Potential uses of cytisine for smoking cessation in menopausal women - literature summary.

Introduction: Menopause is a vital stage in which the risk of the appearance of metabolic syndrome and cardiovascular diseases is increased. Cardiovascular risk in menopausal women must be monitored because it is one of the most common causes of mortality in these women. Smoking is an important risk factor for the development of many diseases, including cardiovascular diseases, so promoting smoking cessation in these women is important for the maintenance of cardiovascular health. Material and methods: Current smoking cessation programs mainly include nicotine and varenicline as therapeutic agents, due to their history of success, safety, and efficacy in aiding in cessation, but they do not include "new" agents such as cytisine as coadjuvant in the elimination of the habit of smoking. Results: Cytisine is a therapeutic agent traditionally used in Eastern Europe, which has demonstrated efficacy and safety in smoking cessation, also showing other new pharmacological actions. It has been widely used since World War II as a nicotine substitute. Conclusions: These pharmacological actions, together with their efficacy in smoking cessation, should be explored to evaluate the convenience of the use of cytisine in premenopausal and postmenopausal women, so that cytisine can be identified as a useful therapeutic tool in smoking cessation programs and in particular in menopausal women.

Intervention model for detection, prevention and control of COVID-19 in community pharmacy

Abstract The announcement by the WHO of the characterization of the new Coronavirus 2019 disease (COVID-19) as a pandemic, entails an adaptation by the community pharmacy in carrying out its care activity in general, with particular emphasis on "Minor Ailments Service" in particular. The measures taken by the different health administrations in which patient telephone care by primary care offices is prioritized have left more consultations on symptoms in the community pharmacist health-related problems as pharmacies are the closest health facilities to the patient. The similarity between the symptomatology caused by the new Coronavirus with that of some Enteroviruses that cause mild respiratory and gastrointestinal tables (dry cough, fever, sore throat, vomiting, diarrhoea, etc.) makes community pharmacies highly capable places for contagion detection and prevention. A model of protocolized intervention is needed to facilitate the pharmacist's work in discriminating during the indication between minor symptoms and symptoms of referral for possible cases of COVID-19 so that in conjunction with the rest of the staff we help control the disease and make better use of primary care consultations.

Impact of a risk-sharing agreement in rheumatoid arthritis in Spain.

CONTEXT AND OBJECTIVE: Risk-sharing agreements(RSA) allow decision-makers to manage the uncertainty associated with effectiveness and costs of treatments. Our objective was to estimate the economic impact of RSA implementation on treatment of patients diagnosed with rheumatoid arthritis(RA) with certolizumab pegol(CZP) and assess the potential impact of alternative RSA. METHODS: Under original RSA, treatment with CZP was reimbursed when the response was optimal (DAS28 score <3.2) or satisfactory (DAS28 score ≥3.2 and reduction from baseline ≥1.2) at 12 weeks. Alternative RSA would additionally include a 50 % reimbursement for moderate responders(DAS28 score >3.2 and ≤5.1, and reduction from baseline between 0.6 and 1.2). We estimated average savings per patient for hospital's pharmacy service(HPS) at 12 weeks, taking into account the pharmacological cost of CZP. Uncertainty associated with effectiveness of CZP was assessed through 1000 Monte Carlo simulations. RESULTS: After 12 weeks of treatment, 57.8 % (n = 52) and 22.2 %(n = 20) of patients had optimal and satisfactory responses, respectively, and average disease activity improved by 1.77 points. Average savings for HPS amounted to 876.9€ and 706.4€ per patient under original and alternative RSA, respectively. Savings in simulated cohort reached 846.2€ and 681.8€ per patient, respectively, leading to estimated net savings for HPS of 846,209€ and 681,790€, respectively. CONCLUSIONS: RSA implementation on patients with RA treated with CZP has generated savings and improved efficiency within HPS.

[Validation of the "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) questionnaire]. / Validação do questionário "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES).

This work cross-culturally adapted the Spanish questionnaire `Patients' knowledge about their medications ("Conocimiento del Paciente sobre sus Medicamentos" - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

Este trabalho adaptou transculturalmente o questionário espanhol "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Validação do questionário "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) / Validation of the "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) questionnaire

Resumo Este trabalho adaptou transculturalmente o questionário espanhol "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Abstract This work cross-culturally adapted the Spanish questionnaire `Patients' knowledge about their medications ("Conocimiento del Paciente sobre sus Medicamentos" - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

A Global Comparison of Internationalization Support Characteristics Available on College of Pharmacy Websites.

Objective. To compare the information regarding entry-level pharmacy degree programs available on college websites worldwide from the perspective of international students. Methods. Data on pharmacy colleges and schools were extracted from the Official World List of Pharmacy Schools on the International Pharmaceutical Federation (FIP) website. The website of each pharmacy college was accessed and the content was analyzed. A scoring method was created to compare the websites. Results. Of the 1839 pharmacy colleges listed worldwide, 246 had no website. Approximately half of pharmacy colleges with websites did not have a complete English version of their site. Academic information considered important by students, including the course syllabi, admission requirements, program costs, and a faculty directory, was not available on 73%, 44%, 65% and 43% of the websites, respectively. The websites of pharmacy colleges in Oceania, North America, and Europe provided the best information for international students, with these regions scoring an average of 9.2, 8.8, and 6.7, respectively out of 12 points. In comparison, pharmacy colleges in Central Asia and East and Southeast Asia scored an average of only 0.2 and 1.5 points, respectively. Conclusion. There are still a high proportion of global colleges of pharmacy without websites. Also, the quality of pharmacy colleges' websites is unevenly distributed around the world. To fulfill the information needs of international students, pharmacy colleges should provide an English version of the website and include at least a complete syllabus of all the courses, financial information (costs and grants), a complete faculty directory, and all the administrative requirements for application and enrollment.

A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe.

Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sciences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care.

Study of the effectiveness of first-line treatment in renal cell carcinoma.

The emergence of novel drugs corresponds with the determination of the effectiveness of the current treatments used in clinical practice. A retrospective observational study was conducted to evaluate the effectiveness of first-line treatments and to test the influence of the prognostic factors established using the Memorial Sloan-Kettering Cancer Center (MSKCC) and the analysis of Mekhail's study for two or more metastatic sites. The primary endpoints were median progression-free survival (mPFS) and median overall survival (mOS) times. A total of 65 patients were enrolled and the mPFS and mOS of the patients treated with sunitinib (n=51) were 9.0 and 20.1 months, respectively, and for the patients treated with temsirolimus (n=14) these were 3.0 and 6.2 months, respectively. In the poor-prognosis (PP) group, a difference of 1.2 months (P=0.049) was found in mPFS depending on the first-line treatment. A difference of 4.1 months (P=0.023) was also found in mPFS when classified by histology (clear verses non-clear cell) in the sunitinib-treatment group. When stratified by the prognostic group, differences of >7 months (P<0.001) were found between the groups. Therefore, it was concluded that the effectiveness of the treatments was reduced compared to previous studies and differences were found in the PP group when classified by first-line drug and histology. Additionally, the influence of prognostic factors on OS and the value of stratifying patients using these factors have been confirmed.

The effect of an educational intervention to improve patient antibiotic adherence during dispensing in a community pharmacy.

OBJECTIVE: To assess the effectiveness of an educational intervention on antibiotic adherence and patient-reported resolution of symptoms. DESIGN: A controlled experimental study with systematic assignment to groups. SETTING: A pharmacy in Murcia. Participants were patients who came to the pharmacy with a prescription for antibiotics. Intervention provided information on treatment characteristics (duration, dose and method of use) and correct compliance. A control group received routine care. Main variables "treatment adherence" and "perceived health" were evaluated one week after dispensation by telephone interview. RESULTS: A total of 126 patients completed the study, 62 in the Control Group (CG) and 64 in the Intervention Group (IG). There were no differences between the groups in baseline characteristics, including the level of knowledge before the intervention. At the end of the study, treatment adherence in the CG was 48.4% (CI: 36.4-60.6), compared with 67.2% (CI: 55.0-77.4) in the IG. The difference of 18.8% was statistically significant (p=0.033; 95% CI=15.8-34.6). Non-compliance through missing more than one dose was 81.2% in the CG versus 38.1% in the IG, which is a statistically significant difference of 43.1% (p=0.001; 95% CI=16.4-63.1%). No significant differences were found in patient-perceived health. Logistic regression showed as predictor of adherence, the medication knowledge and the coincidence between duration of treatment indicated by physician and duration of treatment written in the prescription. CONCLUSIONS: An educational intervention during antibiotic dispensation improves treatment adherence versus routine care.

Effectiveness of the bevacizumab-irinotecan regimen in the treatment of recurrent glioblastoma multiforme: Comparison with other second-line treatments without this regimen.

A retrospective cohort study was conducted to analyse the effectiveness of bevacizumab and irinotecan (BVZ/CPT-11) as a second-line treatment in patients with primary glioblastoma multiforme (GBM) in comparison with a control group that were not administered BVZ/CPT-11 at the first recurrence. The difference in overall survival (OS) between the two groups was used as a predictor of effectiveness. OS was calculated according to prognostic factors and gender. A total of 28 and 32 patients were enrolled in the BVZ/CPT-11 cohort and control group, respectively. The median OS was 17.94 months (95% CI, 14.91-20.96) in the BVZ/CPT-11 treatment cohort and 10.97 months (95% CI, 7.65-14.30) in the control cohort. The results obtained on the effectiveness of BVZ/CPT-11 treatment in patients with primary GBM are consistent with data from previous studies. No significant differences were identified in OS based on prognostic factors; therefore, the latter cannot be used to select patients who would incur the greatest benefits from BVZ/CPT-11 treatment.

[Effect of pharmacist involvement in adherence to medications in patients with high to moderate cardiovascular risk (Study EMDADER-CV-INCUMPLIMIENTO)]. / Efecto de la actuación farmacéutica en la adherencia del tratamiento farmacológico de pacientes ambulatorios con riesgo cardiovascular (Estudio EMDADER-CV-INCUMPLIMIENTO).

OBJECTIVE: To evaluate the effect of pharmacist involvement, by means of Pharmacotherapy Follow-Up (PFU) in the improvement of medication adherence and therapeutic outcomes. DESIGN: An experimental, controlled, and randomised clinical study comparing a PFU program with the routine process in Spanish community pharmacies improved with health education during 8 months. SETTING: Nine Spanish community pharmacies. PARTICIPANTS: Patients between 25 and 74 years with a moderate-high cardiovascular risk (CVR), who arrived with a prescription, in their name, for drugs for at least one CVR factor. INTERVENTIONS: The patients were randomly assigned to the intervention group (IG), and received PFU and health education, or the control group (CG), who received health education only. MAIN MEASUREMENTS: Adherence to treatment, and blood pressure (BP) and total cholesterol (TC) levels at the beginning and end of the study. RESULTS: Of the 87 patients enrolled, 85 finished the study: 41 from the CG and 44 from the IG. Both groups increased adherence at the end of the [CG: 26.9%; 95% CI: 12.7- 41; IG: 27.3%; 95% CI: 13.6 - 41]. Although the IG showed better results in the variation of BP and TC levels, the differences compared to the CG were not statistically significant. CONCLUSIONS: PFU and health education improves adherence to treatment. To be a patient who completes the study is also associated with improvement in the blood pressure and blood pressure/total cholesterol objectives.