Leczenie przewlekłej obturacyjnej choroby płuc - bronchodylatacja i przeciwzapalna farmakoterapia celowana

Currently available pharmacological treatment of COPD relies mostly on prophylaxis (smoking cessation) and symptomatic treatment, i.e. inhaled anticholinergic agents, β2-agonists and phosphodiesterase inhibitors, aiming in their bronchodilatation capacity. Inhaled corticosteroid therapy is mainly prescribed in far advanced stages of the disease and its role in disease modification is still controversial. The authors analize currently available treatment modalities with regards to their potential anti-inflammatory and pleiotropic mode of action, which may lead to disease course modification. Pneumonol. Alergol. Pol. 2011; 79, 1: 32-38Stosowane obecnie farmakologiczne leczenie POChP opiera się na profilaktyce - terapii antynikotynowej oraz leczeniu objawowym, czyli stosowaniu wziewnych leków antycholinergicznych, β2-agonistów, inhibitorów fosfodiesterazy, głównie pod kątem ich skuteczności bronchodylatacyjnej. W zaawansowanym stadium stabilnej choroby zaleca się leczenie wziewnymi steroidami kory nadnerczy, chociaż ich wpływ na przebieg choroby w dalszym ciagu wzbudza kontrowersje. Autorzy niniejszej pracy zanalizowali wybrane grupy leków stosowanych w POChP pod kątem ich potencjalnego mechanizmu działania przeciwzapalnego i plejotropowego, który może mieć wpływ na modyfikację przebiegu choroby. Pneumonol. Alergol. Pol. 2011; 79, 1: 32-3

Ocena skuteczności fentanylu podawanego przezśluzówkowo w terapii bólów przebijających u chorych na nowotwory

Background. In cancer patients persistent pain can co-exist with acute, severe pain, so called breakthrough pain. This kind of pain is relatively common, and difficult to treat. Breakthrough pain is usually managed with supplemental strong and short-acting analgesic medications. The objective of this work was to evaluate effectiveness of oral transmucosal fentanyl citrate for the management of the breakthrough pain. Materials and methods. 26 adult patients of Hospice of Białystok with persistent cancer pain were recruited into this study. Patients received transdermal fentanyl for persistent pain and oral morphine or transmucosal fentanyl for breakthrough pain. Chronic and breakthrough pain intensity, time to pain relief and patients’ satisfaction scores were recorded. Results. The median of chronic pain intensity was 2.1 and median of breakthrough pain was 6 according to visual analogue scale (VAS). There was no difference between oral morphine and submucosal fentanyl in pain relief, but time to pain relief was significantly shorter in case of fentanyl. Plasma fentanyl concentrations ranged between 0.39 and 1.86 ng/ml and did not increase after transmucosal administration of fentanyl. Conclusions. Transmucosal fentanyl appears effective in the management of breakthrough pain. Cancer patients found this therapy acceptable.Wstęp. Bóle przebijające, które występują u chorych na nowotwory leczonych z powodu bólu przewlekłego, stanowią ważny problem kliniczny. W terapii tego rodzaju bólu stosuje się tzw. dawki ratujące silnie i szybko działających leków przeciwbólowych. Celem badania była ocena przeciwbólowego efektu roztworu cytrynianu fentanylu podawanego przezśluzówkowo. Materiał i metody. Badaniem objęto 26 pacjentów Hospicjum w Białymstoku, u których stosowano fentanyl przezskórny jako podstawową terapię bólu oraz wodny roztwór morfiny doustnie lub roztwór cytrynianu fentanylu przezśluzówkowo w wypadku wystąpienia bólu przebijającego. Oceniano natężenie bólu podstawowego oraz przebijającego, czas od podania leku do ustąpienia bólu przebijającego, preferencje w wyborze leku oraz stężenie fentanylu w surowicy krwi. Wyniki. Średnie natężenie bólu podstawowego oceniono w skali VAS na 2,1, zaś bólu przebijającego na 6. Stopień analgezji po podaniu obu preparatów był analogiczny, przy czym fentanyl podany przezśluzówkowo działał znamiennie szybciej niż morfina podana doustnie. Stężenie fentanylu w surowicy krwi wahało się w granicach 0,39–1,86 ng/ml i nie ulegało wykrywalnemu podwyższeniu po podaniu dodatkowej dawki preparatu w formie przezśluzówkowej. Wnioski. Fentanyl podawany przezśluzówkowo stanowi skuteczną i akceptowaną przez pacjentów formę terapii bólów przebijających u chorych na nowotwory

Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics

Aim: Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. Methods: With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. Results: Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. Conclusion: Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials

EurOP2E – the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers

Purpose Sharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers. Methods CPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting. Results Data from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources. Conclusion Key challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system

Key Learning Outcomes for Clinical Pharmacology and Therapeutics Education in Europe: A Modified Delphi Study.

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired