La Atención Farmacéutica, requisito para conseguir una atención sanitaria de calidad y basada en la evidencia científica

La salud es un concepto condicionado por diversos determinantes que conjuntamente interactúan y condicionan laaparición y la extensión de alteraciones en la salud de las poblaciones. Por eso es ya evidente la limitada capacidadde los servicios de salud para ser eficaces contra la enfermedad y es necesario articular políticas que involucren aotros sectores a fin de conseguir la máxima eficacia en las actuaciones para mejorar la salud.El medicamento y el farmacéutico han jugado un papel en la eficacia de los servicios sanitarios para resolverproblemas de salud; la Atención Farmacéutica entendida como un método sistemático para la detección, prevencióny resolución de los problemas relacionados con los medicamentos (PRM) se configura con enorme trascendencia paraobtener respuestas sobre los elementos que condicionan la aparición de los diversos PRM y la afectación de sueficacia terapéutica, aportando indicaciones que harán posible conseguir minimizar sus consecuencias.La Atención Farmacéutica responde al enfoque de salud que la OMS ha pretendido desde sus propuestas de Saludpara Todos en el año 2000 que han sido renovadas con la actual estrategia de Salud para Todos en el Siglo XXI.La investigación es una herramienta que se necesita desarrollar de manera eficaz y continua y en este sentido, lainvestigación aplicada en el campo de los PRM en patologías con estas características es la clave para arrojar luzsobre ellos, sus factores determinantes y las respuestas capaces de superar el efecto negativo que sobre la eficaciade los tratamientos tienen los PRM

El seguimiento farmacoterapéutico: un componente de la calidad en la atención al paciente

The principal aim of management of the Quality of Care is to assure patient satisfaction, through theactive involvement of health care staff and the incorporation of strategies, whose main aim is to achievecontinuous improvement in clinical activities and to incorporate patient safety as one of its principlecomponents.The management of patient safety is a means to minimizing any possible harm to patients in careprocesses, including the use of medicines. The principles of patient safety can be applied to both levelsof patient care and involve all health care professionals. The risk management is an integral part ofpatient care. Patient safety depends on the solution of problems and the prevention of errors.The pharmacist’s role in patient safety is carried out through Pharmaceutical Care processes and especiallythrough Pharmacotherapy follow-up (PF), which aims to prevent, detect and resolve Drug TherapyProblems (DTP).One of the main difficulties associated with this field is the lack of uniformity of the results obtainedthroughout the different studies carried out, where differences in definitions occur, as in the classificationof drug problems themselves, where process and result are constantly intermingled: Adverse effect,undesirable events, medication errors, DTP, etc.The criteria for classifying such aspects should be uniform, so as to make common information available,which will enable pharmacists to obtain greater knowledge on prevalence, their types, causes, severityand consequences.There is a general desire to improve upon patient safety, to assess the technological processes involvedin evaluating effectiveness and safety, and to certify the establishments and health care professionalsresponsible for such processes.This same approach should also be applied to PF, which is subject to the same basic safety principles.As in the case of all work carried out within the health system, the work of the pharmacist involvesthe professional and ethical responsibility of making his knowledge, experience and methodology availableto his patients. Pharmacists now have the opportunity of making a significant contribution to patientsafety, both in general terms and more specifically in the use of medicines, in a field which is currentlyset for future development.La gestión de la Calidad Total busca la satisfacción del usuario, la implicación activa de los profesionalesresponsables de su salud y la incorporación de estrategias para la mejora continua de las actividadesclínicas, incorporando la búsqueda de la seguridad del paciente como componente principal.La gestión de la seguridad del paciente minimiza las lesiones no intencionadas atribuibles a procesosde la atención sanitaria, incluido el uso de medicamentos. Los principios de seguridad del paciente seaplican en ambos niveles asistenciales y a todos los profesionales sanitarios. Gestionar el riesgo escuidar al paciente. La Seguridad del paciente pretende resolver problemas y prevenir errores.La aportación del farmacéutico a la seguridad del paciente se realiza con la Atención Farmacéutica y enconcreto con el Seguimiento Farmacoterapéutico (SFT) que previene, detecta y resuelve ProblemasRelacionados con los Medicamentos (PRM).Uno de los principales problemas para avanzar, es la dificultad para homogeneizar resultados; existendiferencias en las definiciones, al igual que ocurre en el ámbito del medicamento, donde se mezclapermanentemente proceso y resultado: Efecto adverso, Acontecimiento no deseado, Errores de medicación,PRM, etc.Se ha de homogenizar la taxonomia; disponer de una información común permitiría conocer mejor laprevalencia, sus tipos, sus causas, su gravedad así como sus consecuencias.Se quiere caminar hacia la seguridad del paciente evaluando tecnologías su efectividad y su seguridad,acreditando establecimientos y acreditando competencia profesional.Este es el camino también para el SFT que comparte los principios básicos de calidad de la seguridaddel paciente.El farmacéutico tiene la responsabilidad profesional y ética de poner a disposición de los pacientes elconocimiento, la experiencia y el método, igual que las acciones emprendidas por los sistemas sanitarios.Existe la oportunidad de estar, de ser los responsables de esta aportación, porque la seguridad delpaciente, en general, y en relación al uso de los medicamentos en particular, va a desarrollarse

Validación de un cuestionario para la identificación de problemas relacionados con los medicamentos en usuarios de un servicio de urgencias hospitalario

Los problemas relacionados con los medicamentos (PRM) son problemas de salud asociados al uso de medicamentos.Son muchos los PRM que podemos encontrar si analizamos la medicación que toman los pacientes y los problemasde salud que refieren y muy variadas las causas que los ocasionan. La entrevista con el paciente constituye uninstrumento imprescindible para la obtención de información sobre qué medicamentos toma, como los toma y sobrela experiencia que de ellos tiene. Los servicios de urgencias hospitalarios constituyen cada día más una puerta deentrada al sistema sanitario para los ciudadanos, de forma que constituye un escenario adecuado para conocer laprevalencia de PRM, sin embargo las características propias de un servicio de urgencias de hospital requiere laadaptación de la entrevista con el usuario. Objetivo: El presente trabajo pretende diseñar y validar un cuestionariocomo instrumento para la obtención de información suficiente para la evaluación e identificación de PRM en losusuarios de un servicio de urgencias hospitalario. Metodología: Se procederá al diseño de un cuestionario con laintervención de expertos en Seguimiento Farmacoterapéutico, igualmente se procederá a la validación del mismopilotandolo sobre una muestra de 222 pacientes usuarios de un servicio de urgencias hospitalario. Resultado: Trasel pilotaje el cuestionario fue validado

Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia

The patient plays a fundamental role in the attainment of good results in pharmacotherapy. Noncompliance,self-medication, or insufficient knowledge of the therapy being employed may provide asource for the causes of these negative clinical outcomes, otherwise known as medicine related problems(MRP). he Dader method was used in the evaluation, identification and classification of MRP. Theassociation of variables was established through the statistical Chi square test. Patient knowledge of themedicine, degree of compliance to therapy and self-medication were studied as causes of the negativeoutcomes encountered. 2556 patients were interviewed throughout the year that the study took place,giving a total of 2261 of valid cases. 33% presented an MRP as the cause of his/her visit to the hospitalemergency ward. Knowledge of the medicine, compliance and self-medication were only studied in thepopulation that presented an MRP and in this work it is demonstrated that these are aspects that areassociated with different dimensions of MRP. It is not possible to establish an association between theexistence or not of negative clinical outcomes in patients with the factors of knowledge of medication,compliance and self-medication. This is due to the fact that these variables are not attributable to thepatient himself, but rather are associated with the characteristics of each medicine.El paciente juega un papel primordial en la consecución de los resultados terapéuticos. El incumplimiento,la automedicación, o la falta de conocimiento del la farmacoterapia pueden ser causas de esosresultados clínicos negativos, denominados en ocasiones problemas relacionados con medicamentos(PRM). El método Dáder se utilizó para la evaluación, identificación y clasificación de PRM. Laasociación de variables se estableció mediante el estadístico chi cuadrado. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados como causa de estos resultados negativosde la medicación. Fueron entrevistados 2556 pacientes durante el año de estudio, resultando 2261 casosválidos. El 33 % presentaron un PRM como causa de visita a urgencias. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados solo en la población que presentó unPRM y se demuestra que son aspectos asociados a las distintas dimensiones de PRM. No es posibleestablecer asociación entre la existencia o no de resultados clínicos negativos en los pacientes con elconocimiento de la medicación, el cumplimiento y la automedicación, debido a que estas variables noson atributos del paciente sino que están asociadas a cada medicamento

BCL6 is critical for the development of a diverse primary B cell repertoire

BCL6 protects germinal center (GC) B cells against DNA damage–induced apoptosis during somatic hypermutation and class-switch recombination. Although expression of BCL6 was not found in early IL-7–dependent B cell precursors, we report that IL-7Rα–Stat5 signaling negatively regulates BCL6. Upon productive VH-DJH gene rearrangement and expression of a μ heavy chain, however, activation of pre–B cell receptor signaling strongly induces BCL6 expression, whereas IL-7Rα–Stat5 signaling is attenuated. At the transition from IL-7–dependent to –independent stages of B cell development, BCL6 is activated, reaches expression levels resembling those in GC B cells, and protects pre–B cells from DNA damage–induced apoptosis during immunoglobulin (Ig) light chain gene recombination. In the absence of BCL6, DNA breaks during Ig light chain gene rearrangement lead to excessive up-regulation of Arf and p53. As a consequence, the pool of new bone marrow immature B cells is markedly reduced in size and clonal diversity. We conclude that negative regulation of Arf by BCL6 is required for pre–B cell self-renewal and the formation of a diverse polyclonal B cell repertoire

Metabolic adaptation of two in silico mutants of Mycobacterium tuberculosis during infection

ABSTRACT: Background: Up to date, Mycobacterium tuberculosis (Mtb) remains as the worst intracellular killer pathogen. To establish infection, inside the granuloma, Mtb reprograms its metabolism to support both growth and survival, keeping a balance between catabolism, anabolism and energy supply. Mtb knockouts with the faculty of being essential on a wide range of nutritional conditions are deemed as target candidates for tuberculosis (TB) treatment. Constraint-based genome-scale modeling is considered as a promising tool for evaluating genetic and nutritional perturbations on Mtb metabolic reprogramming. Nonetheless, few in silico assessments of the effect of nutritional conditions on Mtb’s vulnerability and metabolic adaptation have been carried out. Results: A genome-scale model (GEM) of Mtb, modified from the H37Rv iOSDD890, was used to explore the metabolic reprogramming of two Mtb knockout mutants (pfkA- and icl-mutants), lacking key enzymes of central carbon metabolism, while exposed to changing nutritional conditions (oxygen, and carbon and nitrogen sources). A combination of shadow pricing, sensitivity analysis, and flux distributions patterns allowed us to identify metabolic behaviors that are in agreement with phenotypes reported in the literature. During hypoxia, at high glucose consumption, the Mtb pfkA-mutant showed a detrimental growth effect derived from the accumulation of toxic sugar phosphate intermediates (glucose-6-phosphate and fructose-6-phosphate) along with an increment of carbon fluxes towards the reductive direction of the tricarboxylic acid cycle (TCA). Furthermore, metabolic reprogramming of the icl-mutant (icl1&icl2) showed the importance of the methylmalonyl pathway for the detoxification of propionyl-CoA, during growth at high fatty acid consumption rates and aerobic conditions. At elevated levels of fatty acid uptake and hypoxia, we found a drop in TCA cycle intermediate accumulation that might create redox imbalance. Finally, findings regarding Mtb-mutant metabolic adaptation associated with asparagine consumption and acetate, succinate and alanine production, were in agreement with literature reports. Conclusions: This study demonstrates the potential application of genome-scale modeling, flux balance analysis (FBA), phenotypic phase plane (PhPP) analysis and shadow pricing to generate valuable insights about Mtb metabolic reprogramming in the context of human granulomas

New approaches in the diagnosis and treatment of latent tuberculosis infection

With nearly 9 million new active disease cases and 2 million deaths occurring worldwide every year, tuberculosis continues to remain a major public health problem. Exposure to Mycobacterium tuberculosis leads to active disease in only ~10% people. An effective immune response in remaining individuals stops M. tuberculosis multiplication. However, the pathogen is completely eradicated in ~10% people while others only succeed in containment of infection as some bacilli escape killing and remain in non-replicating (dormant) state (latent tuberculosis infection) in old lesions. The dormant bacilli can resuscitate and cause active disease if a disruption of immune response occurs. Nearly one-third of world population is latently infected with M. tuberculosis and 5%-10% of infected individuals will develop active disease during their life time. However, the risk of developing active disease is greatly increased (5%-15% every year and ~50% over lifetime) by human immunodeficiency virus-coinfection. While active transmission is a significant contributor of active disease cases in high tuberculosis burden countries, most active disease cases in low tuberculosis incidence countries arise from this pool of latently infected individuals. A positive tuberculin skin test or a more recent and specific interferon-gamma release assay in a person without overt signs of active disease indicates latent tuberculosis infection. Two commercial interferon-gamma release assays, QFT-G-IT and T-SPOT.TB have been developed. The standard treatment for latent tuberculosis infection is daily therapy with isoniazid for nine months. Other options include therapy with rifampicin for 4 months or isoniazid + rifampicin for 3 months or rifampicin + pyrazinamide for 2 months or isoniazid + rifapentine for 3 months. Identification of latently infected individuals and their treatment has lowered tuberculosis incidence in rich, advanced countries. Similar approaches also hold great promise for other countries with low-intermediate rates of tuberculosis incidence

Relationship between self-reported dietary intake and physical activity levels among adolescents: The HELENA study

Background Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. Therefore it is important to investigate associations between dietary and physical activity behavior, the two most important lifestyle behaviors influencing our energy balance and body composition. The objective of the present study is to describe the relationship between energy, nutrient and food intake and the physical activity level among a large group of European adolescents. Methods The study comprised a total of 2176 adolescents (46.2% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Dietary intake and physical activity were assessed using validated 24-h dietary recalls and self-reported questionnaires respectively. Analyses of covariance (ANCOVA) were used to compare the energy and nutrient intake and the food consumption between groups of adolescents with different physical activity levels (1st to 3rd tertile). Results In both sexes no differences were found in energy intake between the levels of physical activity. The most active males showed a higher intake of polysaccharides, protein, water and vitamin C and a lower intake of saccharides compared to less active males. Females with the highest physical activity level consumed more polysaccharides compared to their least active peers. Male and female adolescents with the highest physical activity levels, consumed more fruit and milk products and less cheese compared to the least active adolescents. The most active males showed higher intakes of vegetables and meat, fish, eggs, meat substitutes and vegetarian products compared to the least active ones. The least active males reported the highest consumption of grain products and potatoes. Within the female group, significantly lower intakes of bread and cereal products and spreads were found for those reporting to spend most time in moderate to vigorous physical activity. The consumption of foods from the remaining food groups, did not differ between the physical activity levels in both sexes. Conclusion It can be concluded that dietary habits diverge between adolescents with different self-reported physical activity levels. For some food groups a difference in intake could be found, which were reflected in differences in some nutrient intakes. It can also be concluded that physically active adolescents are not always inclined to eat healthier diets than their less active peers.The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education (EX-2007-1124, and EX-2008-0641), and the Spanish Ministry of Health, Maternal, Child Health and Development Network (number RD08/0072) (JPRL, LAM)