and to evaluate the impact of this strategy on the efficiency of health resource utilization and patient safety. Material and method: we performed a descriptive before-after intervention study in three phases: evaluation of the situation, intervention, and measurement of the results in the nursing home. Indicators related to organization, standardization of the process, quality of drug prescription, and pharmacotherapeutic follow-up in the community pharmacy were determined. An analysis of the situation was performed by identifying six areas of improvement in relation to the healthcare provided to the nursing home residents: coordination between management and clinical units, prescription of drugs and healthcare products, the circuit for laboratory tests, supply of healthcare material, monitoring of patients under treatment with oral anticoagulants and pharmacotherapeutic follow-up in the community pharmacy. Corrective measures were implemented in relation to the coordination and standardization of five of the above-mentioned areas. The community pharmacy initiated a program for the pharmacotherapeutic follow-up of patients in the nursing home. Results: of the indicators proposed, a 24% reduction in the mean cost due to medication. Improvement was also noted in the selected indicators of prescription quality (% generic drugs, % angiotensin II receptor antagonists, % antidiabetic agents of choice, and % angiotensin converting enzyme inhibitors of choice). Pharmacotherapeutic follow-up of 82 patients was performed in the community pharmacy and 61 drug-related problems were detected. Conclusions: the results of this intervention program are useful to improve drug prescription and healthcare resource use in nursing home residents. The methodology has been shown to be appropriate to foment the efficient use of healthcare resources and patient safety

[Drug prescription for chronic obstructive pulmonary disease and asthma by primary care physicians in the Spanish autonomous community of Madrid, 1996-2002]. / Utilización de medicamentos para la EPOC y el asma en atención primaria en la Comunidad de Madrid (1996-2002).

OBJECTIVE: To identify trends in the drug prescription used to treat chronic obstructive pulmonary disease (COPD) and asthma at the primary care level in Madrid between 1996 and 2002, and to assess the repercussion of new treatments. PATIENTS AND METHODS: We analyzed information on primary care general practitioners' and pediatricians drug prescription from the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical Classification System. Drug consumption was measured by recording the number of packages charged to the Spanish National Health Service and dispensed in pharmacies in the Spanish autonomous community of Madrid between 1999 and 2002. Consumption was expressed as defined daily dose per 1000 inhabitants per day. RESULTS: Drug use expressed as defined daily dose per 1000 inhabitants per day for COPD and asthma in Madrid increased by 18.48% between 1996 and 2002. The use of inhalants increased by 33.5% over the same period. The most marked differences were the increase in the number of patients treated with selective beta2 adrenergic agonists, anticholinergics, and combinations of fixed doses of long acting beta2 agonists with corticosteroids. The most-used drugs in 2002 were selective beta2 adrenergic agonist inhalants (37.7%), anticholinergics (22.5%), corticosteroids (19.5%), combinations of fixed doses of long acting beta2 adrenergic agonists with corticosteroids (10.5%) band xanthines (5.03%). In 2002, the prescription of 5 new treatments amounted to 15.76% of total use of COPD and asthma drugs (R03 group). CONCLUSIONS: Drug use for obstructive diseases of the airways showed a sharp increase between 1996 and 2002. Changes in patterns of use were observed, new treatments being quickly adopted, modifying the profile of drug prescription for the management of COPD and asthma.

Utilización de medicamentos para la EPOC y el asma en atención primaria en la Comunidad de Madrid (1996-2002) / Drug prescription for Chronic Obstructive Pulmonary Disease and asthma by primary care physicians in the spanish autonomous Community of Madrid, 1996-2002

Objetivo: Conocer la tendencia en la utilización de los medicamentos para el tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC) y el asma en atención primaria de Madrid entre 1996 y 2002, y evaluar la repercusión de las novedades terapéuticas. Pacientes y métodos: Se ha analizado la información sobre el consumo, en número de envases, de los medicamentos incluidos en el grupo R03 ("Medicamentos para enfermedades obstructivas de las vías aéreas") que prescribieron médicos de familia y pediatras de atención primaria, y que, facturados con cargo al Sistema Nacional de Salud, se dispensaron en las oficinas de farmacia de la Comunidad de Madrid en el período 1996-2002. El consumo se expresa en dosis diarias definidas por 1.000 habitantes y día. Resultados: El consumo de medicamentos, expresado en dosis diarias definidas por 1.000 habitantes y día, para la EPOC y el asma en Madrid aumentó un 18,48% entre 1996 y 2002. La utilización de la vía inhalada creció un 33,5% en dicho período. Las variaciones más destacables se centraron en el incremento del número de pacientes tratados con agonistas adrenérgicos Beta2 selectivos, anticolinérgicos y asociaciones a dosis fijas de agonistas Beta2 de acción larga con glucocorticoides. Los grupos más consumidos en 2002 fueron los agonistas adrenérgicos Beta2 selectivos por vía inhalada (37,7%), anticolinérgicos (22,5%), glucocorticoides (19,5%), asociaciones a dosis fijas de agonistas adrenérgicos Beta2 de acción larga junto con glucocorticoides (10,5%) y xantinas (5,03%). En 2002 la prescripción de 5 novedades terapéuticas generó el 15,76% del total del consumo de los fármacos utilizados en la EPOC y el asma (grupo R03). Conclusiones: El consumo de medicamentos para enfermedades obstructivas de las vías aéreas muestra un notable crecimiento entre 1996 y 2002. Se observan cambios en los patrones de utilización, incorporándose a gran velocidad nuevas opciones terapéuticas que modifican el perfil de prescripción de los medicamentos utilizados en el manejo de la EPOC y el asma

Objective: To identify trends in the drug prescription used to treat chronic obstructive pulmonary disease (COPD) and asthma at the primary care level in Madrid between 1996 and 2002, and to assess the repercussion of new treatments. Patients and methods: We analyzed information on primary care general practitioners´ and pediatricians´ drug prescription from the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical Classification System. Drug consumption was measured by recording the number of packages charged to the Spanish National Health Service and dispensed in pharmacies in the Spanish autonomous community of Madrid between 1999 and 2002. Consumption was expressed as defined daily dose per 1000 inhabitants per day. Results: Drug use expressed as defined daily dose per 1000 inhabitants per day for COPD and asthma in Madrid increased by 18.48% between 1996 and 2002. The use of inhalants increased by 33.5% over the same period. The most marked differences were the increase in the number of patients treated with selective Beta2 adrenergic agonists, anticholinergics, and combinations of fixed doses of long acting Beta2 agonists with corticosteroids. The most-used drugs in 2002 were selective Beta2 adrenergic agonist inhalants (37.7%), anticholinergics (22.5%), corticosteroids (19.5%), combinations of fixed doses of long acting Beta2 adrenergic agonists with corticosteroids (10.5%) band xanthines (5.03%). In 2002, the prescription of 5 new treatments amounted to 15.76% of total use of COPD and asthma drugs (R03 group). Conclusions: Drug use for obstructive diseases of the airways showed a sharp increase between 1996 and 2002. Changes in patterns of use were observed, new treatments being quickly adopted, modifying the profile of drug prescription for the management of COPD and asthma