Impact of patients' perception of COPD and treatment on adherence and health-related quality of life in real-world: Study in 53 community pharmacies.

BACKGROUND: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings. METHODS: We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test. RESULTS: Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001). CONCLUSIONS: The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.

[Javier Sádaba: A bioethics against suffering]. / Javier Sádaba: una bioética contra el sufrimiento.

The philosopher Javier Sádaba (Portugalete, 1940) is the author of an extensive work in the field of bioethics. It is a procedural bioethics (based on the agreement between the participants, not on absolute truths), casuistry (is based on the analysis of specific problem cases), social (evaluates the context in decision-making), gradual (considers other species, is not "narcissistically human"), and secular (autonomous with respect to religion). Sádaba has also opted for an affirmative bioethics, which seeks to improve the living conditions of humans (in medicine, the quality of life). This is difficult to construct because, for the philosopher, the duty and to establish limits are infinitely easier to elaborate than the specific good and to pursue happiness. In its application to medicine, Sádaba's bioethics focuses on avoiding unnecessary suffering, because suffering does not contribute anything positive and hinders happiness. Likewise, he strives to extract the best of science and open the doors to everything that can bring improvements for the human being, but without ceasing to mention responsibility, because man is capable of the best and the worst. From this perspective, the author is faced with the bioethical issues, leaving the greatest possible margin to freedom of choice.

Análisis bibliométrico y temático de la producción científica existente en la base de datos bibliográfica MEDLINE sobre farmacia comunitaria / Bibliometric and thematic analysis of the scientific literature on community pharmacy services, in the MEDLINE bibliographic database

Objetivo: Analizar y caracterizar, mediante técnica bibliométrica, la documentación científica relacionada con la farmacia comunitaria indizada en la base de datos bibliográfica MEDLINE. Método: Estudio descriptivo transversal. Los datos se obtuvieron de la base de datos MEDLINE interrogando los términos a estudio en los campos de descriptores, título y resumen; fecha de búsqueda diciembre 2017. Se calculó el tamaño muestral mediante estimación de parámetros poblacionales en una población infinita (n=386). El método de muestreo fue el aleatorio simple sin reposición. Resultados: Se analizaron 386 referencias. El número de originales fue de 308 (79,79%), identificando 215 instituciones, con Índice de Cooperación de 3,66 autores/artículo. El idioma predominante fue el inglés con 354 (91,71%) artículos. La obsolescencia, según el Índice de Burton-Kebler fue de 7 años y el Índice de Price del 33,42%. El núcleo de Bradford lo constituyeron 4 revistas. El descriptor más utilizado fue Community Pharmacy Services (n=300; 20,65%) y el área temática más representada Health Care Category, (n=551; 37,92%). Conclusiones: La producción científica sobre farmacia comunitaria, indizada en la base MEDLINE representa un área de conocimiento de plena vigencia que está iniciando la fase de "explosión de la información", con claro hegemonía anglosajona. Existe buen número de artículos de investigación, pero con relación institucional e índice de colaboración bajos. La clasificación temática se corresponde plenamente con la materia investigada

Objective: Analyze and characterize, through bibliometric technique, the scientific documentation related to community pharmacy indexed in the MEDLINE bibliographic database Methods: Cross-sectional descriptive study. The data was obtained from the MEDLINE database by interrogating the study terms in the descriptor, title and summary fields. Search date was December 2017. The sample size was calculated by estimating population parameters in an infinite population (n = 386). Sampling method: simple random sample without replacement. Results: A total of 386 references were analyzed. The number of originals was 308 (79.79%), identifying 215 institutions, with a Cooperation Index of 3.66 authors / article. The predominant language was English with 354 (91.71%) articles. The obsolescence, according to the Burton-Kebler Index, was 7 years and the Price Index was 33.42%. The core of Bradford included 4 journals. The most widely used descriptor was "Community Pharmacy Services" on 300 (20.65%) occasions and the most represented theme area Health Care Category, which was repeated 551 (37.92%) times. Conclusions: The scientific production on community pharmacy, indexed in the MEDLINE database, represents a well-known area of knowledge that is starting the "information explosion" phase, with clear Anglo-Saxon hegemony. There are a good number of research articles, but with both, low institutional relationship and collaboration index. The thematic classification is fully concordant with the researched subject

Impact of changes in pill appearance in the adherence to angiotensin receptor blockers and in the blood pressure levels: a retrospective cohort study.

OBJECTIVE: To assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment. DESIGN: Retrospective cohort study of a random sample of consecutive patients collecting their medication. SETTING: 40 community pharmacies in Alicante (Southeast Spain). PARTICIPANTS: 602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included. MAIN OUTCOME MEASURES: Prevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables. RESULTS: 161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136-148) than in those who did not have a change (median BP 127 mm Hg; IQR 118-135; p<0.001). CONCLUSIONS: There was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.

Un caso infrecuente de sudoración nocturna / A rare case of night sweats

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Hipo persistente de 10 años de evolución / No disponible

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Hepatitis aguda por Coxiella burnetti / Acute hepatitis due Coxiella burnetii

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La Higiene en El Quijote / No disponible

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Recurrent infection in the left thumb.

INTRODUCTION: Infections of the hand may be associated with lymphangitis and lymphadenitis. In most cases, bacterial infections are responsible but these may be also due to viral infections. MATERIAL AND METHODS: We describe a clinical case of a recurrent infection in the left thumb of a health male. Bacterial and viral cultures were performed. RESULTS: Herpes simplex virus (HSV) type 2 was isolated on viral culture and on direct fluorescent antibody testing; so, the final diagnosis was herpetic whitlow. CONCLUSIONS: Herpetic whitlow should be considered in cases of recurrent finger infections.

Paciente conflictivo en urgencias: definición, tipología y aspectos éticos / Conflictive patients in the emergency room: Definition, classification and ethical aspects

El paciente conflictivo es aquel que suscita en el médico un problema (un conflicto) por su actitud y/o comportamiento. Los conflictos éticos en urgencias son frecuentes y muchos de ellos se producen con estos pacientes. Entre las tipologías más habituales de pacientes que generan conflictos personales con los sanitarios están los pacientes exageradamente demandantes, los que rechazan actuaciones médicas, los agresivos, los litigadores, los hiperfrecuentadores y los que acuden a urgencias sin patología urgente. Es posible que un paciente incluya varios de estos perfiles (paciente «mixto»). Ante su aparición, el abordaje debe ser en equipo y si es posible, estableciendo un proceso deliberativo. Si existen dudas y es posible, se debe consultar al comité de ética asistencial y se deben buscar los protocolos que haya al respecto, deseablemente institucionales. Tras ello, si se llega a una decisión difícil de tomar, hay que buscar el apoyo del equipo directivo del servicio e inclusive de la institución. Se debe reflejar todo este proceso en la historia clínica. La formación específica en Bioética y habilidades de comunicación puede ser de gran ayuda para minimizar y afrontar mejor los conflictos a largo plazo(AU)

A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles (“mixed” patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts(AU)

[Conflictive patients in the emergency room: Definition, classification and ethical aspects]. / Paciente conflictivo en urgencias: definición, tipología y aspectos éticos.

A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles ("mixed" patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts.

De las ciclínas a la telomerasa. Premios Nobel de medicina del siglo XXI / No disponible

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Necrolisis epidérmica tóxica inducida por fenitoína y radioterapia holocraneal / Toxic epidermal necrolysis induced by phenytoin and whole brain radiotherapy

Los cuadros de necrolisis epidérmica tóxica (NET)-síndrome de Stevens-Johnson (SSJ) se han asociado al consumo de algunos fármacos, en especial a la toma de antiepilépticos como fenitoína. Algunos autores han planteado un incremento en el riesgo de padecer NET/SSJ cuando la fenitoína se asocia con radioterapia craneal. Se presenta el caso de una paciente diagnosticada de adenocarcinoma de mama con metástasis cerebrales en tratamiento con fenitoína que poco después de recibir radioterapia cerebral presenta un cuadro de NET

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) have been associated with some drugs, particularly anticonvulsants such as phenytoin. Some authors have pointed out an increased risk of TEN/SJS when phenytoin is associated with whole brain radiotherapy. We report a patient diagnosed with breast adenocarcinoma and brain metastases that was on treatment with phenytoin and, shortly after receiving whole brain radiotherapy, developed toxic epidermal necrolysis

[Toxic epidermal necrolysis induced by phenytoin and whole brain radiotherapy]. / Necrolisis epidérmica tóxica inducida por fenitoína y radioterapia holocraneal.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) have been associated with some drugs, particularly anticonvulsants such as phenytoin. Some authors have pointed out an increased risk of TEN/SJS when phenytoin is associated with whole brain radiotherapy. We report a patient diagnosed with breast adenocarcinoma and brain metastases that was on treatment with phenytoin and, shortly after receiving whole brain radiotherapy, developed toxic epidermal necrolysis.

Modelling intestinal absorption of salbutamol sulphate in rats.

The objective was to develop a semiphysiological population pharmacokinetic model that describes the complex salbutamol sulphate absorption in rat small intestine. In situ techniques were used to characterize the salbutamol sulphate absorption at different concentrations (range: 0.15-18 mM). Salbutamol sulphate at concentration of 0.29 mM was administered in presence of verapamil (10 and 20 mM), grapefruit juice and sodium azide (NaN3) (0.3, 3 and 6 mM). Different pharmacokinetic models were fitted to the dataset using NONMEM. Parametric and non-parametric bootstrap analyses were employed as internal model evaluation techniques. The validated model suggested instantaneous equilibrium between salbutamol sulphate concentrations in lumen and enterocyte, and the salbutamol sulphate absorption was best described by a simultaneous passive diffusion (ka = 0.636 h(-1)) and active absorption (VMax = 0.726 mM/h, Km = 0.540 mM) processes from intestinal lumen to enterocyte, together with an active capacity-limited P-gp efflux (V'max = 0.678 mM/h, K'm = 0.357 mM) from enterocyte to intestinal lumen. The extent of salbutamol sulphate absorption in rat small intestine can be improved by NaN3, grapefruit juice and verapamil.