Proyecto revisa. ¿Sirve realmente para algo la revisión de la medicación? / Does medication review really do any good?

JUSTIFICACIÓN: la Revisión de la Medicación (RM) es una evaluación estructurada de la medicación del paciente con el objeto de optimizar su uso y mejorar los resultados en salud. “Pharmaceutical Care Network Europe” diferencia entre distintos tipos de RM en función del acceso a información clínica y a una entrevista con el paciente al margen. La Revisión del Uso de los Medicamentos (RUM), que podría encuadrarse en uno de estos subtipos, consiste en la realización junto con el paciente de una revisión estructurada del conocimiento que éste tiene de sus medicamentos y del uso que hace de los mismos, para ayudarle a emplear sus medicamentos con mayor eficacia. Ofreciéndole asesoramiento sobre su utilización, y asegurándose de que entiende por qué los tiene que tomar y sabe cómo utilizarlos, identificando los problemas observados y realizando las recomendaciones oportunas sobre los cambios necesarios. OBJETIVO: conocer la evidencia científica disponible sobre la efectividad de la RM y el RUM, llevado a cabo por farmacéuticos comunitarios, para mejorar resultados clínicos, económicos y humanísticos. MATERIAL Y MÉTODOS: se realizó una búsqueda bibliográfica en Pubmed de revisiones sistemáticas y metaanálisis con las palabras medication review y community pharmacist en el título o resumen y otra con medicine use review y community pharmacist. En el caso de RUM al no encontrar ninguna, se buscó también ensayos clínicos aleatorizados con las mismas palabras clave. (AU)

Proyecto Revisa. Medicamentos “alerta” a la hora de ofrecer el servicio RUM / Project Review. Medicines "alert" when it comes to offering the RUM service

JUSTIFICACIÓN: una clave para poder ayudar a los pacientes con el servicio de Revisión del Uso de los Medicamentos (RUM) es identificar a los pacientes que más se pueden beneficiar de él. Conocer los medicamentos que más incidencias generan en el RUM puede ayudar a los farmacéuticos a lograr ese objetivo. OBJETIVO: identificar los grupos terapéuticos que más incidencias generan en el RUM, con el fin de detectar pacientes “diana” del servicio y facilitar los medicamentos “clave” en los que prestar mayor atención durante este. MATERIAL Y MÉTODOS: estudio descriptivo, transversal, observacional retrospectivo sobre los grupos terapéuticos según la clasificación ATC, de los medicamentos implicados en diferentes incidencias detectadas en 564 RUM realizados por farmacéuticos capacitados por el proyecto Revisa® hasta el 15-02-2022 y registrados en la plataforma SEFAC e_XPERT. Para cada tipo de incidencia detectada se comparó la proporción de incidencia de cada grupo terapéutico con respecto al resto de grupos. Para el análisis estadístico se empleó el test Chi-cuadrado con la corrección de Yates, considerándose la diferencia significativa si p<0,05. El tratamiento informático de los datos se realizó con el programa Microsoft Excel. (AU)

Proyecto revisa. 6 años de RUM: repercusiones en la farmacia y el farmacéutico comunitario / Project revises. 6 years of RUM: impact on pharmacy and the community pharmacist

JUSTIFICACIÓN: el proyecto revisa®, que busca la implantación del servicio de Revisión del Uso del Medicamento (RUM) en la farmacia comunitaria española, cumple 6 años. Tras este periodo se han capacitado 275 farmacéuticos para la prestación del servicio. Desconocemos el nivel de implantación del servicio en la actualidad, así como los aspectos en los que se podría prestar un mayor apoyo desde SEFAC. OBJETIVO: conocer el grado de implantación del servicio RUM entre los farmacéuticos capacitados e identificar en que aspectos necesitan apoyo y cuál es su percepción sobre el servicio. MATERIAL Y MÉTODOS: se envió una encuesta a los farmacéuticos capacitados por SEFAC para el servicio RUM. Con 15 ítems, relativos a la puesta en práctica del servicio en sus farmacias, que tuvieron abierta para contestar desde el 25 de Febrero y el 7 de Marzo de 2022. La encuesta permanece abierta, por lo que los datos finales pueden diferir ligeramente de los expuestos aquí. RESULTADOS: el 15.2 % de los capacitados contestaron a la encuesta. El 29.3 % no hacen ningún RUM al año, el 51.2 % hacen menos de 5 RUMs al año, mientras que el 14.6 % hacen entre 5 y 10, y el 4.9 % hacen más de 10. Las principales dificultades que encuentran son el tiempo 52.8 % y la dificultad para promocionar el servicio 44.4 %, seguidos por el precio 36.1 % y dificultad para implementar el servicio 33.3 %. El 50 % cobra menos de 15€ por el RUM y un 47,2 % no cobra nada. El 83.9 % emplea menos de 40 minutos por RUM. En los pacientes que se ha hecho más de un RUM, el 88.9 % de los encuestados refiere haber apreciado cambios significativos en el uso de los medicamentos y el estado de salud. (AU)

Proyecto revisa. Servicio de Revisión del Uso de los Medicamentos (RUM) a un paciente polimedicado / Project reviews. Medication Use Review (MUR) service to a polymedicated patient

PRESENTACIÓN DEL CASO: varón de 69 años, despistado para su edad. Presenta varias patologías. Tratamiento actual y pauta prescrita:- Bisoprolol 2,5mg1-0-0- Omeprazol 20mg1-0-0 - Sertralina 50mg1-0-0- Ramipril 2,5mg1-0-0- Vidagliptina/Metformina 50/850mg1-0-1 - Empagliflozina 10mg1-0-0- Ácido acetilsalicílico 100mg0-1-0 - Rosuvastatina/Ezetimiba 20/10mg0-0-1- Flurazepam 30mg0-0-1- Colecalciferol 25.000UI1 cada 30 días- Hierro proteinsuccinilato 800mg1 ampolla diaria.Acude a la farmacia asustado, ha tomado el Flurazepam por la mañana por equivocación y se notaba muy atontado conduciendo. Confiesa tomar muchos medicamentos y no saber para qué son algunos de ellos. Le invitamos al servicio RUM. EVALUACIÓN: hacemos RUM y registramos con el programa SEFAC e_XPERT. Trae de casa también Atorvastatina 80mg y Ticagrelor 90mg, que no tiene prescritos actualmente. Ticagrelor no se lo toma pero lo tenía en casa “por si acaso” y Atorvastatina sí sigue tomándolo, no sabía que se lo habían sustituido por Rosuvastatina/Ezetimiba. Detectamos algunos Problemas Relacionados con los Medicamentos (PRM): Administración inadecuada, Falta adherencia parcial, Pauta inadecuada, Sospecha RAM… Por ejemplo, Flurazepam a veces no lo toma porque no le gusta el efecto somnífero que se prolonga por la mañana. Dice que suele tomarlo por la noche pero el otro día se despistó y la tomó por la mañana. INTERVENCIÓN: derivamos al servicio de adherencia, indicando la realización de un Sistema Personalizado de Dosificación (SPD) y al servicio de medida de la presión arterial y de la glucosa.Facilitamos Información Personalizada sobre los Medicamento (IPM) y solucionamos las faltas adherencia.Derivamos al Médico de Atención Primaria (MAP) con un Informe por el Flurazepam.Damos unas recomendaciones de estilo de vida saludable y le entregamos el Informe al paciente con las medidas que hemos acordada. (AU)

Proyecto revisa. Servicio Revisión del Uso del medicamento (RUM). En busca del inhalador perfecto / Project reviews. Review of Medicines Use (RUM) Service. In search of the perfect inhaler

PRESENTACIÓN DEL CASO: varón, 75 años, fumador, diagnosticado de EPOC por médico privado y con visita reciente al Sistema Nacional de Salud (SNS). Tratamiento:-Beclometasona 250mcg Inhalador Cartucho Presurizado (ICP) 1-0- 1 (médico privado)-Bromuro de ipratropio 20mcg ICP 1-1-1 (médico privado)-Salbutamol 100mcg ICP (a demanda) (médico privado)-Fluticasona/Umeclidinio/Vilanterol Ellipta® 92/55/22 (neumólogo SNS)-Prednisona 10mg, 5mg, 2.5mg. Pauta descendente (neumólogo SNS)-Omeprazol 20mg 1-0-0 (centro de salud)-Calcio Carbonato/Colecalciferol 1-0-0 (centro de salud)-Soludronate Semanal 70mg – 1 semanal (centro de salud). Utiliza el tratamiento del médico privado muchos años. Acude a la farmacia tras consulta con el neumólogo del SNS, posterior a varias visitas a urgencias por problemas respiratorios. Refiere confusión con los inhaladores. Le invitamos al servicio RUM. EVALUACIÓN: trae cuatro inhaladores, prescritos por distintos médicos. En su última visita con el neumólogo, éste sugirió dejar la Beclometasona y el Bromuro de ipratropio, y utilizar solamente Fluticasona/Umeclidinio/Vilanterol Ellipta® y Salbutamol. Confiesa no aclararse con el Fluticasona/Umeclidinio/Vilanterol Ellipta® y usar los tres inhaladores según cree conveniente, usando cada vez menos Fluticasona/Umeclidinio/Vilanterol Ellipta®. Comprobamos la técnica de inhalación con In-check Dial®, observando que su condición respiratoria no le permite hacer una inspiración adecuada para Fluticasona/Umeclidinio/Vilanterol Ellipta®. INTERVENCIÓN: considerando que la Beclometasona y el Bromuro de ipratropio no tenían el efecto deseado y que el paciente no podía usar correctamente Fluticasona/Umeclidinio/Vilanterol Ellipta®, derivamos al médico de familia, con informe para que el neumólogo reconsidere el tratamiento. Damos indicaciones sobre técnica inhalatoria, para intentar mejorar la adherencia al nuevo inhalador hasta la nueva revisión médica. (AU)

Train the Brain: Novel Electroencephalography Data Indicate Links between Motor Learning and Brain Adaptations.

EEG differences were examined between part and whole practice in the learning of a novel motor task. Recording was done at 4 sites (i.e., O1, O2, C3, and C4) on 30 participants who performed a novel mirror star tracer task. Individuals were randomly assigned to 3 groups: whole practice, part practice, and control (no practice). Whole practice is defined as practicing a skill in its entirety. Part practice is defined as practicing separate, independent parts of the skill, and gradually combining those parts with parts that are dependent on one another. Each group was assessed during a pretest and posttest. EEG data was analyzed using a 2×2×2×3 (trials×hemisphere×site×practice) repeated measures mixed model ANOVA for each of the wave bands (lower alpha, upper alpha, lower beta, upper beta). All participants performed the task faster as no practice effect was found across the three groups; however the part practice group exhibited a significant decrease in errors. Reduced activation in the occipital and central sites was observed for lower alpha in the posttest compared to the pretest, for all participants. Hemispheric differences were present for all wavebands, with greater activation in the left hemisphere independent of practice type. The results of our study indicate that task learning was likely associated with the observed changes in the lower alpha waveband. Further, a concomitant behavior between the hemispheric lateralization of alpha and beta waveforms was observed. These results have implications for athlete training and rehabilitation. They indicate the utility of EEG for learning assessment in athletes. They also indicate learning strategies with a partial movement focus may be a beneficial strategy to support the development of complex sport skills training and rehabilitation strategies focused on reacquisition of skills prior to sport reintegration.

Sensitivity to µ-opioid receptor-mediated anti-nociception is determined by cross-regulation between µ- and δ-opioid receptors at supraspinal level.

BACKGROUND AND PURPOSE: The perception of pain and its inhibition varies considerably between individuals, and this variability is still unexplained. The aim of the present study is to determine whether functional interactions between opioid receptors are involved in the inter-individual variability in the sensitivity to µ-opioid receptor agonists. EXPERIMENTAL APPROACH: Anti-nociceptive tests, radioligand binding, stimulation of [(35) S]GTP-γ-S binding, inhibition of cAMP production and co-immunoprecipitation experiments were performed in two strains of rat (Sprague-Dawley bred at our university - SDU - and Wistar) that differ in their sensitivity to opioids. KEY RESULTS: The increased anti-nociceptive potency of µ-opioid receptor agonists in SDU rats was reversed by the δ-opioid receptor antagonist, naltrindole. Inhibition of the binding of [(3) H] naltrindole by µ-opioid receptor agonists was different in brain membranes from SDU and Wistar rats. Differences were also evident in the effect of δ-opioid receptor ligands on the binding of [(35) S]GTP-γ-S stimulated by µ-opioid receptors agonists. No strain-related differences were detected in spinal cord membranes. The potency of morphine to inhibit cAMP production in brain membranes varied between the strains, in the presence of deltorphin II and naltrindole. Co-immunoprecipitation experiments demonstrated that δ-opioid receptors were associated with µ-opioid receptors to a higher extent in brain synaptosomal fractions from SDU than in those from Wistar rats. CONCLUSIONS AND IMPLICATIONS: There was increased supraspinal cross-talk between µ and δ-opioid receptors in SDU, as compared with Wistar rats. This was related to an enhanced sensitivity to anti-nociception induced by µ-opioid receptor agonists.

Body-density measurement in children: the BOD POD versus Hydrodensitometry.

OBJECTIVE: To compare estimates of body density (Db) from air-displacement plethysmography (ADP) with measured and predicted thoracic-gas-volume (TGV) measurements and those from hydrodensitometry (HD) in children. METHODS: Seventeen participants (13 male and 4 female; 10.1 ± 2.20 yr, 42.0 ± 15.03 kg, 145.6 ± 17.41 cm, 30.0 ± 8.66 kg/m²) were tested using ADP and HD, with ADP always preceding HD. Db estimates were compared between ADP with measured TGV, ADP with predicted TGV, and the reference measure, HD. Regression analyses were used to assess the accuracy of the ADP methods, and potential bias between the ADP procedures and HD were evaluated using Bland-Altman analyses. The cross-validation criteria described by Lohman for estimating Db relative to HD were used to interpret the results of the study. RESULTS: A significant difference was found between Db estimates from ADP with measured TGV (1.0453 ± 0.01934 g/cm³) and ADP with predicted TGV (1.0415 ± 0.01858 g/cm³); however, neither was significantly different from Db obtained by the reference HD procedure (1.0417 ± 0.02391 g/cm³). For both ADP procedures, regression analyses produced an r = .737-.738, r² = .543-.544, and SEE = 0.02 g/cm³, and the regression lines deviated significantly from the line of identity; however, no significant biases were indicated. CONCLUSIONS: Despite no significant mean differences between Db estimates from the ADP procedures and HD, more cross-validation research is needed before recommending the BOD POD for routine use with children in clinical and research settings.

Integrated electromyogram and eye-gaze tracking cursor control system for computer users with motor disabilities.

This research pursued the conceptualization, implementation, and testing of a system that allows for computer cursor control without requiring hand movement. The target user group for this system are individuals who are unable to use their hands because of spinal dysfunction or other afflictions. The system inputs consisted of electromyogram (EMG) signals from muscles in the face and point-of-gaze coordinates produced by an eye-gaze tracking (EGT) system. Each input was processed by an algorithm that produced its own cursor update information. These algorithm outputs were fused to produce an effective and efficient cursor control. Experiments were conducted to compare the performance of EMG/EGT, EGT-only, and mouse cursor controls. The experiments revealed that, although EMG/EGT control was slower than EGT-only and mouse control, it effectively controlled the cursor without a spatial accuracy limitation and also facilitated a reliable click operation.

Multidimensional comparison of anxiety direction and burnout over time.

The purpose of this study was to assess if athletes who perceived their trait anxiety to be debilitative to performance also experienced higher burnout over a competitive season. Volunteers were 53 NCAA Division I and II male (n = 14) and female (n = 39) athletes, ages 18 to 23 years. Participants completed a trait version of the Competitive State Anxiety Inventory-2D once and the Athlete Burnout Questionnaire three times during the season. A 2 (anxiety direction group) x 3 (time of season) multivariate analysis of variance indicated no significant interaction and no main effect for time of season. A significant main effect for anxiety direction group did emerge, with the Facilitative group reporting significantly lower Burnout scores overall on the Reduced Sense of Accomplishment scale than the Debilitative group. There were no differences found on the other two subscales, Emotional/Physical Exhaustion and Devaluation.

Effects of tamoxifen on lipid profile and coagulation parameters in male patients with pubertal gynecomastia.

BACKGROUND/AIM: The estrogenic actions of tamoxifen on lipid profiles and hemostasis have been extensively demonstrated in women. Due to limited experience with this drug in males, it is uncertain whether these effects are also present in men. The aim of our study was to assess the response of blood lipids, lipoproteins, and coagulation parameters in a group of men taking tamoxifen. METHODS: We studied 15 healthy boys with pubertal gynecomastia who were given 10 mg tamoxifen per day. Total testosterone, sex-hormone-binding globulin, estradiol, serum lipids, apolipoprotein B, apolipoprotein A-I, lipoprotein(a), fibrinogen, antithrombin III, von Willebrand factor, and markers of activated coagulation and fibrinolysis were determined at baseline and 1 and 3 months after beginning of the tamoxifen treatment. RESULTS: Total cholesterol and lipoprotein(a) showed moderate but significant decreases from baseline. Low-density lipoprotein and high-density lipoprotein cholesterol concentrations as well as triglyceride and apolipoprotein B levels became lower, but these changes were not statistically significant. Among clotting parameters, antithrombin III was reduced, and von Willebrand factor increased significantly. Markers of activated coagulation and fibrinolysis remained unchanged throughout the period of therapy. CONCLUSIONS: The effects of tamoxifen on blood lipids and hemostasis we found in this group of healthy young men were qualitatively similar, but lesser than those previously described in women.

A novel (288delC) mutation in exon 2 of GPIIb associated with type I Glanzmann's thrombasthenia.

This work reports the molecular genetic analysis of two patients who suffer mucocutaneous haemorrhages, prolonged bleeding time and failure of platelets to aggregate, either spontaneously or in response to agonists. The absence of platelet surface glycoprotein (GP)IIb-IIIa complexes confirmed the clinical diagnosis of Glanzmann's thrombasthenia (GT). Polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis of exon 2 of GPIIb showed polymorphic bands caused by the homozygous deletion of a cytosine at position 288 relative to the translation start site. causing a shifting of the reading frame and appearance of a premature termination codon. The heterozygous relatives showed a reduced platelet content of GPIIb-IIIa, and a correlation was found between the levels of GPIIb mRNA and surface expression of GPIIb-IIIa complexes. Unlike other mRNAs carrying a nonsense mutation, (288Cdel)GPIIb does not force alternative splicing of GPIIb mRNA. As expected, co-transfection of Chinese hamster ovary (CHO) cells with cDNAs encoding GPIIIa and (288delC)GPIIb failed to enhance the surface exposure of GPIIIa. It is concluded that the (288delC)GPIIb mutation is responsible for the thrombasthenic phenotype of the patients. In addition, it has also been determined that heterodimerization of GPIIb-IIIa requires the integrity of exons 2 and 3 of GPIIb.

[Biochemical assessment of nutritional status in the Canary Islands population (1998)]. / Evaluación bioquímica del estado nutricional de la población canaria (1998).

UNLABELLED: Nutrition surveys include information about dietary intake and nutritional status utilising clinical, biochemical and anthropometric measurements. OBJECTIVE: To evaluate the nutritional status of the Canary Island population by means of biochemical and haematological indicators METHODOLOGY: A cross-sectional study was realised in a representative subsample aged 6 to 75 years that participated in the Nutritional Survey of the Canary Islands, 1997-98 (ENCA). We determined levels of ferritin and vitamin B12 (enzyme-immunoassay), serum and erythrocytic folic acid (automated ionic catchment), retinol, tocopherol and carotenes (high performance liquid chromatography) and minerals (atomic absorption spectrometry) RESULTS: There were neither sex, age nor socio-economic differences in the reference population sample and the ENCA sample. The participation rate was 48.8%. 25% of the women had deficit levels of ferritin and the prevalence of anaemia in women over 18 years was 2.9%. 13% of the population had low erythrocyte folic acid levels, that increased with age, and 3.4% had low vitamin B12 levels, which, on the contrary, decreased with age, 15% of the population presented a deficit of alpha-tocopherol and 5.2% of retinol, being more frequent in the youngest group, and 56.4% and 41.1% exhibited low levels of beta-carotene and lycopene respectively. Among mineral and trace elements, low levels of manganese drew attention due to its heightened prevalence, and, to a lesser extent, selenium. CONCLUSIONS: In spite of the complexity of its interpretation, this data yields a precise estimation of nutritional status for certain vitamins and minerals in the Canary Island population.

Use of antithrombin III in critical patients.

OBJECTIVE: To evaluate the effect of the AT III concentrates upon the clinical evolution and hemostatic parameters. DESIGN: Prospective, open, randomized trial. PATIENTS AND PARTICIPANTS: Septic and multiple trauma patients admitted to our Intensive Care Unit. SETTING: Levels of AT III below 70% were used as criteria to choose 36 patients, 20 of whom received treatment with AT III and 16 did not. INTERVENTIONS: AT III concentrates were administered at an initial dose of 60 U/kg followed by 10 U/kg every six hours. RESULTS: The administration of AT III neither contributes to alterations in haemostasis, nor the clinical evolution (evaluated according to Apache II score). CONCLUSIONS: The results suggest that the administration of AT III concentrates to critical patients with acquired low levels, but without manifest DIC, may not be justified; although further studies on a larger population are required to establish definite conclusions.