The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients

© 2016 The British Pharmacological Society Aims: The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs. Methods: This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months. Pharmacists in the comparison group (CG) delivered usual care. For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations. Inter-rater reliability was measured using Fleiss's kappa. Hospital costs were calculated using diagnosis related groups. Results: One thousand four hundred and three patients were included in the main study and they had 83 hospitalizations. Forty-two hospitalizations (50.6%) were medicine-related, with a substantial level of agreement among the experts (kappa = 0.65, 95% CI 0.52, 0.78, P < 0.01). The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0.042). The probability of being hospitalized was 3.7 times higher in the CG (odds ratio 3.7, 95% CI 1.2, 11.3, P = 0.021). Costs for a medicine-related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018]. Conclusion: MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy

Vasa picta ibérica. Talleres de cerámica del Sureste hispano (s.II a.C-I d.C.)

Coordinadores: Trinidad Tortosa Rocamora y Antonio M. Poveda Navarro.Este libro recoge los resultados de la propuesta del Seminario organizado en Elda (Alicante) que, como su título indica, recoge análisis sobre el interesante conjunto de materiales vasculares que se enmarcan en un tiempo y una geografía precisa del sureste peninsular, área valenciana y albacetense. Esta iniciativa nos pareció que, en este momento, adquiría un valor añadido ya que nuevas revisiones obtenidas a la luz de antiguas informaciones, hoy revisadas o la información aportada por nuevos contextos, con estudios, como los aquí presentados, configuran el momento oportuno para dedicar una obra a estos objetos arqueológicos tan significativos en la bibliografía, sobre todo, del siglo XX. El Monastil, el Tossal de Manises, el Tolmo de Minateda, el Cabecico del Tesoro… son algunos de los nombres iconos de esta cerámica que vuelven a lucir en esta obra. Por otra parte, el libro guarda una estructura un tanto peculiar debido al ámbito global al que pretende atender y que se convierte, en nuestra opinión, en su valor añadido. Se trata del propio hecho de que lo presentemos como homenaje a Ricardo Olmos, quien ha dedicado parte de su obra a tratar algunos de los temas específicos que se afrontan en estas páginas, como por ejemplo, en el caso de los estudios sobre la Alcudia (Elche, Alicante). Los avances que este investigador ha venido proporcionando a lo largo del tiempo han supuesto para la disciplina de la iconografía arqueológica, un avance en la metodología y en el conocimiento del ámbito ibérico. Finalizamos estas páginas con un entrañable recuerdo hacia una de las primeras arqueólogas que observó y sistematizó la cerámica ibérica en la provincia alicantina, Solveig Nordström (1923-2021), desaparecida en el tiempo en el que se imprimía este libro.Esta publicación se integra en el proyecto nacional de I+D+i: HAR2017-87897-P, Reubicando los objetos ibéricos del MAN: de rituales, biografías y observaciones a través de los modelos 3D.Peer reviewe

Frontal fibrosing alopecia: A multicenter review of 355 patients

Background: To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. Objective: We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. Methods: This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. Results: In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). Limitations: The retrospective design is a limitation. Conclusions: Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment. ( J Am Acad Dermatol 2014;70:670-8.

Escmid And Ecmm Joint Clinical Guidelines For The Diagnosis And Management Of Systemic Phaeohyphomycosis: Diseases Caused By Black Fungi

The aetiological agents of many invasive fungal infections are saprobes and opportunistic pathogens. Some of these fungi are darkly pigmented due to melanin production and traditionally have been named dematiaceous'. The melanized fungi cause a wide array of clinical syndromes ranging from superficial to deep-seated infections. Diagnosis relies on histopathological examination of clinical specimens and on examination of cultures. Sequencing is recommended for accurate species identification, especially for unusual or newly described pathogens. In cases of mycetoma and chromoblastomycosis, pathognomonic histological findings are useful and the Fontana-Masson stain, specific for melanin, usually confirms the diagnosis. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug. However, voriconazole may presumably be superior for central nervous system infections because of its ability to achieve good levels in the cerebrospinal fluid. Posaconazole is a well-tolerated alternative drug, backed by less clinical experience but with excellent salvage treatment results after failure of other antifungals. Amphotericin B has been useful as alternative therapy in some cases. Combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients.WoSScopu