Social and economic value of Portuguese community pharmacies in health care

Background: Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal. Methods: The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: "with service" versus "without service". Results: It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (Msic), including 342.1 Msic in non-remunerated pharmaceutical services and 448. 1 Msic in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 Msic: 120.3 Msic in non-remunerated services and 24.5 Msic in potential savings with health resource consumption. Conclusions: Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society

QUANTIFICATION OF RESIDUAL CLOVE OIL, BENZOCAINE AND TRICAINE IN FISH FILLETS USING SPE AND UPLC-DAD

Residual quantification of the anesthetics clove oil (CO) – isoeugenol (ISO), eugenol (EUG) and methyleugenol (MET) –,benzocaine (BZN) and tricaine (MS-222) was made in fillets of two fish species: Nile tilapia (Oreochromis niloticus) and acatfish hybrid, cachadia (Pseudoplatystoma reticulatum x Leiarius marmoratus). Samples (n=4) of each fish wereevaluated after submitted to anesthesia in five dosages defined based on the induction time of each species afterdepuration times (0h, 12h, 24h and 48h). Different methodologies of sample preparation were tested and selectedaccording to the better recovery. The quantification of anesthetics was performed by UPLC-DAD. The variance of residualmeans among anesthetics, dosages and fish species was compared. After anesthesia (0h) both species, tilapia andcachadia, presented residual anesthetics. Fishes depurated during 12h, 24h and 48h did not present detectable values, itmeans, values were below the limits of detection. BZN presented the highest mean residual concentration for tilapia andcachadia (p=0.01), while MS-222 presented the lowest residual amounts in tilapias and EUG in cachadias, what may berelated to the metabolism and carcass composition of each fish species. There were no significant differences among thefive dosages, except the lowest MS-222 concentration in tilapias that resulted in higher residual concentrations becauselow dosages increase the induction time and consequently the permanence of the fish in anesthesia. Ultimately, meanvalues of residues in cachadia were higher than in tilapia, and MS-222 and EUG presented the lowest residual values fortilapia and cachadia, respectively

SMART: An Application Framework for Real Time Big Data Analysis on Heterogeneous Cloud Environments

International audienceThe amount of data that human activities generate poses a challenge to current computer systems. Big data processing techniques are evolving to address this challenge, with analysis increasingly being performed using cloud-based systems. Emerging services, however, require additional enhancements in order to ensure their applicability to highly dynamic and heterogeneous environments and facilitate their use by Small & Medium-sized Enterprises (SMEs). Observing this landscape in emerging computing system development, this work presents Small & Medium-sized Enterprise Data Analytic in Real Time (SMART) for addressing some of the issues in providing compute service solutions for SMEs. SMART offers a framework for efficient development of Big Data analysis services suitable to small and medium-sized organizations, considering very heterogeneous data sources, from wireless sensor networks to data warehouses, focusing on service composability for a number of domains. This paper presents the basis of this proposal and preliminary results on exploring application deployment on hybrid infrastructure

Protocol for a multi-centre, parallel-arm, 12-month, randomised controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN)

INTRODUCTION: Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. METHODS: We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). ETHICS AND DISSEMINATION: Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology Assessment, and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ISRCTN64081839; Pre-results

Caracterização físicas e físico-químicas da uva cv. Mourvèrdre procedente do Banco Ativo de Germoplasma da Embrapa Semiárido.

Para subsidiar decisões sobre o melhor aproveitamento das uvas da cultivar Mourvèdre, é importante que sua composição química seja conhecida mais detalhadamente, nas condições específicas onde estão sendo produzidas. Desta forma, devido à possibilidade de melhor exploração dessa cultivar no Submédio do Vale do São Francisco e da pouca disponibilidade de informações nessas condições climáticas, realizou-se o presente trabalho como o objetivo de caracterizar a qualidade da uva da cultivar Mourvèdre, colhida de plantas procedentes do Banco Ativo de 27 Germoplasma da Embrapa Semiárid

Influence of Sedation Level and Ventilation Status on the Diagnostic Validity of Delirium Screening Tools in the ICU—An International, Prospective, Bi-Center Observational Study (IDeAS)

Background and objectives: The use of delirium screening instruments (DSIs) is recommended in critical care practice for a timely detection of delirium. We hypothesize that the patient-related factors "level of sedation" and "mechanical ventilation" impact test validity of DSIs. Materials and Methods: This is a prospective, bi-center observational study (clinicaltrials.gov: NCT01720914). Critically ill patients were screened for delirium daily for up to seven days after enrollment using the Nursing Delirium Screening Scale (Nu-DESC), Intensive Care Delirium Screening Checklist (ICDSC), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Reference standard for delirium diagnosis was the neuropsychiatric examination using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Immediately before delirium assessment, ventilation status and sedation levels were documented. Results: 160 patients were enrolled and 151 patients went into final analysis. Delirium incidence was 23.2%. Nu-DESC showed a sensitivity and specificity of 88.5%, a positive predictive value (PPV) of 71.9%, and a negative predictive value (NPV) of 95.8%. ICDSC had a sensitivity of 62.5%, a specificity of 92.4%, a PPV of 71.4%, and a NPV of 89.0%. CAM-ICU showed a sensitivity of 75.0%, a specificity of 94.7%, a PPV of 85.7%, and a NPV of 90.0%. For Nu-DESC and ICDSC, test validity was significantly better for non-sedated patients (Richmond Agitation Sedation Scale (RASS) 0/-1), whereas test validity for CAM-ICU in a severity scale version showed no significant differences for different sedation levels. No DSI showed a significant difference in test validity between noninvasively and invasively ventilated patients. Conclusions: Test validities of DSIs were comparable to previous studies. The observational scores ICDSC and Nu-DESC showed a significantly better performance in awake and drowsy patients (RASS 0/-1) when compared with other sedation levels. Physicians should refrain from sedation whenever possible to avoid suboptimal performance of DSIs

SARS-CoV-2 reinfection caused by the P.1 lineage in Araraquara city, Sao Paulo State, Brazil

Reinfection by the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) has been reported in many countries, suggesting that the virus may continue to circulate among humans despite the possibility of local herd immunity due to massive previous infections. The emergence of variants of concern (VOC) that are more transmissible than the previous circulating ones has raised particular concerns on the vaccines effectiveness and reinfection rates. The P.1 lineage was first identified in December 2020 in Manaus city and is now globally spread. We report the first case of reinfection of SARS-CoV-2 caused by the P.1 variant outside of Manaus. The potential of these new variants to escape naturally and vaccine- induced immunity highlights the need for a global vigilance

Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure : a systematic review and meta‐analysis

Aims: To assess the feasibility and efficacy of interatrial shunt devices (IASD) for the treatment of chronic heart failure (CHF). Methods and results: MEDLINE and the Cochrane Central Register of Controlled Trials from inception until April 2021 were searched for prospective studies investigating dedicated transcatheter IASD for the treatment of CHF. Standardised mean differences were calculated for the within‐group changes before and after implantation of the IASD. The pre‐defined primary outcome was change in 6‐min walking distance (6MWD) from baseline to 12 months. Other outcomes were change in New York Heart Association class, health‐related quality of life (HRQoL), echocardiographic and haemodynamic data, device performance and safety. Subgroup analyses were crude univariable meta‐regression analyses. Six studies (five single‐arm open‐label studies, one sham‐controlled trial) were included. In these, 226 patients underwent IASD implantation using four different devices. From baseline to 12 months, 6MWD increased by 28.1 m [95% confidence interval (CI) 10.9–45.3] with no evidence for a difference between devices (P for interaction = 0.66) and patients with left ventricular ejection fraction (LVEF) >40% or ≤40% (P for interaction = 0.21). At 12 months, HRQoL improved by 17.7 points (95% CI 10.8–24.6) and pulmonary capillary wedge pressure (PCWP) decreased by 2.0 mmHg (95% CI −3.6 to −0.4). There were no changes in LVEF or N‐terminal pro brain natriuretic peptide during follow‐up. Shunt patency ranged from 50% for the first‐generation v‐Wave to 100% for the Corvia IASD II and the second‐generation v‐Wave system, respectively. The summary risk of serious adverse device‐related effects was 8% (95% CI 1–20) at 12 months. Conclusions: Interatrial shunt device implantation in CHF is feasible and associates with improved submaximal exercise capacity (measured by 6MWD) and HRQoL, and reductions in PCWP