Campaña de atención farmacéutica como estrategia de implementación de los servicios farmacéuticos: Experiencia Perú

Introducción: Se necesita mostrar las actividades farmacéuticas enfocadas en el cuidado de los pacientes, logrando un uso efectivo y seguro del medicamento y, finalmente, alcanzar las metas terapéuticas de los pacientes. Objetivo: Describir las actividades realizadas en una campaña de atención farmacéutica como estrategia para la implementación de servicios farmacéuticos. Material y métodos: Estudio observacional, descriptivo, transversal, que incluyó a pacientes que asistieron a la farmacia institucional el día de la campaña, quienes recibieron al menos uno de los 3 servicios siguientes: 1. Información sobre medicamentos usando un atril con láminas; 2. Medición de la presión arterial; 3. Seguimiento farmacoterapéutico. Resultados: Se desarrollaron las tres actividades programadas. Un total de 815 personas estuvieron interesadas en la información brindada con el atril con láminas. Un total de 96 personas acudieron para que se les midiera la presión arterial (un 62,5% varones y el resto mujeres). El promedio de edad fue de 67,83 años (desviación estándar [DE]: 13,624). El 25% de los pacientes presentó valores de presión arterial por encima del objetivo terapéutico. El servicio de SFT fue solicitado por 39 pacientes (un 66,66% mujeres y el resto varones). El promedio de edad fue de 64,7 años (DE: 19,7). En 33 se detectaron problemas reales relacionados con los medicamentos, y en 7 problemas potenciales habiéndose tomado el Segundo Consenso de Granada como referencia para la clasificación. Se notificaron 12 reacciones adversas a medicamentos, el 50% graves. Conclusión: El desarrollo de la campaña farmacéutica ha permitido obtener datos sobre el uso de medicamentos en enfermedades crónicas y las reacciones adversas, así como valorar en qué medida los pacientes alcanzan sus objetivos terapéuticos. En definitiva, se muestra la urgente necesidad de que los pacientes ambulatorios reciban de modo sistemático servicios farmacéuticos que logren optimizar sus tratamientos farmacológicos

Campaña de atención farmacéutica como estrategia de implementación de los servicios farmacéuticos: Experiencia Perú

Introducción: Se necesita mostrar las actividades farmacéuticas enfocadas en el cuidado de los pacientes, logrando un uso efectivo y seguro del medicamento y, finalmente, alcanzar las metas terapéuticas de los pacientes. Objetivo: Describir las actividades realizadas en una campaña de atención farmacéutica como estrategia para la implementación de servicios farmacéuticos. Material y métodos: Estudio observacional, descriptivo, transversal, que incluyó a pacientes que asistieron a la farmacia institucional el día de la campaña, quienes recibieron al menos uno de los 3 servicios siguientes: 1. Información sobre medicamentos usando un atril con láminas; 2. Medición de la presión arterial; 3. Seguimiento farmacoterapéutico. Resultados: Se desarrollaron las tres actividades programadas. Un total de 815 personas estuvieron interesadas en la información brindada con el atril con láminas. Un total de 96 personas acudieron para que se les midiera la presión arterial (un 62,5% varones y el resto mujeres). El promedio de edad fue de 67,83 años (desviación estándar [DE]: 13,624). El 25% de los pacientes presentó valores de presión arterial por encima del objetivo terapéutico. El servicio de SFT fue solicitado por 39 pacientes (un 66,66% mujeres y el resto varones). El promedio de edad fue de 64,7 años (DE: 19,7). En 33 se detectaron problemas reales relacionados con los medicamentos, y en 7 problemas potenciales habiéndose tomado el Segundo Consenso de Granada como referencia para la clasificación. Se notificaron 12 reacciones adversas a medicamentos, el 50% graves. Conclusión: El desarrollo de la campaña farmacéutica ha permitido obtener datos sobre el uso de medicamentos en enfermedades crónicas y las reacciones adversas, así como valorar en qué medida los pacientes alcanzan sus objetivos terapéuticos. En definitiva, se muestra la urgente necesidad de que los pacientes ambulatorios reciban de modo sistemático servicios farmacéuticos que logren optimizar sus tratamientos farmacológicos

Reacciones Adversas a Medicamentos reportadas como resultado de la implementación de Atención Farmacéutica en la Farmacia Institucional DIGEMID - Ministerio de Salud de Perú

Objetivos: Determinar el resultado de la implementación de la Atención Farmacéutica en las notificaciones de sospechas de reacciones adversas de medicamentos (RAM) en los pacientes ambulatorios de la Farmacia Institucional de la DIGEMID. Material y métodos: Se realizó un estudio retrospectivo, descriptivo, observacional y transversal del año 2013. Se emplearon las fichas farmacoterapéuticas de los pacientes atendidos en el año 2013. Se seleccionaron las fichas de los pacientes que tuvieron notificación de sospecha de RAM. Resultados: Se recolectó las notificaciones de sospecha de RAM de 44 pacientes ambulatorios de la Farmacia Institucional de DIGEMID y se procedió a analizar las notificaciones de la RAM. Se notificaron 77 sospecha de RAM y el mayor porcentaje fueron los de trastorno gastrointestinal (26,0%). El medicamento causante del mayor porcentaje de RAM fue carbamazepina (6,7%), siendo los medicamentos relacionados con el sistema nervioso los que presentaron más RAM (28,9%), Según la gravedad la RAM más frecuente fueron las serias (61%) y en cuanto a la categoría de la causalidad el más frecuente fue “probable” (43,1%). Conclusión: La implementación de la atención farmacéutica tuvo un resultado positivo en las notificaciones de las sospechas de RAM en la Farmacia Institucional de DIGEMID

Reacciones Adversas a Medicamentos reportadas como resultado de la implementación de Atención Farmacéutica en la Farmacia Institucional DIGEMID - Ministerio de Salud de Perú

Objetivos: Determinar el resultado de la implementación de la Atención Farmacéutica en las notificaciones de sospechas de reacciones adversas de medicamentos (RAM) en los pacientes ambulatorios de la Farmacia Institucional de la DIGEMID. Material y métodos: Se realizó un estudio retrospectivo, descriptivo, observacional y transversal del año 2013. Se emplearon las fichas farmacoterapéuticas de los pacientes atendidos en el año 2013. Se seleccionaron las fichas de los pacientes que tuvieron notificación de sospecha de RAM. Resultados: Se recolectó las notificaciones de sospecha de RAM de 44 pacientes ambulatorios de la Farmacia Institucional de DIGEMID y se procedió a analizar las notificaciones de la RAM. Se notificaron 77 sospecha de RAM y el mayor porcentaje fueron los de trastorno gastrointestinal (26,0%). El medicamento causante del mayor porcentaje de RAM fue carbamazepina (6,7%), siendo los medicamentos relacionados con el sistema nervioso los que presentaron más RAM (28,9%), Según la gravedad la RAM más frecuente fueron las serias (61%) y en cuanto a la categoría de la causalidad el más frecuente fue “probable” (43,1%). Conclusión: La implementación de la atención farmacéutica tuvo un resultado positivo en las notificaciones de las sospechas de RAM en la Farmacia Institucional de DIGEMID

Portuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes Mellitus

Background: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction ( 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.info:eu-repo/semantics/publishedVersio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe