Helminth Fauna of Scomberomorus Sierra (Actinopterygii: Scombridae) in Southeastern Gulf of California, Mexico.

From January to May 2015, a sample of 50 individuals of the Pacific sierra Scomberomorus sierra Jordan and Starks, 1895 captured off Mazatlán (southeastern Gulf of California, Mexico) were reviewed for helminths. A total of 6, 255 parasitic worms belonging to 11 species (9 in adult stage and 2 larvae) were obtained. Trematoda was the best represented group with 6 species of Didymozoidae Monticelli, 1888 and 1 of Bucephalidae Poche, 1907. In addition, 2 monogenean species and 2 of Nematoda were collected. In this study, the first molecular sequences for didymozoid species in Mexico were generated, and for Glomeritrema sp. at worldwide level. The most prevalent species were Didymocylindrus sp. (92 %) and Didymocystis scomberomori (MacCallum & MacCallum, 1916) (88 %), whereas the monogenean Thoracocotyle crocea MacCallum, 1913 reached the highest value of mean intensity (75.2). The coincidence between the helminthological composition established in our study and that reported for the same scombrid in 4 localities from the Mexican South Pacific (sharing 10 species) suggests that this group of species persistently parasitize S. sierra throughout its distribution along the Mexican Pacific coast; furthermore, due to the richness of didymozoids and the affinity of Thoracocotylidae species for S. sierra, both groups can be considered typical parasites of this fi sh.

Aplicación de una herramienta informática para mejorar el control de caducidades en medicamentos / Application of a computer program tool to improve the control of medicinal product expiry dates

Implantación en un centro de salud de una herramienta informática con el objetivo de facilitar el control de caducidades y garantizar la adecuada trazabilidad de los medicamentos existentes en los botiquines. El proceso se inicia con el registro de entrada de los medicamentos (marca y principio activo), lotes, caducidades y cantidad en la aplicación informática, y al final de cada mes se imprime el informe de caducidades por lotes procediendo a su retirada del botiquín. El programa también permite obtener un informe con los lotes de los medicamentos almacenados permitiendo su rápida localización y retirada en caso de alerta farmacéutica de la Agencia Española de Medicamentos y Productos Sanitarios. El nuevo sistema agiliza y mejora el control y retirada de los medicamentos ya que ahora se revisan lotes y no unidades de ampollas o comprimidos. Ante los buenos resultados obtenidos, se procederá en los próximos meses a su implantación en el resto de centro de salud del Distrito, mediante formación dirigida a los responsables de botiquines (AU)

Deployment Health Center (CS) of a tool, in order to facilitate monitoring of expiry dates and ensure proper tracking of existing drugs in the medicine chest. The process begins with check of drugs (brand and active), batch, expiry dates and quantity in the software, and end of each month to print the batch report forfeitures to the removal of the medicine chest. The program also allows for a report with lots of drugs stored enabling the rapid location and retrieval in the event of drug alert from the Spanish Agency of Medicines and Health Products (Competent Authority). The new system streamlines and improves the control and removal of drugs and lots now reviewed and no blisters or compressed drives. Given the good results obtained, we proceed in the coming months to its implementation in the rest of CS District by training for those responsible for first aid kits (AU)

Implantación de un programa sistemático de revisión de prescripciones electrónicas / Implementation of a systematic review program of electronic prescriptions

Objetivo: Implantar un programa de revisión sistemática de prescripciones electrónicas para potenciar el uso seguro y eficiente de los medicamentos. Material y método: Proyecto que comenzó en mayo de 2010 en un distrito sanitario de Atención Primaria que da cobertura a medio millón de habitantes aproximadamente. Consiste en la revisión y seguimiento estrecho de las prescripciones electrónicas por los médicos de familia. En esta revisión se incluyó a todos los pacientes con prescripciones electrónicas, priorizando a aquellos polimedicados. Este programa, que desde su implantación fue considerado como punto crítico para mejorar el uso de los medicamentos, fue diseñado e impulsado por la Dirección del Distrito y el Servicio de Farmacia, y contó con el seguimiento de los directores de cada centro de salud. Para dimensionar su impacto, se analizaron como indicadores de seguimiento: el importe/TAFE estimado anual y el número de recetas/TAFE estimado anual. La TAFE es la tarjeta sanitaria ponderada según la edad del usuario y su peso en farmacia asociado. Resultados: El objetivo del proyecto se ha alcanzado con éxito, lo que se ha visto reflejado en el elevado número de pacientes revisados, la disminución del número de recetas estimadas anuales y por tanto, del importe generado por ellas. Conclusión: La receta electrónica es una herramienta importante para conseguir una gestión más eficiente de las consultas médicas, pero la falta de seguimiento por parte de los médicos de los tratamientos prescritos durante períodos prolongados conduce a una utilización inadecuada de los recursos terapéuticos, que es necesario abordar con estrategias como la realizada (AU)

Objective: To implement a systematic review of electronic prescriptions with a view to promoting the safe and efficient use of drugs. Materials and method: This scheme was introduced in May 2010 in a Primary Healthcare District serving a population of approximately half a million inhabitants, and involved the analysis and close monitoring of the electronic prescriptions generated by general practitioners. All patients receiving electronic prescriptions were included in the study, and priority was given to patients on multiple medication. From its very inception the project was considered crucial to improving the safe and efficient use of prescription drugs, and was designed and promoted by the Directors of the Primary Healthcare District and by the members of its Pharmacy Department, with monitoring provided by the Directors of each Primary Healthcare Centre. To measure its impact, we employed the following as monitoring indicators: estimated annual cost/TAFE and estimated annual number of prescriptions/TAFE. TAFE relates to the individual healthcare card weighted in accordance with the age of the user and his or her related pharmaceutical cost. Results: The original aim was successfully achieved, and is reflected in the large number of patients reviewed, in a decrease in the estimated annual number of prescriptions, and, consequently, in the corresponding pharmaceutical cost. Conclusion: Electronic prescribing is an important tool in developing more effective management of the general practitioner clinic, but failure by the physician to monitor prescribed treatments over prolonged periods leads to the inappropriate use of therapeutic resources and, to avoid this, it is essential to implement strategies such as the one described (AU)

Repercusión de la introducción en precios máximos de fármacos indicados en la hiperplasia benigna de próstata / Impact of the introduction of “máximum prices” on drugs used in the treatment of bening prostatic hiperplasia

La prescripción por principio activo está sometida en Andalucía al sistema de financiación denominado de Precios Máximos. En Junio de 2006, dos de las principales moléculas empleadas en el tratamiento de la hiperplasia benigna de próstata, tansulosina y finasterida, entran en este sistema de financiación. El objetivo de este estudio es valorar, en el ámbito de un distrito de atención primaria, cómo repercute en el perfil de prescripción de las marcas y los medicamentos genéricos que contienen estos principios activos su entrada en este sistema especial de financiación. Además, se comparan estas dos moléculas con otros fármacos con la misma indicación: terazosina (que lleva años en ese sistema de Precios Máximos) y dutasterida (que no está afectad aún por ese tipo de financiación). Los resultados del estudio evidencian que el fomento de la prescripción por principio activo en este grupo de fármacos –sumado al sistema de Precios Máximos- constituye una estrategia eficaz para la contención del gasto farmacéutico en atención primaria, si bien el ahorro hipotético que se podría llegar a alcanzar dista mucho de los resultados obtenidos (AU)

In Andalusia (Spain) the cost of generic drug prescription in controlled by a system which establishes celing or “Maximum Prices” for these drugs. In June 2006, two of the most common generic molecules employed in the treatment of benign prostatic hyperplasia (tamsulosn and finasteride) were included in this system. The aim of this study is to evaluate, within the scope of a primary healthcare district, the impact of their inclusion in this pricing structure on the prescription profile of branded and generic drugs containing these active ingredients. Moreover, we compare these two molecules with other drugs of similar therapeutic indication: terazosin (which has been included on the register for a number of years) and dutasteride (which, to date, has not). Our results show that the promotion of generic prescription within this group of therapeutic drugs, together with the system of price control, is an effective means by which to achieve pharmaceutical cost restraint in Primary Healthcare, although the savings actually obtained in this study fall far short of those which might, hypothetically, be achieved (AU)

Impacto del envío de información por correo sobre el uso racional del medicamento / Impact of sending by post information relating to the rational use of drugs

Para realizar este trabajo la Unidad de Farmacia de un Distrito de A´tención Primaria seleccionó el centro de salud con mayor desviación presupuestaria en recetas. Para mejorar el uso racional del medicamento se desarrolla una nueva estrategia consistente en enviar a cada facultativo, por carta, su perfil de prescripción. Hasta ahora, esta información se enviaba entre sus médicos. La carta contiene los datos personalizados sobre el gasto, el porcentaje de desviación presupuestario y el porcentaje de ajuste a indicadores de calidad de prescripción para diversos grupos terapéuticos. Aquellos facultativos más desviados en su presupuesto, recibieron una información más detallada a fin de poder identificar todas sus áreas de mejora. Tras el envío de cartas de Enero-Junio de 2.006, el centro se encuentra ajustado de presupuesto y todos los indicadores cualitativos mejoraron. Esta herramienta, además de mejorar los datos en farmacia fue bien aceptada

To undertake this study the Pharmacy Unit of a Primary Healthcare District selected the healthcare centre showing the greatest deviation from approved budgetary limits in terms of prescription expenditure. To promote the rational use of medicine a new strategy was developed whereby each doctor received, by post, his individual prescription profile. Previously, this informationhad been sent by e-mail to the director of each health centre, who would then distribute it among the doctors. The letter contained personalised details of expenditure, the percentage of deviation from budgetary limits and the percentage of adjustment to indicators of quality precribing for various therapeutic groups. doctors recording a greater budgetary deviation received more detailed information to enable them to identify all the areas requiring improvement. Following the dispatch of the letters in the period from January to June 2006, the health centre in question is now within budget and all quality indicators have improved. This tool served not only to improve overall pharmaceutical figures but was well received by the doctors

Estrategia multifactorial realizada en un distrito de atención primaria dirigida a la mejora de los perfiles de prescripción / No disponible

ha actuado frente a todos los factores identificados como potenciales, oportunidades de mejora para alcanzarun mejor uso racional del medicamento. Esta estrategia ha consistido en diversas actividades llevadas a cabopor la Dirección Gerencia, la Dirección de Salud y el Servicio de Farmacia. Las líneas básicas de trabajo sehan centrado en el análisis pormenorizado de los sistemas de información, intensificar el feedback de información a los profesionales, entrevistas individua-lizadas dirigidas, implicación de los equipos directivos y mandos intermedios y potenciación de la gestión clínica como elemento clave de implicación de los profesionales. El trabajo realizado se ha reflejado en que el año 2003 finalizó con un gasto un 6,6% por encima de lo presupuestado y según el último dato disponible en abril de 2.006, el Distrito se encuentra un 3,18% por debajo del objetivo presupuestado. En el ámbito cualitativo, han mejorado notablemente seis de los diez indicadores establecidos en el Contrato Programa (especialmente la prescripción por principio activo); dos apenas variaron (porcentaje de tiazidas y porcentaje de novedades terapéuticas no recomendadas); por el contrario, disminuyó el porcentaje de prescripción de los inhibidores de la enzima convertidora de angiotensina (IECA) frente a los antagonistas de los receptores de angiotensina-II (ARA-II) y los antidepresivos de elección

During the period between January 2003 and April 2006, in the Bahía de Cádiz-La Janda Primary CareDistrict, the effort was undertaken to evaluate all the potential opportunities for improvement to achieve amore rational drug use. This strategy consisted of a series of activities promoted by the Managing Directorate, the Health Care Administration and the Pharmacy Service. The work focused mainly on the detailedanalysis of the information systems, intensifying information feedback to the health care professionals,directed individualized interviews, involvement of the management team and intermediate managers, andpotentiation of the clinical administration as a key element for the implication of the professionals. Theresults of this undertaking were reflected in the fact that, while the year 2003 ended with a budgetary overrunof 6.6%, according to the most recent available data, provided in April 2006, the district is now 3.18% underbudget. In qualitative terms, notable improvements have been made in six of the ten indicators establishedin the program contract (especially that regarding prescription according to active ingredient); two havehardly changed (percentage of thiazides and percentage of new unapproved therapies); in contrast, the rateof prescription of angiotensin-converting enzyme (ACE) inhibitors decreased with respect to that of angiotensin-II receptor antagonists (ARA-II) and the antidepressants of choice

Impacto de las actividades de uso racional del medicamento en médicos que nunca han recibido esta información / Impact of activities designed to improve the rational use of drugs on doctors who have never received the information before

Los médicos del Instituto Social de la Marina en España, a partir de enero de 2005, se incorporaron a trabajar para los sistemas de salud de la comunidad autónoma donde trabajaban, en el caso de Andalucía al Sistema Andaluz de Salud. Desde ese momento integraron en su trabajo los objetivos del nuevo sistema sanitario al que pertenecen, entre ellos el Uso Racional del Medicamento. El presente artículo explica la metodología seguida para difundir e inculcarles la importancia de una prescripción de calidad, siguiendo los indicadores establecidos por grupos de expertos. Tras catorce meses trabajando en su nueva plaza, se observa una disminución general del importe de un 9,77% y una mejora muy considerable en los indicadores cualitativos de prescripción, fundamentalmente en lo referente a la prescripción por principio activo, al empleo de omeprazol como antiulceroso y de simvastatina como hipolipemiante de elección

From January 2005 all doctors employed by the “Instituto Social de la Marina” in Spain were incorporated into the health services of the corresponding Autonomous Communities in which they worked: in the case of Andalousia, the “Sistema Andaluz de Salud”. Henceforward, they were required to assimilate all the objectives of the health system to which they now belonged, the Rational Use of Drugs included. This paper sets out the methodology employed to transmit the information and to highlight the importance of quality prescription in accordance with indicators established by groups of experts. After fourteen months in their new positions, an overall decrease in cost of 9.77% has been noted, along with a very appreciable improvement in quality prescription indicators, primarily with regard to active ingredient prescription, the use of Omeprazol in the treatment of ulcers and of Simvastatin as the drug of choice in the treatment of hyperlipidaemias

Thrombolytic therapy for acute myocardial infarction.

Numerous factors must be considered when determining the formulary status of thrombolytic agents for the treatment of acute myocardial infarction. Defined treatment options, predicted outcomes, and the economic consequences of this disorder continue to evolve from clinical trials. Pharmacists have a major role in delivering patient care, with responsibility for evaluating, procuring, and monitoring thrombolytic agents and drug therapy in general. By participating in the development and implementation of treatment guidelines, evaluating economic and therapeutic outcomes, providing timely optimal drug therapy, and educating health care providers and the public, they contribute significantly to the health care team.

Work activities before and after implementation of an automated dispensing system.

The impact of an automated dispensing system (ADS) on medication-related work activities by nurses and pharmacists was studied. A point-of-care ADS (Baxter Sure-Med) was installed on two nursing units (the surgical intensive care unit [SICU] and a medicine unit [4NMU]) of a 400-bed university hospital as part of a pilot project. A self-reported work-sampling study was used to collect observations of medication-related work activities by nurses, health unit coordinators (nursing support staff), and pharmacists for a seven-day period before ADS implementation and a seven-day period after implementation. There were 7797 observations of nurse work activities, 1408 observations of health unit coordinator work activities, and 4236 observations of pharmacist work activities. The percentage of nurse work activities that were medication related decreased from 20.7% before ADS implementation to 18.4% afterward on 4NMU and increased slightly from 10.8% to 11.0% on the SICU. Medication-related health unit coordinator work activities increased from 17.5% to 25.3% of total activities on 4NMU and decreased from 16.6% to 10.7% on the SICU. None of these changes was significant. For decentralized pharmacists supporting 4NMU, the percentage of work activities classified as clinical increased significantly from 36.5% to 49.1%. For decentralized pharmacists supporting the SICU, clinical activities increased from 27.9% to 35.1%. There were no significant changes on either unit in pharmacist activities classified as technical. An overall measure of the efficiency with which pharmacists used their time for patient care-related activities increased. A point-of-care ADS did not affect the proportion of time spent by nurses on medication-related activities and seemed to give pharmacists more time for clinical work.

Work activities of pharmacy teams with drug distribution and clinical responsibilities.

The time spent by satellite pharmacists and technicians on various activities was measured by using work sampling to evaluate the pharmacists' use of time for patient care. Between December 1992 and April 1993, pharmacists and technicians on satellite pharmacy teams at a tertiary care teaching hospital reported their work activities on forms. A total of 11,485 observations of pharmacist work activities and 7,626 observations of technician work activities were made. Pharmacists on teams with fewer support staff members spent less time on patient care-related work activities, and vice versa. As measured by an institution-specific index, the efficiency with which pharmacists used the available work time for patient care ranged from 60% to 83% for the various teams (100% would mean that pharmacists spent all their work time on patient care tasks). Changes were made in technician staffing that enabled the pharmacists to devote more time to patient care. Measuring the time pharmacists and technicians spent on various work activities provided a means of identifying and correcting organizational inefficiencies in order to give the pharmacists more time for patient care.

Documenting the provision of pharmaceutical care.

There is a growing importance and need for the documentation of the clinical work done by the pharmacist in providing pharmaceutical care. The data provided by documentation of care are critical to the effective and efficient transition from a product-based profession to a patient-care, service-based profession, especially during a period of great scrutiny of resource utilization in the hospital industry. Intervention documentation can serve both to document the provision of pharmaceutical care to individual patients and to provide critical information to managers to justify and expand the level of service provided.

Pharmacist salaries and hiring practices in teaching hospitals.

A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)

Using pharmacists' perceptions in planning changes in pharmacy practice.

Pharmacists' perceptions of and goals for clinical pharmacy services, as well as the proportion of time devoted to clinical services, were studied at one hospital as part of the process for establishing departmental goals. Three methods were used in evaluating pharmacists' perceptions of clinical pharmacy services. The first was a departmental survey. Second, staff members were asked to generate and prioritize a list of goals for clinical pharmacy services; this was done by means of an interactive, small-group process. Finally, a work-sampling study was performed that indirectly measured use of staff pharmacist and technician time. Staff pharmacists perceived that clinical pharmacy services were being provided to individual patients; however, support for these services from upper management was perceived as inadequate. Staff development had the highest priority for the further development of clinical pharmacy services. Only 19.7% of pharmacists' time was devoted to clinical services. Data from all three studies were incorporated into the development of a strategic plan that set forth long-term departmental goals and objectives. The plan includes a statement of commitment to develop management systems to eliminate deficiencies identified in the study. Among the changes in pharmacy operations introduced as a result of the survey were (1) a career-ladder system, (2) new opportunities for staff development, and (3) improved documentation systems. Surveying staff perceptions of existing services, joint goal setting and prioritization, and work-sampling studies formed the basis for the development and implementation of a new model of integrated pharmacy services at this institution.