Perfiles de locus de control en deportistas: relación con ira y personalidad resistente / Locus of control profiles in athletes: relationship with anger and hardiness

El estudio tuvo como objetivo identificar perfiles de locus de control en deportistas y examinar su relación con la ira y personalidad resistente. La muestra fue de 383 deportistas (Medad= 28.14; DT= 9.42) que completaron una serie de cuestionarios para medir: locus de control (E I-E), ira (STAXI-II) y personalidad resistente (EPRM). El análisis de conglomerados reveló dos perfiles distintos. Los análisis de ANOVA mostraron diferencias significativas en temperamento, reacción, expresión interna de ira, expresión externa de ira, control externo de ira, compromiso, desafío, control y el factor general de personalidad resistente. En este sentido, el perfil de locus de control externo bajo reportó los niveles más bajos de ira y niveles más altos de personalidad resistente. Como conclusión, del análisis de conglomerados surgieron dos perfiles de locus de control externo, de los cuales el perfil de locus de control externo bajo resultó ser un perfil más funcional (AU)

The study aimed to identify the locus of control profiles in athletes and examine whether participants from distinct profiles significantly differed on anger and hardiness. The sample was made up of 383 athletes (Mage = 28.14; SD =9.42) that completed a series of self-report questionnaires designed to measure: locus of control (E I-E), anger (STAXI-II) and hardiness (EPRM). Cluster analysis revealed two distinct profiles. Results of follow-up ANOVAs showed significant differences in temperament,reaction, internal anger expression, external anger expression, external anger control, commitment, challenge, control and hardy personality general factor. The low external locus of control profile reported the lowest anger levels and the highest hardiness levels. In 0354134conclusion, two locus of control external profiles emerged from the cluster analysis, in which the low external locus of control profile turned out to be the most functional profile (AU)

Randomized clinical trial on the usefulness of 3D printing in intra-articular fractures of the distal radius. / Ensayo clínico aleatorizado sobre la utilidad de la impresión 3D en las fracturas intraarticulares de radio distal.

OBJECTIVES: We evaluated the utility of 3D printing technology for preoperative planning in the treatment of intra-articular fractures of the distal radius in relation to the improvement of surgical technique, radiological and clinical results. MATERIAL AND METHODS: A total of 30 patients with 2B and C fractures of the AO classification were operated on by a single surgeon with a volar plate, randomly divided into two groups, 15 of them with conventional planning (Rx and CT) and 15 adding a 3D model of the fracture and the previous simulation of the intervention. Simulation time, surgical time in minutes, radioscopy time in minutes, loss of material expressed in lost screws were recorded. Clinical evaluation based PRWE questionnaire and full radiographic analysis was done for all patients with a mean follow-up of 6 months by an independent, blinded observed. RESULTS: No statistically significant differences were observed in the PRWE questionnaire (p=0.22), nor were we observed differences in the radiological values, except in relation to the articular step (p=0.028), which represents statistical significance, but in both groups the median was of 0.0 (0.0-0.0). We also did not see statistically significant differences in surgical times (p=0.745), radioscopy (p=0.819) or in the loss of synthesis material (p=0.779). CONCLUSIONS: 3D printing has not improved the parameters studied in relation to routinely operated patients.

Hospitalization budget impact during the COVID-19 pandemic in Spain.

OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at €15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was €10,744. The main costs were staffing costs (10,131 to 11,357 €/patient for physicians and 10,274 to 11,215 €/patient for nurses). Scenario analysis showed that the range of hospital expenditure was between €14,693,256 and €16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was €9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and €10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies.

BACKGROUND: Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS: A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS: The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS: There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.

Stakeholder analysis in health innovation planning processes: A systematic scoping review.

Integrating health innovations into the health system is a complex endeavour that requires a well-designed planning process engaging key stakeholders. Stakeholder analyses lay the foundations to inform appropriate planning processes and undertake strategic actions. A systematic scoping review was performed to explore how stakeholder analyses are applied in health innovation planning processes and a guideline to report stakeholder analyses was developed. The literature search was conducted in PubMed, Scopus and DOAJ; grey literature was sought using Google. Articles reporting stakeholder analyses during the planning process of health policies, systems, products and technologies, and services and delivery methods were included. Fifty-one records were incorporated in the qualitative synthesis. Stakeholder analyses were conducted worldwide, used in all types of health innovations, applied in all phases of the planning process and conducted both prospectively and retrospectively. The steps followed to perform stakeholder analysis, the methods used, the stakeholder attributes analysed and how authors reported the analyses were heterogeneous. Forty-one studies reported the identification of stakeholders, 50 differentiated/categorised them and 25 analysed stakeholder relationships. Only some authors proposed future actions based on the results obtained in their stakeholder analysis. A list of Reporting Items for Stakeholder Analysis (i.e., the RISA tool) is proposed to contribute to the reporting guidelines to enhancing the quality and transparency of health research.

Collaborative health service planning: A stakeholder analysis with social network analysis to develop a community pharmacy service.

BACKGROUND: Stakeholder participation optimizes health planning, fostering the acceptability and integration of new health services. Collaborative approaches may help overcome existing challenges in the development, implementation and evaluation of community pharmacy services (CPSs). Stakeholder analyses lay the foundation for building collaboration in the integrated delivery of health care. OBJECTIVES: This stakeholder analysis was performed to organize a collaborative initiative to develop a CPS aimed at preventing cardiovascular diseases in Andalucía (Spain). It aimed to identify stakeholders, differentiate/categorize them, and analyze stakeholder relationships. METHOD: Stakeholders were identified using the snowballing technique. To differentiate/categorize stakeholders and analyze the relationships (i.e., collaboration) an online web-based questionnaire was sent to 186 stakeholders. Stakeholders were asked for: (1) their influence, interest and attitude toward the initiative; (2) stakes/interests; (3) capacity to contribute to the initiative; (4) desire for involvement; (5) concerns; (6) whom they considered a key stakeholder; and (7) the level of collaboration they had with other stakeholders. Data analysis combined descriptive qualitative content analysis, descriptive quantitative analysis and social network analysis. RESULTS: Of the 186 stakeholders approached, 96 (51.6%) participated. The identification process yielded 217 stakeholders (individuals, organizations or collectives), classified into 10 groups. Fifty-seven stakeholders were considered critical to the intended initiative. Most participant stakeholders supported the initiative and were willing to collaborate in the development of the CPS. Public health and science were the main driving interests. A collaboration network existed between the 96 stakeholders. CONCLUSION: This study revealed the magnitude of the social system surrounding the development of a CPS aimed at preventing cardiovascular disease. A large array of stakeholders was identified and analyzed, and a group of critical stakeholders selected. Stakeholder characteristics such as attitude toward the initiative, potential contribution, desire for involvement, and the existing collaboration network, provided complementary information that was helpful for planning the process and stakeholder engagement.

A finite element-based machine learning approach for modeling the mechanical behavior of the breast tissues under compression in real-time.

This work presents a data-driven method to simulate, in real-time, the biomechanical behavior of the breast tissues in some image-guided interventions such as biopsies or radiotherapy dose delivery as well as to speed up multimodal registration algorithms. Ten real breasts were used for this work. Their deformation due to the displacement of two compression plates was simulated off-line using the finite element (FE) method. Three machine learning models were trained with the data from those simulations. Then, they were used to predict in real-time the deformation of the breast tissues during the compression. The models were a decision tree and two tree-based ensemble methods (extremely randomized trees and random forest). Two different experimental setups were designed to validate and study the performance of these models under different conditions. The mean 3D Euclidean distance between nodes predicted by the models and those extracted from the FE simulations was calculated to assess the performance of the models in the validation set. The experiments proved that extremely randomized trees performed better than the other two models. The mean error committed by the three models in the prediction of the nodal displacements was under 2 mm, a threshold usually set for clinical applications. The time needed for breast compression prediction is sufficiently short to allow its use in real-time (<0.2 s).

Estudio clínico comparativo de 2 técnicas quirúrgicas de rizartrosis del pulgar / Comparative clinical study of 2 surgical techniques for trapeziometacarpal osteoarthritis

Objetivo. En la rizartrosis del pulgar existe gran controversia sobre la técnica quirúrgica a elegir: trapeciectomía simple, artroplastia de resección-interposición, artroplastia de resección-suspensión, artrodesis, artroplastia de suspensión-resección-interposición o artroplastia con prótesis. Estas 2 últimas son las más empleadas, sin consenso en la literatura sobre la técnica a elegir y sin suficientes estudios comparativos. El objetivo es comparar las 2 técnicas más empleadas en la actualidad: artroplastia de resección-suspensión y artroplastia con prótesis. Material y método. Presentamos un estudio prospectivo de 15 pacientes diagnosticados de rizartrosis del pulgar grados ii-iii tratados con artroplastia de resección-suspensión (grupo 1) y 15 con prótesis (grupo 2) mostrando resultados clínicos, ventajas e inconvenientes de cada una. Como variables se emplearon la escala EVA, el cuestionario DASH, la fuerza de puño y de pinza terminoterminal y terminolateral; el balance articular en aducción-abducción, en anteposición-retroposición y la oposición. Los 2 grupos son de 2 hospitales diferentes, intervenidos por un cirujano de mano de la unidad. El tiempo de seguimiento para todos los pacientes incluidos fue de 12 meses. Resultados. El EVA, DASH y fuerza de puño a los 12 meses no muestran diferencias significativas; en cuanto a la fuerza de pinza terminoterminal y terminolateral, el grupo 2 mostró los mayores valores en todos los periodos de seguimiento, con diferencias estadísticamente significativas. Conclusiones. Es fundamental la selección del paciente y la experiencia del cirujano, dados los resultados satisfactorios de ambas técnicas. La artroplastia con prótesis se reserva para grados ii y iii, pacientes de mediana edad, buena arquitectura del trapecio y cirujanos con experiencia (AU)

Objective. In trapeziometacarpal osteoarthritis (or rhizarthrosis), there is great controversy over the surgical technique to choose: simple trapeziectomy, resection-interposition arthroplasty, interposition arthroplasty suspension-or arthroplasty with implant or prosthesis. These latter 2 are the most used without consensus in the literature on the technique to choose and without sufficient comparative studies. The objective is to compare the 2 techniques most used today: suspension-interposition arthroplasty and arthroplasty with prosthesis. Material and method. A prospective study was conducted on 15 patients diagnosed with grade 2-3 rhizarthrosis treated with interposition arthroplasty-suspension (group 1) and 15 with prosthesis (group 2) showing clinical outcomes, advantages and disadvantages of each. The study variables were the visual analogue scale (VAS), the DASH questionnaire, the grip strength, the strength of end to end and end-lateral clamp, the joint balance adduction-abduction and preemption-retropositioning, and the opposition. The 2 groups are from 2 different hospitals operated on by a hand surgeon from the Hand Unit. The follow-up time for all patients included in the study was 12 months. Results. The VAS, DASH and grip strength at 12 months did not show significant differences. As regards the strength of end to end and end-lateral clamp, group 2 showed the highest values in all follow-up periods with statistically significant differences. Conclusions. Patient selection and surgical experience is essential, given the satisfactory results of both techniques. Arthroplasty prosthesis is reserved for grades 2 and 3, middle-aged patients, good trapezium architecture, and experienced surgeons (AU)

[Comparative clinical study of 2 surgical techniques for trapeziometacarpal osteoarthritis]. / Estudio clínico comparativo de 2 técnicas quirúrgicas de rizartrosis del pulgar.

OBJECTIVE: In trapeziometacarpal osteoarthritis (or rhizarthrosis), there is great controversy over the surgical technique to choose: simple trapeziectomy, resection-interposition arthroplasty, interposition arthroplasty suspension-or arthroplasty with implant or prosthesis. These latter 2 are the most used without consensus in the literature on the technique to choose and without sufficient comparative studies. The objective is to compare the 2 techniques most used today: suspension-interposition arthroplasty and arthroplasty with prosthesis. MATERIAL AND METHOD: A prospective study was conducted on 15 patients diagnosed with grade 2-3 rhizarthrosis treated with interposition arthroplasty-suspension (group 1) and 15 with prosthesis (group 2) showing clinical outcomes, advantages and disadvantages of each. The study variables were the visual analogue scale (VAS), the DASH questionnaire, the grip strength, the strength of end to end and end-lateral clamp, the joint balance adduction-abduction and preemption-retropositioning, and the opposition. The 2 groups are from 2 different hospitals operated on by a hand surgeon from the Hand Unit. The follow-up time for all patients included in the study was 12 months. RESULTS: The VAS, DASH and grip strength at 12 months did not show significant differences. As regards the strength of end to end and end-lateral clamp, group 2 showed the highest values in all follow-up periods with statistically significant differences. CONCLUSIONS: Patient selection and surgical experience is essential, given the satisfactory results of both techniques. Arthroplasty prosthesis is reserved for grades 2 and 3, middle-aged patients, good trapezium architecture, and experienced surgeons.

Fractura-luxación transemilunar / Translunate fracture-dislocation

Presentamos el caso de un varón deportista de profesión, que tras un traumatismo durante su práctica deportiva habitual sufre una fractura-luxación transestiloides radial-transemilunar, lesión que es poco común y que escapa de los patrones típicos. Tras reducción cerrada de urgencia fue intervenido quirúrgicamente realizando osteosíntesis del semilunar y reparación del ligamento escafolunar, con recuperación satisfactoria. Las fracturas-luxaciones carpianas son lesiones severas que pueden asociarse a múltiples patrones de lesiones ligamentosas y óseas. Bain añade el arco translunar(fractura del semilunar) para usarlo como complemento al modelo de clasificación de inestabilidades perilunares de Johnson de arco mayor-arco menor. Este tipo de lesión translunar no sigue el esquema descrito por Mayfield, aunque sí es una combinación de este concepto con una fractura del semilunar. En el caso que presentamos se produjo una afectación de los 3 arcos: fractura de la estiloides radial (arcomayor), fractura del semilunar (arco translunar) y lesión de los ligamentos carpianos (arco menor); esto aún no se ha estudiado biomecánicamente (AU)

We present the case of a 26-year-old male sportsman by profession, who suffers a radial transstyloid-translunatefracture-dislocation after a trauma during a sport practice. This is an uncommon injury that escapes from the typical injury patterns. After an urgent closed reduction, the patient undergoes surgery by osteosynthesis of the lunate fracture and scapholunate ligament repair, with a successful recovery. Carpal fracture-dislocations are severe injuries that may be associated with multiple patterns of ligamentous and bone injuries. Bain adds the translunate arc (lunatefracture) as a complement to the greater arc-lesser arc classification model of perilunate inestabilities from Johnson. This mechanism of translunate injury does not follow the pattern described by Mayfield, although it is a combination of such concept and the lunate fracture. In our clinical case, there was an involvement of the3 arches: radial styloid fracture (greater arc), lunate fracture(translunate arc) and carpal ligaments fracture (lesserarc); this has not yet been studied biomechanically (AU)

Evaluación de las modificaciones dietéticas en el periodo de Ramadán / Evaluation of dietetic changes in the perior of Ramadan

Fundamentos: Entre las modificaciones introducidas en los hábitos de vida por el mes de Ramadán, destacan los cambios dietéticos, tanto cualitativos como cuantitativos. El objetivo fundamental del presente estudio es evaluar las modificaciones producidas por el ayuno de Ramadán en la población musulmana. Material y métodos: Se analizó la dieta diaria realizando una encuesta recordatorio a 100 voluntarios musulmanes de los que se encontraron bajo este periodo. Consistió en un inventario de 3 días sobre los alimentos consumidos, su preparación y su cantidad. Resultados: Se dedujeron cambios significativos en la dieta de ramadán. Ésta resultó ser hiperprotéica, donde predominaba la ingesta de proteínas (27%). De la repartición de energía entre las comidas, se dedujo que es igualmente desequilibrada siendo la mayor parte de energía concentrada en la primera comida. Conclusiones: Sería esencial hacer reajustes en la dieta de ramadán a fin de equilibrarla lo máximo posible. Para ello habrá que promocionar una adecuada educación e información nutricional adaptada al mes de ramadán antes de que empiece dicho mes (AU)

Background: Amongst the changes affecting daily habits during the month of Ramadan, we can distinctively observe the dietetic changes, either qualitatively of quantitatively. Our essential objective of this study is to evaluate the changes brought about by the fasting during Ramadan among Muslims. Methods: We analyzed the daily diet by carrying out a prompting survey among 100 volunteer Muslims during the period of Ramadan. We calculated inventory of 3 days consumed food and the preparation and quality of meals. Results: Observing significant changes in diets during Ramadan. The diet is a hyper-protein dominated by the intake of proteins (27%). As for the repartition of energy between meals, we concluded also disequilibrium by taking the most part of energy during the first meal. Conclusions: It would be essential to re-adjust the diet during Ramadan in order to reach the most equilibrium possible, which should be necessarily based on adequate education and adaptable nutritional information before the beginning of the month of Ramadan (AU)

Patient-specific simulation of the intrastromal ring segment implantation in corneas with keratoconus.

PURPOSE: The purpose of this study was the simulation of the implantation of intrastromal corneal-ring segments for patients with keratoconus. The aim of the study was the prediction of the corneal curvature recovery after this intervention. METHODS: Seven patients with keratoconus diagnosed and treated by implantation of intrastromal corneal-ring segments were enrolled in the study. The 3D geometry of the cornea of each patient was obtained from its specific topography and a hyperelastic model was assumed to characterize its mechanical behavior. To simulate the intervention, the intrastromal corneal-ring segments were modeled and placed at the same location at which they were placed in the surgery. The finite element method was then used to obtain a simulation of the deformation of the cornea after the ring segment insertion. Finally, the predicted curvature was compared with the real curvature after the intervention. RESULTS: The simulation of the ring segment insertion was validated comparing the curvature change with the data after the surgery. Results showed a flattening of the cornea which was in consonance with the real improvement of the corneal curvature. The mean difference obtained was of 0.74 mm using properties of healthy corneas. CONCLUSIONS: For the first time, a patient-specific model of the cornea has been used to predict the outcomes of the surgery after the intrastromal corneal-ring segments implantation in real patients.

Orientación hacia el paciente en la enseñanza de farmacia en España / Patient centeredness in Pharmacy education in Spain

La educación de un profesional consiste en la aportación de conocimientos, actitudes y habilidades que hacen posible el ejercicio. El paradigma de la enseñanza universitaria se ha desplazado desde el ‘sabe’, o incluso el ‘sabe cómo’, hacia el ‘muestra cómo’ y, más importante aún, el ‘hace’. Este era uno de los fundamentos en los que se basaba la modernización del Espacio Europeo de Educación Superior (EEES), creado por la Declaración de Boloña. Como consecuencia de esta normativa, los currículos de los estudios de farmacia han sufrido modificaciones en los pasados años. Varios organismos internacionales apoyan el movimiento del papel del farmacéutico hacia el de un profesional involucrado en los cuidados directos al paciente. Este enfoque en el paciente de la práctica farmacéutica, debería estar basado en similar enfoque en la educación del farmacéutico, lo que no siempre se está consiguiendo en España y en la mayoría de los países del EEES

Education of professionals comprises providing knowledge, attitudes and skills that enable them to practice. The paradigm of university education has shifted from ‘knows’, or even ‘knows how’, to ‘shows how’ and, even more important, to ‘does’. This was one of the fundamentals to build the modern European Higher Education Area (EHEA) created with the Bologna Declaration. As a consequence of this regulation, pharmacy curricula have been modified in the past years. Several international institutions support the movement of pharmacists’ role towards a professional involved on direct patient care. This patient focusing of pharmacy practice should be supported by a similar patient focus pharmacy education, which not always has been achieved in Spain and the majority of EHEA members

A new methodology for the in vivo estimation of the elastic constants that characterize the patient-specific biomechanical behavior of the human cornea.

This work presents a methodology for the in vivo characterization of the complete biomechanical behavior of the human cornea of each patient. Specifically, the elastic constants of a hyperelastic, second-order Ogden model were estimated for 24 corneas corresponding to 12 patients. The finite element method was applied to simulate the deformation of human corneas due to non-contact tonometry, and an iterative search controlled by a genetic heuristic was used to estimate the elastic parameters that most closely approximates the simulated deformation to the real one. The results from a synthetic experiment showed that these parameters can be estimated with an error of about 5%. The results of 24 in vivo corneas showed an overlap of about 90% between simulation and real deformed cornea and a modified Hausdorff distance of 25 µm, which indicates the great accuracy of the proposed methodology.

Methodology based on genetic heuristics for in-vivo characterizing the patient-specific biomechanical behavior of the breast tissues.

This paper presents a novel methodology to in-vivo estimate the elastic constants of a constitutive model proposed to characterize the mechanical behavior of the breast tissues. An iterative search algorithm based on genetic heuristics was constructed to in-vivo estimate these parameters using only medical images, thus avoiding invasive measurements of the mechanical response of the breast tissues. For the first time, a combination of overlap and distance coefficients were used for the evaluation of the similarity between a deformed MRI of the breast and a simulation of that deformation. The methodology was validated using breast software phantoms for virtual clinical trials, compressed to mimic MRI-guided biopsies. The biomechanical model chosen to characterize the breast tissues was an anisotropic neo-Hookean hyperelastic model. Results from this analysis showed that the algorithm is able to find the elastic constants of the constitutive equations of the proposed model with a mean relative error of about 10%. Furthermore, the overlap between the reference deformation and the simulated deformation was of around 95% showing the good performance of the proposed methodology. This methodology can be easily extended to characterize the real biomechanical behavior of the breast tissues, which means a great novelty in the field of the simulation of the breast behavior for applications such as surgical planing, surgical guidance or cancer diagnosis. This reveals the impact and relevance of the presented work.

Modelos de remuneración del servicio de Seguimiento Farmacoterapéutico / Potential remuneration models for medication review with follow-up service in community pharmacy

Introducción: Existen diferentes motivos que justifican la necesidad de remunerar el servicio de seguimiento farmacoterapéutico (SFT). El cálculo de su precio se puede realizar de varias maneras y es importante para que su pago salvaguarde la sostenibilidad de la actividad. Objetivo: Explorar cómo se justifica la necesidad de remunerar la provisión del servicio de SFT, describir las propuestas sobre quién y a quién se debería pagar, así como los modelos de remuneración propuestos. Método: Se realizaron 21 entrevistas semiestructuradas a farmacéuticos Innovadores con experiencia en la realización de SFT y a otros que acababan de comenzar a realizar SFT en el entorno del Programa conSIGUE. Resultados: En ambos grupos, se argumenta que el farmacéutico posee la formación necesaria para proveer el servicio y aventaja la cercanía que tiene con los pacientes. Además, se alude a la asunción de responsabilidad del farmacéutico y al impacto económico y clínico generado por la provisión del servicio. Se sugiere que sea la Administración la que sufrague el servicio y que el pago se efectúe a la farmacia como organización, sin dejar de compensar económica y profesionalmente al proveedor. El precio del servicio debe cubrir, entre otros, los costes de provisión y tener en cuenta el tiempo empleado transcurrido. También se podría valorar la complejidad de los casos, el impacto y eficiencia, el número de pacientes, etc. Conclusión: Es necesario conseguir la remuneración del servicio de SFT con un precio adecuado para que sea sostenible a lo largo del tiempo. Este tipo de servicio debe ser sufragado por la Administración sanitaria aunque no se descarta la participación de los beneficiarios. El pago se debe realizar a la farmacia y el farmacéutico proveedor debe recibir el complemento correspondiente

Introduction: Different reasons justify the need to remunerate the provision of the service of Medication Review with follow-up (MRF). Its price could be obtained through several calculations and its value is essential to sustain the activity. Objective: To explore how is being justified the need to remunerate the MRF’ provision, to describe the proposals on who should pay and to whom, as well as to explore the models of remuneration proposed. Method: 21 semi-structured interviews were conducted with innovative pharmacists experienced in the provision of MRF service and with others that have just been introduced to it within the framework of the conSIGUE program. Results: Pharmacists justified the need to obtain the remuneration of the service for different reasons. In both groups, it is argued that the pharmacist possesses the expertise to provide the service and is surpassed by an easy access to patients. In addition to this, participants referred to the assumption of responsibility and to the economic and clinical impact of the service provision. In both groups the Administration is proposed as the main payer while it is recommended to pay to the pharmacy as an organization as well as, to economically and professionally compensate the provider. The price must cover between others, costs of provision and the spent time. It could be also considered the complexity of the case, the impact and efficiency, the number of patients, etc. Conclusion: It is necessary to obtain the remuneration of MRF’s service with a suitable price in order to sustain the activity. This type of service must be defrayed by the Administration without ruling a patient copayment. The community pharmacy must bill the service provision and the provider must be compensated

Evaluación del impacto del ayuno en Ramadán en el estilo de vida y salud / Evaluating the impact of the Ramadan fasting on the life style and health

Fundamentos: Durante el Ramadán, los individuos de confesión islámica se abstienen de comer y beber desde la salida del sol hasta su puesta. El objetivo fundamental de este estudio es evaluar cómo influye el precepto del Ramadán en los hábitos alimenticios de las personas, su sueño, actividad física, actividad u ocupación diarios y también determinar cómo varía la incidencia y la frecuencia de ciertos síntomas y patologías. Material y métodos: Se procedió a un estudio transversal en el cual se realizó un cuestionario a 200 personas de las que se encontraron ayunando en el mes de Ramadán del 2013. El cuestionario constó de cinco partes y trató sobre los hábitos alimenticios, los hábitos de sueño de estas personas, su actividad diaria y actividad física, también de cómo varia la incidencia de patologías y de sintomatologías. Resultados: Ante una inadecuada higiene de vida, el Ramadán cambia radicalmente los hábitos alimenticios de las personas, influye en sus adicciones, altera la naturaleza de su sueño, baja el ritmo de su ocupación diaria y de su actividad física. Afecta al estado de ánimo de las personas y aumenta su irritabilidad (42%). Aumenta la frecuencia de padecer dolor de cabeza (49%) y náuseas (34%). Altera la memoria (17%) y la concentración en algunas personas (18%). Aumenta a su vez la incidencia de padecer indigestiones, acidez gástrica y molestias digestivas (40%), estreñimiento (36%), flatulencia y dispepsia (36%), induce también una bajada de la temperatura corporal (49%) y provoca una sequedad bucal en casi todos los individuos (73%). Las molestias dentales (30%) y la halitosis (39%) son otras de las consecuencias del Ramadán. Conclusiones: Amortiguar este gran impacto que tiene el Ramadán sobre la salud de las personas seria primordial informar, prevenir y mejorar al máximo la higiene de vida por motivo de este periodo sería la solución (AU)

Background: During Ramadan individuals abstain totally from drinking and eating from sunrise to sunset. The principal objective of this study is to evaluate how the precept of Ramadan influences food habits, sleeping, physical activities, and daily routines and occupations, and determine the variety and frequency of some symptoms and pathologies. Methods: A data was collected by questioning 200 volunteers muslims in the period of Ramadan. They indicated they were fasting. The questionnaire asked about the food habits of these individuals, their sleeping patterns, daily and physical activities, and the variety of pathologies and symptomologies. Results: Due to an inadequate hygiene of life, Ramadan fasting can change radically food habits, influences addictions, alters the nature of sleeping, reduces the rhythm of daily occupation and physical activities; influences the state of mind and rises irritation (42%), increases the frequency of headache (49%) and nauseas (34%); alters the memory (17%) and the concentration (18%) , increases the occurrence of ingestion illnesses, gastric acidity and digestive problems (40%), constipation (36%) , flatulency and dyspepsia (36%) , decreases the corporal temperature (49%) and provokes mouth dryness in almost all individuals (73%). Dental troubles (30%) and halitosis (39%) are some of Ramadan consequences. Conclusions: So often the great impact of Ramadan may have on the health is primordial. Inform, prevent, educate and enhance to the maximum the life hygiene during this period is the solution (AU)

Identificación de los costes de la provisión sostenible del servicio de Seguimiento Farmacoterapéutico / Costs’ identification of the sustainable provision of the Medication Management Service

Introducción: A pesar de la baja implantación de servicios de Atención Farmacéutica en España, y de la falta de remuneración de la mayoría de sus prestaciones, algunos farmacéuticos apuestan por el desarrollo del servicio de seguimiento farmacoterapéutico en las farmacias en las que ejercen. La sostenibilidad de su prestación es precaria y depende de la correcta identificación de los costes que genera en la organización. Objetivo: Identificar todos los recursos necesarios para la prestación del servicio profesional SFT en cualquier farmacia en la que se inicie la actividad y se pretenda sostener su provisión a lo largo del tiempo. Método: Se realizaron entrevistas semiestructuradas a farmacéuticos innovadores con experiencia en la realización de SFT y a otros que acababan de comenzar a realizar SFT en el entorno del Programa conSIGUE. Resultados: Los denominados farmacéuticos Innovadores, con experiencia en la provisión del servicio de seguimiento farmacoterapéutico, identifican una serie de recursos necesarios para proveer el servicio. Estos son, por un lado, los recursos materiales que incluyen la habilitación de la zona ZAP, el hardware y el software, diversos aparatos, las fuentes de información y la publicidad y la promoción del servicio. Por otro lado se identifican, los recursos humanos y la formación. El coste de personal depende del tiempo de provisión y la categoría del farmacéutico proveedor. Los farmacéuticos con escasa experiencia en la provisión del servicio, los denominados farmacéuticos conSIGUE, apenas identifican gastos generados por la provisión del servicio excepto el coste de personal. Conclusión: Es necesario identificar los recursos necesarios para proveer el servicio de SFT para mantener una provisión sostenibledel servicio y establecer su precio

Introduction: Despite the low provision of Pharmaceutical Care services in Spain, and the lack of remuneration, some pharmacists opt for the development of the provision of Medication Review with follow-up (MRF) in the pharmacies where they practice. There is a poor sustainable provision which depends on the correct identification of the costs that it generates in the organization. Objective: To identify all the resources needed for the provision of the MRF service in any pharmacy in where it starts and pretends to continue over time. Methods: Semi-structured interviews were conducted. On the one hand, with innovative pharmacists experienced in the provision of MRF service and on the other hand, with others that have just been introduced to it within the framework of the conSIGUE program. Results: The so called Innovative pharmacists, with experience in the provision of MRF, identify a series of necessary resources to provide the service. These are, on the one hand, the material resources which include: the enabling of the private care area, the hardware and the software, some devices, the information sources and the advertising and promotion of the service. On the other hand, they identify the human resources and training. Personnel cost depends on the length of provision and the grade of the provider pharmacist. The pharmacists with limited experience known as conSIGUE pharmacists hardly identify costs generated by the service' provision with the exception of the personnel ones. Conclusions: The costs generated by the provision of MRF must be identified in order to keep its provision and to fix its price