Programa de atención a pacientes diabéticos y prediabéticos en farmacia comunitaria: 'DayBTS' / Treatment program for diabetic and prediabetic patients in community pharmacy: 'DayBTS'

JUSTIFICACIÓN: en España hay 6 millones de personas con diabetes. Canarias está 1,86 puntos porcentuales por encima de la media nacional. Aunque haya mejor conocimiento de la diabetes, el número de pacientes sigue aumentando. El farmacéutico comunitario puede jugar un papel importante a través de su formación académica como sanitario experto en el medicamento y por su cercanía al paciente. Por ello, son importantes proyectos de diseño y estandarización de servicios de seguimiento farmacoterapéutico en diabetes más un abordaje multidisciplinar. OBJETIVO: diseño de un servicio para atención a pacientes diabéticos y prediabéticos en farmacia comunitaria denominado DayBTS. Población diana: mayores de edad que acuden a la farmacia y cumplen al menos uno de estos requisitos: tratamiento con medicación antidiabética, presenten sobrepeso u obesidad, hipertensión arterial o hipercolesterolemia, presenten antecedentes familiares de diabetes o directamente soliciten el servicio. Estructura: serie de visitas divididas en dos fases. Fase inicio, comprende 5 visitas. Fase continuación, 2 visitas para seguimiento y nuevas dudas o problemas. Las actividades a realizar de forma general son: educación diabetológica, medición de variables clínicas (glucemia capilar, índice de masa corporal, hemoglobina glicosilada, patrones en glucemia), variables económicas (visitas a atención primaria, urgencias, número de medicamentos utilizados) y variables humanísticas (adherencia al tratamiento, calidad de vida, conocimientos sobre diabetes). Coste previsto: el coste por visita se estima en función de: tipo de visita, recursos materiales y tiempo del personal farmacéutico. Entre 5,95 € (paciente prediabético) a 20,90€ (paciente diabético) con precio propuesto de 7,44 € y 26,13 € para margen 20 %. El coste del servicio completo sería de 88,31-111 € (Prediabetes-Diabetes)

REASON: in Spain there are 6 million people with diabetes. The Canary Islands are 1.86 percentage points above the national average. Although information on diabetes has improved, the number of patients continues to increase. Community pharmacists can play a significant role thanks to their academic training as healthcare providers specialized in medications and their proximity to patients. For this reason, it is important to have projects for the design and standardization of pharmacotherapeutic monitoring services in diabetes, besides a multidisciplinary approach. OBJECTIVE: design of a treatment service for diabetic and prediabetic patients in community pharmacy called DayBTS. Target population: older people who visit the pharmacy and meet at least one of the following requirements: treatment with antidiabetic medication, are overweight or obese, arterial hypertension or hypercholesterolemia, with family history of diabetes or who ask for the service directly. Structure: series of visits in four phases. Initial phase, includes 5 visits. Continuation phase, 2 visits for monitoring and new doubts or issues. The activities to perform in general are as follows: diabetes education, measurement of clinical variables (blood glucose, body mass index, glycosylated hemoglobin, glycemic patterns), economic variables (visits at primary care, acute care, number of medications used) and human variables (treatment compliance, quality of life, knowledge of diabetes). Expected cost: the cost per visit is estimated according to: type of visit, material supplies and pharmaceutical staff time. Between 5.95 € (prediabetic patient) and 20.90 € (diabetic patient) with cost proposed 7.44 € and 26.13 € for a 20 % margin. The cost of the complete service would be 88.31-111 € (Prediabetes-Diabetes)

Risk excess of mortality and use of antipsychotics: a case-noncase study.

Severe mental disorders are associated with an increased mortality risk and the use of antipsychotic drugs may be one of the causes. In this study, we addressed the potential association of the reported mortality among patients on antipsychotics compared to other drugs from a pharmacovigilance database with the aim of evaluating the drug-induced mortality risk. A database containing 189 441 entries of suspected adverse reactions reported from 1 January 1995 to 31 December 2012 was explored for fatal outcomes. Potential disproportionality was estimated using the reporting odds ratio, proportional reporting ratio, and the χ-test. Two-hundred fatal outcomes were reported in patients on antipsychotics, which indicated the occurrence of disproportionality for this pharmacological class compared with any other drugs. When data were analysed by antipsychotic subclass, disproportionality was found only for atypical but not for typical antipsychotics. When individually analysed by active substances and routes, only a few substances were found to show disproportionality. The disproportionality encountered in this study compared with the mortality associated with other drugs suggests that the active substances under study may be associated with a mortality risk higher than what is assumed currently. Also, it suggests that atypical antipsychotics are likely to have a mortality risk higher than the risk of typical antipsychotics. The disproportionality found for zuclopentixol, in both oral and depot formulations, can be considered to be a drug surveillance signal.

Prevention of chloridazon and metribuzin pollution using lignin-based formulations.

The herbicides chloridazon and metribuzin, identified as groundwater pollutants, were incorporated in lignin-based granules with different sizes to obtain controlled release formulations (CRFs) and reduce water pollution risk. Kinetics release tests in water and soil showed that the release rate of both from CRFs diminished in comparison to technical products. A linear correlation was obtained between the time taken for 50% of the active ingredient to be released (T(50)) into water and granule size of the CRFs. Besides, a linear correlation was reached between T(50) values in water and soil. Mobility experiments carried out in calcareous soil show that the use of lignin-based CRFs reduces the presence of both herbicides in the leachate compared to the technical grade products. The set of experiments developed in this research can be useful to design, prepare and evaluate formulations with CR properties which can reduce the pollution derived from the use of herbicides.

Effects of dissolved organic carbon on phosphate retention on two calcareous soils.

To evaluate the effects of dissolved organic carbon (DOC) on phosphate retention (including both sorption and/or precipitation reactions) on soils, experiments were performed by using two typical calcareous soils from southeastern Spain (Calcic Regosol and Luvic Xerosol) and two different types of DOC: (1) extracts from a commercial peat (DOC-PE) and (2) high-purity tannic acid (DOC-TA). The experiments were carried out from a 0.01 M CaCl2 aqueous medium at 25 degrees C. The results obtained show that the presence of both DOC-PE and DOC-TA, over a concentration range of 15 (DOC-15) to 100 (DOC-100) mg L(-1), produces in all cases a decreasing amount of phosphate retained in the soils studied, the decrease observed being higher when DOC-PE is used as source of DOC. The values of the decrease observed when DOC-PE was added ranged between 19.9% (DOC-15) and 15.6% (DOC-100) for the Calcic Regosol and between 17.3% (DOC-70, DOC-100) and 14.6% (DOC-15) for the Luvic Xerosol. The variation observed when DOC-TA was added ranged between 8.5% (DOC-100) and 0.5% (DOC-35) for the Calcic Regosol and between 7.0% (DOC-100) and 1.0% (DOC-15) for the Luvic Xerosol.

Use of activated bentonites in controlled-release formulations of atrazine.

The herbicide atrazine (6-chloro-N2-ethyl-N4-isopropyl-1,3,5-triazine-2,4-diamine) was incorporated in alginate-based granules to obtain controlled-release (CR) properties. The basic formulation [sodium alginate (1.40%)-atrazine (0.60%)-water] was modified by the addition of sorbents. The effect on atrazine release rate caused by the incorporation of acid-treated bentonite (0.5 and 2.5 M H2SO4) in alginate formulation was studied by immersion of the granules in water under static conditions. The water uptake, sorption capacity of the sorbent, permeability, and time taken for 50% of the active ingredient to be released into water, t50, were calculated for the comparison of the preparations. t50 values were longer for those formulations containing acid-treated bentonite (36.78 and 29.01 days for 0.5 and 2.5 M H2SO4 treatments, respectively) than for the preparation without bentonite (9.69 days). On the basis of a parameter of an empirical equation used to fit the herbicide release data, it appears that the release of atrazine from the various formulations into water is controlled by diffusion mechanism. The sorption capacity of the sorbents and the permeability of the formulations (ranging from 4.99 to 20.83 mg day(-1) mm(-1)) were the most important factors affecting herbicide release.