Discrasias sanguíneas por medicamentos con inicio de síntomas respiratorios / Drug-induced blood dyscrasias with onset of respiratory symptoms

Paciente diagnosticada de colitis ulcerosa y artritis reumatoide que está siendo tratada con mesalazina e hidroxicloroquina y que presenta síntomas catarrales similares a los de la COVID-19. El seguimiento farmacoterapéutico (SFT) realizado a la paciente permite asociar estos síntomas con un efecto secundario debido a los medicamentos que toma, consistente en discrasias sanguíneas. La intervención, realizada con el propio estado de situación, para informar al médico, consigue que éste realice modificaciones del tratamiento hasta conseguir el control de la enfermedad mediante disminución de las dosis de los medicamentos utilizados. (AU)

"Validation of a spanish version of the 'Unité Rhumatologique Des Affections De La Main' (URAM) scale".

BACKGROUND: In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. METHODS: The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. RESULTS: The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. CONCLUSION: The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology.

Revisión de la evidencia del empleo de SYSADOAs en el manejo de la artrosis / Review of the evidence in the usage of SYSADOA in the management of the osteoarthritis

OBJETIVO: Revisar la evidencia reciente disponible sobre la eficacia del empleo de los SYSADOA (Symptomatic Slow Acting Drugsfor Osteoarthritis) en artrosis, como estrategia terapéutica que pudiera adaptarse mejor a la etiología de la enfermedad como al paciente por su elevada seguridad y tolerabilidad. Metodología: Se ha realizado una búsqueda bibliográfica de la literatura publicada hasta 30 de agosto de 2019 en PubMed, las palabras clave empleadas en la búsqueda fueron:"evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" y "glucosamine". Se revisaron guías médicas internacionales, estudios epidemiológicos y fichas técnicas de medicamentos de la Agencia Española del Medicamento y Productos Sanitarios. RESULTADO: Se identificaron un total de154 artículos con los algoritmos de búsqueda empleados orientados a valorar la evidencia de este grupo terapéutico como el impacto económico y sanitario generado por la artrosis. Tras la lectura de títulos y resúmenes se procedió al descarte de 82 artículos por no adaptarse al objetivo del presente trabajo. Se realizó una segunda selección valorando la calidad metodológica y contenido. Finalmente se escogieron 8 artículos. También se consultaron las fichas técnicas de los fármacos involucrados como guías médicas y estudios epidemiológicos como el EPISER. Los últimos estudios muestran una tendencia favorable a los SYSADOA como alternativa al consumo continuado de AINE (Antiinflamatorios No Esteroideos), mostrándose una eficacia comparable al celecoxib, tanto en combinación en el estudio MOVES, como por separado en el estudio CONCEPT, ambos en 2017. CONCLUSIÓN: La elevada prevalencia de la artrosis y los inconvenientes derivados de su manejo tradicional hacen necesario el empleo de alternativas terapéuticas. Los SYSADOA se postulan como una herramienta que pudiera adaptarse mejor a la enfermedad por su carácter crónico, y al tipo de paciente al que frecuentemente van dirigidas estas terapias. Sin embargo, la disparidad obtenida en los ensayos clínicos dificulta alcanzar un consenso y ponen de manifiesto la necesidad de aclarar la confianza depositada en ellos

OBJECTIVE: To review the available recent evidence about the effectiveness of the usage of SYSADOA (Symptomatic Acting Drugsfor Osteoarthritis) in osteoarthritis, as a therapeutic strategy that could evolve with the etiology of the disease and the patient thanks toits high security and tolerability. METHODS: It was carried out a bibliographical research of the published literature until 30th August 2019 in PubMed. The key words employed in the search were: "evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" and "glucosamide". International medical guides, epidemiologic studies and data sheets of drugs from The Spanish Agency for Medication and Healthcare Products (AEMPS) were examined. RESULTS: A total of 154 articles were identified with the search algorithms used, orientated to evaluate the evidence of this therapeutic group as well as the economic and health impact generated by the osteoarthritis. After having read titles and abstracts, 82 articles were dismissed because they did not fit in the objective of the present work. A second selection was done taking into account the methodological quality and the content. In the end, 8 articles were chosen. The data sheets of the involved drugs together with the medical guides, the epidemiology studies and the EPISER were checked. The last studies show a favorable tendency to the SYSADOA as an alternative to the continued consume of non-steroidal anti-inflammatories. It was shown effectiveness comparable to celecoxib in combination with the study MOVES but also separately in the study CONCEPT, both in 2017. CONCLUSION: The high prevalence of osteoarthritis and the disadvantages derived from its traditional management make the usage of therapeutic alternatives necessary. The SYSADOA postulate as a key that could adapt better to the disease because of its chronic character and the kind of patient to whom are commonly targeted these therapies. Nevertheless, the disparity obtained in the clinical trials makes difficult to reach a consensus and reveals the necessity of clarifying the confidence placed in them

Revisión de test validados para la valoración de la adherencia al tratamiento farmacológico utilizados en práctica clínica habitual / Screening of validated tests for measuring adherence to pharmacological treatment employed in usual clinical practice

OBJETIVO: El objetico de este trabajo es la identificación de test para la valoración de la adherencia que puedan ser utilizados en la práctica clínica habitual. METODOLOGÍA: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos Medline (PubMed) y en las referencias de artículos considerados relevantes sobre los métodos de autoinforme para la valoración de la adherencia. Los test identificados se clasificaron en función de la fiabilidad, mediante el valor de alfa de Cronbach (alfa). RESULTADOS: Las escalas identificadas utilizando como base la medida α de Cronbach son: PETiT, BARS, SEAMS, MBG, CULIG, TAI, A14, VOILS, MMAS-8, Hill-Bone, ARMS, MARS, SMAQ y MUAH-questionnaire, BMQ. CONCLUSIONES: No existe un test patrón de oro que se pueda utilizar para cualquier paciente. Sin embargo, el test más versátil es el MMAS-8 (Tabla 4) por su adaptación a muchas patologías e idiomas, por presentar un número de ítems adecuado, ya que una excesiva cantidad de elementos producen fatiga o desmotivación. Sólo presenta una pregunta de frecuencia tipo Likert a las cuales a veces no es fácil responder y presenta unos enunciados sencillos, sin ninguna complejidad. Por otra parte, se dispone de un conjunto de test validados para elegir el más adecuado para cada circunstancia en función del tipo de paciente

TARGET: The objective of this work is the identification of tests to assess adherence that can be employed in usual clinical practice. METHODOLOGY: A non-systematic bibliographic search was performed in the Medline databases (PubMed) and in the references of articles considered relevant on self-report methods for assessing adherence. The identified tests were classified according to reliability, using the Cronbach's alpha value (Alpha). RESULTS: The scales identified using Cronbach's α measure as a basis are: PETiT, BARS, SEAMS, MBG, CULIG, TAI, A14, VOILS, MMAS-8, Hill-Bone, ARMS, MARS, SMAQ and MUAH-questionnaire, BMQ. CONCLUSIONS: There is no gold standard test that can be used for any patient. However, the most versatile test is MMAS-8 (Table 4) for its adaptation to many pathologies and languages and also because it presents an adequate number of items, since an excessive number of elements produce fatigue or demotivation. It only presents a Likert type frequency question that is sometimes not easy to answer and presents simple sentences, without any complexity. On the other hand, there is a set of validated tests to choose the most appropriate for each circumstance depending on the type of patient

Aspectos clave en el abordaje de las infecciones desde la farmacia comunitaria / Key factors in the approach to infections from the community pharmacy

La resistencia a los antimicrobianos es un problema de Salud Pública mundial debido a su aumento exponencial en muchas partes del mundo en los últimos años, y a que la generación de nuevos antibióticos es muy escasa. Aunque las bacterias multirresistentes se detectan principalmente en los hospitales, la Organización Mundial de la Salud (OMS) ha advertido que la reducción de las resistencias bacterianas debe alcanzarse a través de la mejora del uso de antibióticos en la comunidad. El farmacéutico comunitario es el último contacto que tiene el paciente antes de recibir el antibiótico. La información que estos profesionales pueden ofrecer a los pacientes puede influir en gran manera en sus expectativas ante el papel de los antibióticos en las infecciones. Por este motivo, la propia OMS ha establecido que la implicación del farmacéutico comunitario es fundamental en la lucha contra la amenaza de las resistencias bacterianas. Este artículo, adaptación del capítulo "El papel de la Farmacia Comunitaria en los Programas de Optimización de antimicrobianos" de la "Guía de Terapéutica Antimicrobiana del Aljarafe 3ª edición", está orientado a proporcionar información sobre el papel del farmacéutico comunitario en relación a su participación en los programas de optimización de antimicrobianos (PROA) en nuestro país. El artículo también proporciona herramientas útiles para la adquisición de las competencias para la integración del farmacéutico comunitario como miembros de los equipos multidisciplinares PROA en la comunidad

Antimicrobial resistance is a worldwide public health problem because of two main aspects. On the one hand, during the last years, it has been rising exponentially in many parts of the world. On the other hand, the creation of antibiotics is very limited. Although multiresistant bacteria are mainly detected in hospitals, the World Health Organization (WHO) has warned that the reduction of bacterial resistances must be reached through the improvement in the usage of antibiotics among the community. The community pharmacist is the last contact that has the patient before receiving the antibiotic. The information that these professionals can offer to patients may largely influence in their expectations of antibiotics' role in infections. For this reason, the WHO itself has established that the community pharmacist's implication is essential in the fight against the threat of bacterial resistances. This article is an adaptation of the chapter "The role of the Community Pharmacy in the Programs of antimicrobial agents' Optimization" published in the "Guide of Antimicrobial Therapy of the Aljarafe 3rd edition", focused on providing information about the role of the community pharmacist related to his participation in the programs of antimicrobial agents' optimization (PROA) in our country. The article also provides useful tools to get the competences for the integration of community pharmacists as members of the (PROA) multidisciplinary teams in the community

Consumo de preparados de plantas medicinales por la población mayor de 65 años en la provincia de Guadalajara (España) / Consumo de preparações à base de plantas de medicinais pela população com mais de 65 anos na província de Guadalajara (Espanha) / Consumption of herbal preparations by the population older than 65 years in the province of Guadalajara (Spain)

En las personas mayores de 65 años se producen una serie de cambios corporales, como consecuencia de la edad, factores psicológicos y sociales, que comportan un mayor número de patologías y, en consecuencia, un mayor consumo de medicamentos y de plantas medicinales, bien en forma de infusión o de otros preparados comerciales. En el presentetrabajo se ha estudiado el consumo de productos a base de plantas medicinales en una población geriátrica (n=384) de la provincia de Guadalajara. El 88,3% de la población de la tercera edad estudiada consume preparados de plantas medicinales. Todos estos pacientes consumen diariamente algún tipo de planta medicinal en infusión, y de media consumen 2,1 infusiones al día. La infusión más consumida es la de manzanilla (70,8 % de la población estudiada), seguida de anís y tila (49,7 % y 42,4%, respectivamente). El 47,6 % de los pacientes también utiliza otros productos de plantas medicinales, de éstos, el gel de áloe, las cápsulas de valeriana, los sobres de ispágula y la crema de árnica, son los más utilizados. Un 76% de los pacientes que toman plantas medicinales consume simultáneamente varios preparados de plantas (más de la mitad de los pacientes consume 3 o más), mayoritariamente para el tratamiento de dispepsia (el 67% de la población consume entre 2 y 4 preparados) (AU)

Nas pessoas com mais de 65 anos, há uma série de mudanças no organismo, como consequência da idade, fatores psicológicos e sociais, que envolvem um maior número de patologias e, consequentemente, um maior consumo de medicamentos e de plantas medicinais, tanto na forma de infusão como de outras preparações comerciais. No presente trabalho estudou-se o consumo de produtos à base de plantas medicinais numa população geriatrica (n = 384) na província de Guadalajara (Espanha), tendo-se verificado que 88,3% da população idosa estudada consome preparações de plantas medicinais. Todos esses pacientes consomem diariamente algum tipo de planta medicinal em infusão e, em média, consomem 2,1 infusões por dia. A infusão mais consumida é a de camomila (70,8% da população estudada), seguida pelas de anis e tília (49,7% e 42,4%, respetivamente). Dentro das outras preparações comerciais à base de plantas medicinais, utilizadas por 47,6% dos pacientes, destacam-se como mais utilizadas gel de aloe, cápsulas de valeriana, saquetas de ispagula e creme de arnica. Cerca de 76% dos pacientes que tomam plantas medicinais consomem simultaneamente várias preparações (mais de metade dos pacientes consomem 3 ou mais), principalmente para o tratamento da dispepsia (67% da população consome entre 2 e 4 preparações) (AU)

In people over 65, there are a number of bodily changes, as a consequence of age, psychological and social factors, which involve a greater number of pathologies and, consequently, a higher consumption of medicines and medicinal plants, either as teas or as other commercial preparations. Here, the consumption of herbal products in a geriatric population (n = 384) in the province of Guadalajara (Spain) has been studied. A 88.3% of the elderly population studied consumes herbal products. All these patients consume herbal teas dayly (2.1 infusions per day in average). The most consumed plant as tea is chamomile (70.8% of the population studied), followed by anise seed and lime flower (49.7% and 42.4%, respectively). A 47.6% of the patients also use other herbal products, being aloe gel, valerian capsules, ispaghula sachets and arnica cream the most used. Seventy-six percent of patients who take medicinal plants, simultaneously consume several preparations along the day (more than half of the patients take 3 or more), mostly for the treatment of dyspepsia (between 2 and 4 preparations by 67% of the population) (AU)

Fiabilidad y validez externa de un cuestionario de conocimiento sobre riesgo y enfermedad cardiovascular en pacientes que acuden a farmacias comunitarias de España / Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies

OBJETIVOS: Determinar la fiabilidad test-retest de un cuestionario, con validación preliminar, para valorar el conocimiento sobre riesgo cardiovascular (RCV) y enfermedad cardiovascular, en pacientes atendidos en farmacias comunitarias de España.complementar la validez externa, estableciendo la relación entre una actividad educativa y el aumento del conocimiento sobre RCV y enfermedad cardiovascular. DISEÑO: Subanálisis del estudio clínico controlado EMDADER-CV, en el que se aplicó un cuestionario de conocimiento sobre RCV en 4 momentos. Emplazamiento. Farmacia comunitaria española. PARTICIPANTES: Trescientos veintitrés pacientes del grupo control, de los 640 que finalizaron el estudio. MEDICIONES PRINCIPALES: Coeficiente de correlación intraclase para evaluar la fiabilidad en 3 comparaciones (postactividad educativa con semana 16, postactividad educativa con semana 32, y semana 16 con semana 32); y prueba no paramétrica de Friedman para establecer la relación entre una actividad educativa oral y escrita con el aumento del conocimiento. RESULTADOS: Para los 323 pacientes, en las 3 comparaciones, los valores del coeficiente de correlación intraclase fueron 0,624; 0,608 y 0,801 (fiabilidad aceptable-buena a excelente). Por su parte, la prueba de Friedman mostró relación entre la actividad educativa y el aumento del conocimiento, estadísticamente significativa (p < 0,0001). CONCLUSIONES: Acorde con el coeficiente de correlación intraclase, el cuestionario orientado a valorar el conocimiento sobre el RCV y enfermedad cardiovascular tiene una fiabilidad entre aceptable y excelente, lo cual, sumado a la validación previa, indica que dicho instrumento cumple los criterios de validez y fiabilidad. Además, el cuestionario evidencia capacidad de relacionar un aumento en el conocimiento con una intervención educativa, característica que complementa su validez extern¡a

OBJECTIVES: To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. DESIGN: Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. LOCATION: Spanish Community Pharmacies. Participants. There were 323 patients in the control group, from the 640 who completed the study. Main measurements. Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. RESULTS: For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < 0,0001). CONCLUSIONS: According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity

[Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies]. / Fiabilidad y validez externa de un cuestionario de conocimiento sobre riesgo y enfermedad cardiovascular en pacientes que acuden a farmacias comunitarias de España.

OBJECTIVES: To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. DESIGN: Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. LOCATION: Spanish Community Pharmacies. PARTICIPANTS: There were 323 patients in the control group, from the 640 who completed the study. MAIN MEASUREMENTS: Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. RESULTS: For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). CONCLUSIONS: According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity.

The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study.

BACKGROUND: Potential adverse drug events (PADEs) are defined as being potentially harmful unintentional medication discrepancies. Discrepancies regarding medication history (MH) often occur when a patient is being admitted to a hospital's emergency department (ED); they are clinically important and represent a significant source of data regarding adverse drug events occurring during emergency admission to hospital. This study sought to measure the impact of pharmacist-acquired MH during admission to an ED; it focused on whether a patient's current home medication regimen being available for a doctor when consulting a patient in an ED would have reduced potential adverse drug events. METHOD: A multicentre, double-blind, randomised, controlled parallel-group study was carried out at 3 large teaching hospitals in Bogota, Colombia. Two hundred and seventy patients who had been admitted to an ED were enrolled; each had a standardised, comprehensive MH interview, focusing on a patient's current home medication regimen prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The main outcome dealt with comparing the intervention and control groups regarding the percentage of patients having at least 1 potential adverse drug event. RESULTS: There were 811 PADE (3.35 per patient), 528 (65%) on the standard care arm and 283 (35%) on an intervention arm. Most PADEs were judged to have had the potential to cause moderate discomfort (42.6%), 33.4% were deemed unlikely to have caused harm and 23.9% were judged to have had the potential to cause clinical deterioration. CONCLUSION: Many patients suffer potentially adverse drugs events during the transition of care from home to a hospital. Patient safety-focused medication reconciliation during admission to an ED involving a pharmacist and drawing up a history of complete medication could contribute towards reducing the risk of PADES occurring and improve follow-up of patients' medication-based therapy. TRIAL REGISTRATION: 28/10/2012, ISRCTN63455839.

Comparación de las intervenciones de educación sanitaria y de seguimiento farmacoterapéutico enpacientes con factores de riesgo cardiovascular que acuden a una farmaciacomunitaria (Estudio FISFTES-PM) / Comparison of health education and drug therapy monitoring interventions in patients with cardiovascular risk factors attending a community pharmacy (FISFTES-PM Study)

OBJETIVO:Comparar las intervenciones farmacéuticas de educación sanitaria (ES) y seguimiento farmacoterapéutico (SFT) en pacientes con factores de riesgo cardiovascular (FRCV). DISEÑO: Estudio experimental aleatorizado. Emplazamiento: Farmacia Playa-Miramar (Valencia). Marzo del 2010-noviembre del 2011. PARTICIPANTES: Pacientes con uno o más FRCV, detectados por medicación o consulta del paciente, asignados a cada uno de los grupos (ES o SFT) según tabla de números aleatorios. Se incluyó a 100 pacientes por grupo. INTERVENCIONES: ES o SFT durante 6 meses. MEDICIONES PRINCIPALES: La variable principal fueron los FRCV modificables (hipertensión arterial, dislipidemia, diabetes, tabaquismo, obesidad, inactividad física).como variables secundarias, se utilizaron los FRCV no modificables (edad, sexo, antecedentes personales de enfermedad cardiovascular), el perímetro de la cintura, el índice perímetro abdominal/estatura, el índice cintura-cadera, el porcentaje de grasa corporal, el grado de cumplimiento, los problemas relacionados con los medicamentos y los resultados negativos asociados a la medicación. RESULTADOS: Las diferencias en el porcentaje dereducción fueron estadísticamente superiores en el GSFT frente al GES para losparámetros presiónarterial sistólica, 5,40% (p = 0,001); frecuencia cardiaca, 2,95% (p = 0,015);peso, 2,00% (p = 0,002); IMC, 2,24% (p = 0,003); glucosa basal, 8,65% (p = 0,004); colesteroltotal, 6,45% (p = 0,002); perímetro cintura, 1,85% (p = 0,010) e índice cintura-altura 1,66% (p = 0,002). Los triglicéridos y la grasa corporal se redujeron 12,78% (p < 0,001) y 1,84%(p < 0,001) más respectivamente en el GSFT. Estas diferencias no fueron estadísticamente significativas entre grupos. CONCLUSIONES: El GSFT mostró en general porcentajes de reducción mayores para todos los parámetros estudiados excepto para la presión arterial diastólica, que disminuyó un 4,7% (p < 0,001) más en el GES, ya que partía de valores basales superiores

AIM: To compare health education (HE) and drug therapy monitoring (DTM) interventions in patients with cardiovascular risk factors (CVRF). DESIGN: Randomised experimental studys: 100 patients per group. SETTING: Playa-Miramar pharmacy (Valencia, Spain). March 2010-November 2011. PARTICIPANTS: Patients with one or more CVRF detected based on medication they were taking or questions they asked when drugs were dispensed. Patients were assigned to one of the two groups (HE or DTM) using a random number table.100 patients by group were included. INTERVENTIONS: Six months of DTM (DTMG) or health education (HEG) per patient. MAIN MEASUREMENTS: The primary variables were modifiable CVRF: hypertension, dyslipidaemia, diabetes, smoking, obesity and low physical activity. Secondary variables were non modifiable CVRF (age, sex, cardiovascular disease), heart rate, body mass index, waist measurement, waist-to-hip ratio, waist-to-height ratio, body fat, treatment compliance. RESULTS: The differences in the reduction percentages were statistically greater in DTMG than in HEG for the following variables: systolic pressure 5.40% (p = 0.001); heart rate 2.95%(p = 0.015); weight 2.00% (p = 0.002); BMI 2.24% (p = 0.003); fasting glucose 8.65% (p = 0.004); total cholesterol 6.45% (p = 0.002); waist measurement 1.85% (p = 0.010); and waist-to-height ratio 1.66% (p = 0.002). Triglycerides and body fat were reduced by 12.78% (p < 0.001) and 1.84% (p < 0.001) more, respectively, in DTMG. These differences were not statistically significant. CONCLUSIONS: The reduction percentages were generally higher for all variables in DTMG except diastolic blood pressure, which decreased by 4.7% (P<.001) more in HEG because the baseline values were higher

[Comparison of health education and drug therapy monitoring interventions in patients with cardiovascular risk factors attending a community pharmacy (FISFTES-PM Study)]. / Comparación de las intervenciones de educación sanitaria y de seguimiento farmacoterapéutico enpacientes con factores de riesgo cardiovascular que acuden a una farmaciacomunitaria (Estudio FISFTES-PM).

AIM: To compare health education (HE) and drug therapy monitoring (DTM) interventions in patients with cardiovascular risk factors (CVRF). DESIGN: Randomised experimental studys: 100 patients per group. SETTING: Playa-Miramar pharmacy (Valencia, Spain). March 2010-November 2011. PARTICIPANTS: Patients with one or more CVRF detected based on medication they were taking or questions they asked when drugs were dispensed. Patients were assigned to one of the two groups (HE or DTM) using a random number table. 100 patients by group were included. INTERVENTIONS: Six months of DTM (DTMG) or health education (HEG) per patient. MAIN MEASUREMENTS: The primary variables were modifiable CVRF: hypertension, dyslipidaemia, diabetes, smoking, obesity and low physical activity. Secondary variables were non modifiable CVRF (age, sex, cardiovascular disease), heart rate, body mass index, waist measurement, waist-to-hip ratio, waist-to-height ratio, body fat, treatment compliance. RESULTS: The differences in the reduction percentages were statistically greater in DTMG than in HEG for the following variables: systolic pressure 5.40% (p=0.001); heart rate 2.95%(p=0.015); weight 2.00% (p=0.002); BMI 2.24% (p=0.003); fasting glucose 8.65% (p=0.004); total cholesterol 6.45% (p=0.002); waist measurement 1.85% (p=0.010); and waist-to-height ratio 1.66% (p=0.002). Triglycerides and body fat were reduced by 12.78% (p<0.001) and 1.84% (p<0.001) more, respectively, in DTMG. These differences were not statistically significant. CONCLUSIONS: The reduction percentages were generally higher for all variables in DTMG except diastolic blood pressure, which decreased by 4.7% (P<.001) more in HEG because the baseline values were higher.

Prevalence and attitude towards smoking in first, third and fifth-year pharmacy students in Spain: PRECOTABAC study.

AIM OF THIS STUDY: The aim of this study is to calculate smoking prevalence among first, third and fifth-year pharmacy students in Spain, and to describe their attitude towards giving up smoking. METHODS: Cross-sectional multi-center study using an ad hoc self-administered questionnaire in first, third and fifth-year pharmacy students at seven Spanish universities. Bivariate analysis with chi-square and Student's t-test, statistical significance p<0.05. RESULTS: Smoking prevalence: 34.92%. The smokers smoke 31.04 (SD=43.182) cigarettes/week on average. Pharmacy students have a positive attitude towards giving up smoking, with differences between year groups (p=0.036). CONCLUSIONS: Four in ten pharmacy students in Spain smoke every day by the time they finish their degree. Smoking prevalence is lower in the first few years of the degree and increases over time. Students also have a positive attitude towards giving up smoking, and are in favor of measures that can be taken to try to stop people smoking.

A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department.

BACKGROUND: Admission to an emergency department (ED) is a key vulnerable moment when patients are at increased risk of medication discrepancies and medication histories are an effective way of ensuring that fewer errors are made. This study measured whether a pharmacist-acquired medication history in an ED focusing on a patient's current home medication regimen, and available to be used by a doctor when consulting in the ED, would reduce the number of patients having at least 1 medication discrepancy related to home medication. METHODS: This multicentre, double-blind, randomised, controlled parallel-group study was conducted at 3 large teaching hospitals. Two hundred and seventy participants were randomly allocated to an intervention (n = 134) or a standard care (n = 136) arm. All consecutive patients >18 years old admitted through the ED were eligible. The intervention consisted of pharmacists conducting a standardised comprehensive medication history interview focusing on a patient's current home medication regimen, prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The admission medication order form was given to doctors at a later stage in the control arm for them to amend prescriptions. The effect of the intervention was assessed primarily by comparing the number of patients having at least 1 admission medication discrepancy regarding medication being taken at home. Secondary outcomes concerned the characteristics and clinical severity of such medication discrepancies. RESULTS: The intervention reduced discrepancies occurring by 33% (p < 0.0001; 0.1055 odds ratio, 0.05-0.24 95% confidence interval), despite recall bias. Regarding total discrepancies, omitting medication occurred most frequently (55.1%) and most discrepancies (42.7%) were judged to have the potential to cause moderate discomfort or clinical deterioration. CONCLUSIONS: A pharmacist-acquired medication history in an ED focusing on a patient's current home medication regimen available to be used by a doctor at the time of consulting in the ED reduced the number of patients having at least 1 home medication-related discrepancy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN63455839.

Pharmacotherapeutic Follow-up and Pharmacogenetics of CYP2C9 and CYP3A4 in Antihypertensive Therapy: A Pilot Study in a Community Pharmacy.

No pharmacogenetic studies have yet been conducted in community pharmacies, despite pharmacogenetics being an emerging discipline. Pharmacotherapeutic follow-up (PFU) was performed for 6 months in 37 patients receiving antihypertensive treatment, and they were genotyped for variant alleles *2 and *3 in the CYP2C9 gene and *1B in CYP3A4. Systolic blood pressure, cardiovascular risk, and adherence improved with PFU. Most of the interactions between drugs were represented by concurrent administration of statins and calcium channel blockers, which both use CYP3A4 for their metabolism. Heterozygotic patients for the CYP2C9*2 allele showed higher mean heart rate values after PFU than homozygous patients (73.4 ± 10.0 pulse/min vs 66.2 ± 10.6 pulse/min, respectively; P = .048). Carriers of CYP2C9*2 showed a tendency to less frequent negative outcomes associated with medication due to inefficacy than homozygous patients (50% vs 78.9%, respectively; P = .072). Pharmacogenetics and PFU can be used in community pharmacies to carry out a more exhaustive study of medication in hypertensive outpatients.

Conocimiento sobre tabaco y sus métodos de deshabituación entre los estudiantes de 1º, 3º y 5º curso de Farmacia en España. Estudio PRECOTABAC. Parte II / No disponible

Objetivos: Los estudiantes generalmente no reconocen al tabaco como una de las principales causas de enfermedades, por lo que se plantea estudiar el conocimiento del tabaco y los métodos de deshabituación tabáquica del alumno de 1º, 3º y 5º curso de la licenciatura de Farmacia en España. Pacientes y método: Estudio multicéntrico observacional descriptivo transversal con componente analítico desarrollado mediante un cuestionario "ad hoc" y autocumplimentado por los alumnos de 1º, 3º y 5º de Farmacia de siete Facultades de Farmacia españolas. Resultados: Se totalizaron 922 cuestionarios, observándose que el grado de conocimiento de tabaco del alumno de 1º y 3º de Farmacia de España está en su mayoría en un percentil medio-bajo, mientras que el mayor porcentaje de 5º tiene un percentil alto (p<0,001). Al aumentar el curso aumenta también el conocimiento del tabaco y disminuye ser extranjero y ser fumador (p<0,001). En el grado de conocimiento sobre métodos de deshabituación tabáquica, el alumno de 5º obtiene su mayor porcentaje en percentil alto (p<0,001). Influyen positivamente el curso académico y ser extranjero. Ser fumador influye de forma negativa, sabiendo menos cuanto más se fuma. No se encontraron diferencias en el conocimiento del tabaco (p=0,528) y en el conocimiento sobre métodos de deshabituación tabáquica (p=0,508) según el género. Conclusiones: Cuatro de cada diez alumnos de Farmacia al terminar su licenciatura consigue un buen nivel de conocimientos sobre tabaco y tres de cada diez conocen los métodos de deshabituación tabáquica(AU)

Aim: Students generally do not recognize the snuff as a major cause of disease, so it is to study the knowledge of tobacco and methods of smoking cessation student's 1 st, 3 rd and 5 th year of the undergraduate of Pharmacy in Spain. Patients and methods: Cross-sectional observational multicenter study with an analytical component developed through a questionnaire "ad hoc" and self-completed by the students of 1, 3 and 5 of Pharmacy Faculty of Pharmacy of seven selected Spanish. Results: He totaled 922 questionnaires, showing that the degree of knowledge of tobacco the student of 1 and 3 of Pharmacy of Spain is mostly on a percentile medium-low, while the highest percentage of 5 ° has a percentile higher (p <0.001) . By increasing the current also increases the knowledge of being a foreigner and decreases snuff and smoking (p <0.001). The degree of knowledge about smoking cessation methods, the student gets 5 th percentile for the most high percentage (p <0.001). Positively influence the academic year and a foreigner. Being a smoker has a negative influence, knowing the more you smoke less. There were no differences in knowledge of snuff (p = 0.528) and knowledge about methods of smoking cessation (p = 0.508) according to gender. Conclusions: Four out of ten students complete their undergraduate Pharmacy achieved a good level of knowledge of snuff and only three in ten know the methods to quit smoking(AU)

Adherencia y conocimiento del tratamiento en pacientes hipotiroideos desde una farmacia comunitaria en Sevilla. Estudio piloto / Adherence and knowledge of treatment in hypothyroid patients from a community pharmacy in Seville. A pilot study

No disponible

Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial.

BACKGROUND: Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease (CVD), more evidence derived from randomized controlled trials (RCTs) is needed, including assessment of the effect of community pharmacist interventions in patients with CVD. OBJECTIVE: To assess the effectiveness of the Dader Method for pharmaceutical care on achieving therapeutic goals for blood pressure (BP), total cholesterol (TC), and both BP and TC (BP/TC) in patients with CVD and/or high or intermediate cardiovascular (CV) risk attending community pharmacies in Spain. METHODS: Patients aged 25 to 74 years attending community pharmacies with a prescription for at least 1 drug indicated for CVD or CV risk factors were randomized to 2 groups: an intervention group that received pharmaceutical care, which was provided by specially trained pharmacists working in collaboration with physicians, and a control group that received usual care (routine dispensing counseling) and verbal and written counseling regarding CVD prevention. Patients were recruited from December 2005 to September 2006, and both groups were followed for 8 months. Study outcomes were assessed at baseline and at 16 and 32 weeks after randomization. The primary outcome measures were the proportions of patients achieving BP, TC, and BP/TC therapeutic goals (BP lower than 140/90 mm Hg for patients with uncomplicated hypertension and lower than 130/80 mm Hg for patients with diabetes, chronic kidney disease, or history of myocardial infarction or stroke; TC lower than 200 mg per dL for patients without CVD and lower than 175 mg per dL for patients with CVD). Secondary outcomes were mean BP and TC values. BP was assessed manually by the pharmacist after a 10-minute rest in the supine position. This measurement was performed twice for every participant, and the average of the 2 measurements was calculated. TC was measured by the pharmacist during the study visit using the enzymatic dry method. Statistical analyses were performed using 2-tailed McNemar tests, Pearson chi-square tests, and Student's t-tests; P < 0.05 was considered statistically significant. RESULTS: 714 patients were included in the study (356 intervention, 358 control), and the mean [SD] age was 62.8 [8.1] years. The 2 groups were similar at baseline in clinical and demographic characteristics, including the proportion of patients at therapeutic goals for BP, TC, and BP/TC. After 8 months of follow-up, there were statistically significant differences in favor of pharmaceutical care in the proportions of patients who achieved therapeutic goals for BP (52.5% vs. 43.0%, P=0.017), TC (56.5% vs. 44.1%, P=0.001), and BP/TC (37.1% vs. 21.8%, P < 0.001). CONCLUSION: Compared with usual care plus written education, pharmaceutical care focused on patient evaluation and follow-up in collaboration with physicians improved the achievement of BP, TC, and BP/TC treatment goals in patients with CVD and/or high or intermediate CV risk attending community pharmacies in Spain.

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

Objetivo: Evaluar el efecto de la actuación del farmacéutico, mediante seguimiento farmacoterapéutico(SFT) en la mejora de la adherencia y de objetivos terapéuticos.Diseño: Estudio clínico experimental controlado, aleatorizado, comparativo de un programade SFT con el proceso habitual en farmacias comunitarias españolas mejorado con educaciónsanitaria, durante 8 meses.Emplazamiento: Nueve farmacias comunitarias españolas.Participantes: Pacientes entre 25-74 años con riesgo cardiovascular (RCV) alto-moderado, queacudieron con una receta, a su nombre, de medicamentos para al menos un factor de RCV.Intervenciones: Los pacientes se asignaron aleatoriamente al grupo intervención (GI), querecibió SFT y educación sanitaria, o al grupo control (GC), que recibió solamente educación sanitaria. Mediciones principales: Adherencia al tratamiento y cifras de presión arterial (PA) y colesteroltotal (CT), al inicio y final estudio.Resultados: De los 87 pacientes reclutados, 85 acabaron el estudio: 41 del GC y 44 del GI.Ambos grupos aumentaron la adherencia al final del estudio [GC: 26,9%; IC95%:12,7 a 41; GI:27,3%; IC95%:13,6 a 41]. Aunque el GI mostró mejores resultados en la variación de las cifrasde PA y CT, las diferencias en relación al GC no fueron estadísticamente significativas.Conclusiones: El SFT y la educación sanitaria mejoran la adherencia al tratamiento. Ademásser paciente cumplidor al final del estudio se relaciona con la mejora de los objetivos de lapresión arterial y de presión arterial/colesterol total(AU)

Objective: To evaluate the effect of pharmacist involvement, by means of PharmacotherapyFollow-Up (PFU) in the improvement of medication adherence and therapeutic outcomes.Design: An experimental, controlled, and randomised clinical study comparing a PFU programwith the routine process in Spanish community pharmacies improved with health educationduring 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 receivedPFU and health education, or the control group (CG), who received health educationonly.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, thedifferences compared to the CG were not statistically significant.Conclusions: PFU and health education improves adherence to treatment. To be a patient whocompletes the study is also associated with improvement in the blood pressure and bloodpressure/total cholesterol objectives(AU)

[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.