Improving the Quality of Publications in and Advancing the Paradigms of Clinical and Social Pharmacy Practice Research: The Granada Statements / Mejorando la calidad de las publicaciones y avanzando en todos los paradigmas de la investigación de la farmacia asistencial, clínica y social: las declaraciones de Granada

Pharmacy and pharmaceutical sciences embrace a series of different disciplines. Pharmacy practice has been defined as “the scientific discipline that studies the different aspects of the practice of pharmacy and its impact on health care systems, medicine use, and patient care”. Thus, pharmacy practice studies embrace both clinical pharmacy and social pharmacy elements. Like any other scientific discipline, clinical and social pharmacy practice disseminates research findings using scientific journals. Clinical pharmacy and social pharmacy journal editors have a role in promoting the discipline by enhancing the quality of the articles published. As has occurred in other health care areas (i.e., medicine and nursing), a group of clinical and social pharmacy practice journal editors gathered in Granada, Spain to discuss how journals could contribute to strengthening pharmacy practice as a discipline. The result of that meeting was compiled in these Granada Statements, which comprise 18 recommendations gathered into six topics: the appropriate use of terminology, impactful abstracts, the required peer reviews, journal scattering, more effective and wiser use of journal and article performance metrics, and authors’ selection of the most appropriate pharmacy practice journal to submit their work (AU)

Direct Patterning of p-Type-Doped Few-layer WSe2 Nanoelectronic Devices by Oxidation Scanning Probe Lithography.

Direct, robust, and high-resolution patterning methods are needed to downscale the lateral size of two-dimensional materials to observe new properties and optimize the overall processing of these materials. In this work, we report a fabrication process where the initial microchannel of a few-layer WSe2 field-effect transistor is treated by oxygen plasma to form a self-limited oxide layer on top of the flake. This thin oxide layer has a double role here. First, it induces the so-called p-doping effect in the device. Second, it enables the fabrication of oxide nanoribbons with controlled width and depth by oxidation scanning probe lithography (o-SPL). After the removal of the oxides by deionized H2O etching, a nanoribbon-based field-effect transistor is produced. Oxidation SPL is a direct writing technique that minimizes the use of resists and lithographic steps. We have applied this process to fabricate a 5 nm thick WSe2 field-effect transistor, where the channel consists in an array of 5 parallel 350 nm half-pitch nanoribbons. The electrical measurements show that the device presents an improved conduction level compared to the starting thin-layer transistor and a positive threshold voltage shift associated to the p-doping treatment. The method enables to pattern devices with sub-50 nm feature sizes. We have patterned an array of 10 oxide nanowires with 36 nm half-pitch by oxidation SPL.

Revisión sistemática de los estudios españoles sobre atención farmacéutica comunitaria en hipertensión arterial / Systematic review of the spanish studies about community pharmaceutical care in hypertension

Introducción: La hipertensión arterial es un problema de salud pública mundial de gran prevalencia, y responsable de una morbimortalidad muy elevada. A pesar de los grandes esfuerzos sanitarios y económicos realizados, el grado de control es muy escaso, situándose alrededor del 20% los hipertensos bien controlados entre los tratados, tanto en España como en los países de nuestro entorno. Objetivo: Revisar sistemáticamente la evidencia que aportan los estudios españoles sobre el impacto de la atención farmacéutica en hipertensión arterial, realizados en el ámbito comunitario. Métodos: Se realizó una búsqueda bibliográfica en MEDLINE, COCHRANE, DIALNET, y en revistas y webs especializadas en atención farmacéutica. Se incluyeron estudios de intervención farmacéutica en hipertensión arterial multicéntricos, realizados en España en el ámbito de la farmacia comunitaria. Se excluyeron estudios piloto, muestras inferiores a 10 pacientes y estudios descriptivos o cribados. Resultados: De los 18 estudios encontrados, 9 cumplían los criterios de inclusión. 6 eran ensayos controlados, y 3 no controlados. La descripción de cada estudio incluye el número y tipo de pacientes, tiempo de seguimiento, intervención farmacéutica y resultados obtenidos. Conclusiones: Los estudios españoles sobre el impacto de la atención farmacéutica comunitaria en el control de la presión arterial muestran mejoras en resultados clínicos (disminución de presión arterial media o de la proporción de pacientes mal controlados), en línea con los estudios realizados a nivel internacional. Por otro lado, se necesitan estudios de calidad adicionales que exploren el impacto de la intervención farmacéutica en resultados económicos y humanísticos

Background: Hypertension is an important public health problem around the world, with a high prevalence, and responsible for a very high morbidity and mortality. In spite of the big sanitary and economic efforts that have been made until now, the degree of control of this disease is very limited. Only around 20% of the treated hypertensive patients are well controlled, both in Spain and in the countries around us. Objective: To review systematically the evidence from Spanish studies about the impact of pharmaceutical care in hypertension, conducted in the community pharmacy setting. Methods: A comprehensive literature search was performed using MEDLINE, COCHRANE, DIALNET, and journals and web pages specialized in pharmaceutical care. Multicenter studies of pharmaceutical interventions in hypertension, conducted in Spain in the community pharmacy setting were included. Pilot studies, screenings, descriptive studies, or samples with less than 10 patients were excluded. Results: 18 studies were found. 9 out of them met the inclusion criteria. 6 were controlled trials, and 3 were uncontrolled trials. The description of each study includes the number and type of patients, monitoring length, pharmaceutical interventions, and outcomes achieved. Conclusions: The Spanish studies about the impact of community pharmaceutical care on blood pressure control show improvements in clinical outcomes (decrease of either mean blood pressure or percentage of uncontrolled patients). The results are similar to those carried out internationally. On the other hand, further quality studies exploring the economic and humanistic outcomes of the pharmaceutical intervention are required

Programa D-VALOR, análisis de registros de dispensación. Benzodiazepinas / D-VALUE program, analyzing dispensing records. Benzodiazepines

Objetivo: El objetivo del presente trabajo dentro del programa D-VALOR consiste en la evaluación de las dispensaciones de benzodiazepina (BZD), así como su registro, y comprobar si el paciente tiene conocimiento acerca de los medicamentos que recibe, si los usa de forma correcta y si observa las precauciones necesarias que requiere el grupo terapéutico. Método: Se trata de un estudio multicéntrico, observacional y prospectivo de registros de dispensaciones. Se registraron 47.829 dispensaciones. Resultados: En todas las edades la mujer usa más este tipo de medicación que el hombre. El 82,10% de los tratamientos son de continuación; un 51% de los pacientes desconocen la duración del tratamiento en los de inicio, y un 44% en los de continuación. Esto es preocupante, pues los problemas que presentan los tratamientos con BZD y sus análogos (caídas, fracturas y efectos sobre la psicomotricidad) están relacionados con su uso prolongado. En cuanto al conocimiento de los pacientes sobre el medicamento, sólo un 54% tienen un conocimiento global del tratamiento en lo que se refiere a la posología, la pauta de uso y su duración. Un 23% de pacientes manifiestan no estar satisfechos con su tratamiento, de los cuales un 6% declaran estarlo parcialmente tras haber sufrido resultados negativos asociados a la medicación. Las BZD más demandadas fueron lorazepam (11.862 casos), alprazolam (9.131) y lormetazepam (6.339), y de entre sus análogos zolpidem fue el más solicitado (3.331). Conclusiones: Dada la falta de conocimientos del paciente, especialmente en lo que se refiere a la duración del tratamiento con BZD y las precauciones que lleva asociadas su administración, una correcta dispensación puede ser de gran ayuda al paciente para que el tratamiento farmacológico se lleve a cabo de forma segura y eficaz(AU)

Objectives: The major objective of this work, within the frame work of D-VALOR program, is to evaluate and record benzodiazepines (BZD) dispensations. At the same time patients knowledge about the medicines they receive will be evaluated, if these are used in the correct way and if the necessary precaution measures are taken. Methods: This is a multi-centre project for observation and prospection of dispensation records, based on 47,829 recorded dispensations. Results: The results show that at all ages this type of medicine is mostly used by women and less by men. 82.10% of all treatments are of continuation or follow-up type with not very well determined duration time. 51% is unaware of the duration of the treatment when it is an initial treatment and 44% when it is a follow-up treatment. This of course is a worrying fact, as prolonged treatments with BZD and analogue drugs involve falls, fractures and effects on psychomotricity problems. This study also shows that with respect to patients’ medicine knowledge, only 54% has a global knowledge about the treatment: dosage, pattern of use and treatment duration. 23% of patients declare partially (6%) or not at all satisfied with their treatment. The most demanded benzodiazepines were: lorazepam (11,862), alprazolam (9,131) and lormetazepam (6,339). For analogue drugs, the most demanded one was zolpidem (3,331). Conclusions: This study shows that patient’s knowledge, specially the treatment duration and related precautions, is very low or not sufficient. The correct dispensation and follow-up information are key factors for a successful, effective and secure pharmacologic treatment with BZD(AU)

Análisis de registros de dispensación en antiinflamatorios no esteroideos dentro del programa D-Valor / Analysis of dispensing records for non-steroidal anti-inflammatory drugs under the D-Valor programme

Objetivo: Analizar y evaluar los datos obtenidos durante la dispensación de antiinflamatorios no esteroideos (AINE) dentro del programa D-Valor. Método: Se trabajó con un diseño de estudio multicéntrico, observacional y prospectivo de registros de datos de dispensación de medicamentos de grupos terapéuticos definidos. Resultados: En el 23% de las dispensaciones, el paciente utilizaba además otro medicamento susceptible de interacción. Más del 60% de los pacientes no conocía el uso adecuado del medicamento. El principio activo más dispensado fue ibuprofeno (38%). Conclusiones: Los AINE están entre los medicamentos más utilizados, pero debe mejorarse el conocimiento sobre su utilización. El diálogo con el paciente en el momento de la dispensación de AINE facilita la detección de situaciones de riesgo relacionadas(AU)

Aim: To analyse and assess the data gathered during dispensing of non-steroidal anti-inflammatories (NSAIDs) under the D-Valor programme. Method: The method used was a prospective multi-centre observational study of drug dispensing records for specific therapeutic groups. Results: In 23% of dispensing, the patient was also using another drug on which it was a possibility of interaction. Over 60% of the patients were not familiar with the proper use of the drug. The most widely-dispensed active ingredient was ibuprofen (38%). Conclusions: NSAIDs are among the most widely-used drugs, but knowledge about their use needs to be improved. Dialogue with the patient at the time when NSAIDs are dispensed improves the detection of related risk situations(AU)

Binding of transcriptional activators to sigma 54 in the presence of the transition state analog ADP-aluminum fluoride: insights into activator mechanochemical action.

Conformational changes in sigma 54 (sigma(54)) and sigma(54)-holoenzyme depend on nucleotide hydrolysis by an activator. We now show that sigma(54) and its holoenzyme bind to the central ATP-hydrolyzing domains of the transcriptional activators PspF and NifA in the presence of ADP-aluminum fluoride, an analog of ATP in the transition state for hydrolysis. Direct binding of sigma(54) Region I to activator in the presence of ADP-aluminum fluoride was shown and inferred from in vivo suppression genetics. Energy transduction appears to occur through activator contacts to sigma(54) Region I. ADP-aluminum fluoride-dependent interactions and consideration of other AAA+ proteins provide insight into activator mechanochemical action.

[Detection of prescription errors in drug dispensing: incidence and typology]. / Detección del error de prescripción en la dispensación farmacéutica: incidencia y tipología.

OBJECTIVE: Description and quantification of the types of prescribing errors during dispensing activities at community pharmacies. DESIGN: Descriptive transversal study carry out along four weekly periods. SITE. Eighteen pharmacies from six of the spanish autonomous regions dispensing prescription orders mainly issued by the National Health Service. PATIENTS AND OTHER TAKING PART: 37,321 prescriptions of specialties dispensed by the mentioned pharmacies along the four week period. MAIN MEASUREMENTS AND RESULTS: An unstructured questionnary was applied to all persons asking for one of the mentioned prescriptions. When an error was suspected, a second structured questionnary was applied by the pharmacist to the order bearer and the answers plus the information contents at the prescription form was collected on a data-sheet. Data were processed on a dBase and SPSS programs. Incidence detected error of 1.35%. Types of error classified into five categories. Study of the variability of error detection by week and by pharmacy. Analysis and comparison with references of the "order author" data and "prescriptor" data. CONCLUSIONS: Our global incidence of detected error was lower in relation with other studies. We found short differences by weeks and large by pharmacies. Inadequate definition of the drug was the most frequent type of error. The detection frequency of posology error was higher following the use of the new prescription order model. The number of orders from different prescriptor/author was larger in our study in relation to the notified by other studies.

Clinical and pathological aspects of human African trypanosomiasis (T. b. gambiense) with particular reference to reactive arsenical encephalopathy.

Fourteen of 330 patients treated with melarsoprol (Mel B) for human African trypanosomiasis (HAT) developed a severe reactive arsenical encephalopathy (RAE). Six of these cases were fatal and postmortem examination was performed on 5 patients. Symptoms of "sleeping sickness" were compared with symptoms after treatment with arsenicals and the subsequent onset of RAE. There are 3 characteristic syndromes of RAE: convulsive status associated with acute cerebral edema, rapidly progressive coma without convulsions, and acute nonlethal mental disturbances without neurological signs. Three subjects revealed hypoxic brain damage with acute cerebral edema, and multiple hemorrhages of brain stem in those comatose. The pathology of the underlying HAT (chronic perivascular inflammation and plasma cytic infiltration of the brain) and the pathology of the RAE (characterized by acute vasculitis) are distinct. RAE occurs in the first as well as in the second stage (CNS involvement) of trypanosomiasis but the reason for this is unclear; an exclusive toxicity of the drug, or a Herxheimer reaction are possible but seem unlikely. Both clinical and laboratory findings point rather to a drug-related, delayed immune response.

Human African trypanosomiasis (T.b. gambiense): a study of 16 fatal cases of sleeping sickness with some observations on acute reactive arsenical encephalopathy.

The principal clinical and pathological findings in 16 fatal cases of human African trypanosomiasis caused by T.b. Gambiense are described. The changes in the brain took the form of a non-specific lymphoplasmacytic meningo-encephalitis of varying intensity. Other features included morular cells, diffuse microglial hyperplasia, and large reactive astrocytes in the white matter. Carditis was identified in 10 cases. Acute reactive arsenical encephalopathy appeared to be the principal cause of death in 10 patients. Convulsions figured prominently in this type of encephalopathy in seven patients and were sufficiently severe to produce hypoxic brain damage. In three cases of acute reactive arsenical encephalopathy the structural changes in the brain were those of acute haemorrhagic leucoencephalopathy.