Tratamiento de la neutropenia febril: filgrastim y pegfilgrastim

Objetivos: El uso terapéutico de los factores estimulantes de colonias de granulocitos resulta desconocido en comparación con el uso como profilaxis de los mismos. El objetivo de este estudio fue recopilar la información relativa al uso terapéutico encontrada en estudios llevados a cabo del año 2003 en adelante. Métodos: La búsqueda se realizó en siete bases de datos electrónicas en mayo de 2012. Resultaron elegibles los estudios publicados en inglés, francés y español desde el año 2003 en adelante. Se buscaron estudios que abordasen el uso terapéutico de filgrastim y pegfilgrastim en neutropenia febril secundaria a quimioterapia. La búsqueda se completó revisando las referencias de los artículos seleccionados. Resultados: Hubo cuatro estudios que reunieron los criterios de selección. Uno se llevó a cabo en un hospital del Líbano, otro en un hospital británico, otro fue un estudio multicéntrico en España y el último se realizó en Australia a través de una encuesta electrónica a especialistas en cáncer. En el estudio del Líbano, 59 de 137 ciclos de tratamiento con factores estimulantes de colonias de granulocitos se realizaron como uso terapéutico. En el estudio LEARN en España, el 29,7% de los pacientes que usaron factores estimulantes de colonias de granulocitos los utilizaron como tratamiento, al igual que el 17,3% de los pacientes que recibieron pegfilgrastim. El 9,7% de los tratamientos con filgrastim fueron terapéuticos en el hospital británico. Finalmente, en Australia, el 27% de los hematólogos utilizarían factores estimulantes de colonias de granulocitos en el primer caso de los que se les presentaron (bajo riesgo de complicaciones médicas). El 7% de los oncólogos los utilizaría en su caso de bajo riesgo de complicaciones médicas y el 9% los utilizaría en el segundo caso (riesgo mayor). La duración media de la terapia en los diferentes estudios varió de 4,8 a 6 días. El efecto adverso más frecuente fue el dolor de huesos. Conclusiones: Según los resultados de esta revision, los factores estimulantes de colonias de granulocitos de uso diario se utilizaron más que el pegfilgrastim para uso terapéutico, siendo el último poco utilizado e incluso considerado una excepción. Las terapias fueron cortas y seguras.Aim: The use of granulocyte colony-stimulating factors in the therapeutic setting of febrile neutropenia is still unknown with regard to the prophylaxis one. The aim of the present work was to collect the information about this therapeutic use found out in the studies performed since 2003. Methods: Seven electronic databases were searched in May 2012. Eligibility included works published in English, French and Spanish from 2003 on. Studies that involved the therapeutic use of filgrastim or pegfilgrastim in chemotherapy-induced febrile neutropenia were sought. Reviews, meta-analysis and works published as abstracts were excluded. The search was completed by checking the reference lists from the selected studies. Results: One of them was performed in a hospital in the Lebanon, another one in a British hospital, another was a multi-centre study in Spain and the last one was performed in Australia through an electronic survey made to cancer specialists. In the Lebanon study, 59 out of 137 granulocyte colony-stimulating factors treatment courses were performed in the therapeutic setting. In the LEARN study in Spain 29.7% patients treated with daily granulocyte colony-stimulating factors used them as treatment, so did 17.3% patients receiving pegfilgrastim. 9.7% treatments with filgrastim were therapeutic in the British hospital. Finally, in Australia 27% haematologist would use granulocyte colony-stimulating factors in case 1 (low risk of medical complications). 7% oncologists would use them in their low risk case of medical complications and 9% would use them in case 2 (higher risk). The mean duration of the therapy in the different studies ranged between 4.8 and 6 days. The most frequent adverse effect was bone pain. Conclusions: The results from the present review showed that daily granulocyte colony-stimulating factors were used more than pegfilgrastim in the treatment setting, being the latter used very little and even considered an exception. Therapies were short and safe

A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation

The authors would like to thank all participants in this research for their valuable input into the co-design process.Background: Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. Methods: A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacybased health programs was used to build a theoretical model of the service. Results: Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). Conclusion: A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.This work was funded by Covidien Pty Ltd. (Medtronic Australasia Pty Ltd) [UTS Project code: PRO16–0688], which is the company that has the rights to distribute the device Microlife BP A200 AFIB in Australia. Also, funding for this research has been provided by a UTS Chancellor’s postdoctoral fellowship awarded to the first author of this article (ID number: 2013001605)

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Participatory Research for the Development of Community Pharmacy Services

The early involvement of key stakeholders (with various roles and perspectives) in the planning process of a community pharmacy service (CPS), increases the potential of such services to respond to real needs and to be integrated in practice. Participatory development of CPSs was explored in this thesis by reviewing the applicability of stakeholder analysis within planning processes, then putting into practice the initial steps of the development of a cardiovascular disease-prevention CPS. As a result, a preliminary model for chronic care that stipulates which stakeholder groups to consider, seven principles for advanced care and six environmental factors that may influence the implementation of these principles (the NSW-MCC) was proposedTesis Univ. Granada.To the University of Technology Sydney (UTS), for granting me the UTS President’s Scholarship (UTSP) and the International Research Scholarship (IRS). Additionally, the UTS Chancellor’s Postdoctoral Fellowship awarded to Dr Daniel Sabater-Hernandez (ID number: 2013001605) provided funding for the studies conducted in Australia (Chapters 3 & 5). The Graduate School of Health at UTS and the Pharmaceutical Care Research Group at the University of Granada (UGR) provided funding for the stakeholder analysis in Spain (Chapter 4)

Febrile neutropenia treatment: filgrastim and pegfilgrastim.

Objetivos: El uso terapéutico de los factores estimulantes de colonias de granulocitos resulta desconocido en comparación con el uso como profilaxis de los mismos. El objetivo de este estudio fue recopilar la información relativa al uso terapéutico encontrada en estudios llevados a cabo del año 2003 en adelante.Métodos: La búsqueda se realizó en siete bases de datos electrónicas en mayo de 2012. Resultaron elegibles los estudios publicados en inglés, francés y español desde el año 2003 en adelante. Se buscaron estudios que abordasen el uso terapéutico de filgrastim y pegfilgrastim en neutropenia febril secundaria a quimioterapia. La búsqueda se completó revisando las referencias de los artículos seleccionados.Resultados: Hubo cuatro estudios que reunieron los criterios de selección. Uno se llevó a cabo en un hospital del Líbano, otro en un hospital británico, otro fue un estudio multicéntrico en España y el último se realizó en Australia a través de una encuesta electrónica a especialistas en cáncer. En el estudio del Líbano, 59 de 137 ciclos de tratamiento con factores estimulantes de colonias de granulocitos se realizaron como uso terapéutico. En el estudio LEARN en España, el 29,7% de los pacientes que usaron factores estimulantes de colonias de granulocitos los utilizaron como tratamiento, al igual que el 17,3% de los pacientes que recibieron pegfilgrastim. El 9,7% de los tratamientos con filgrastim fueron terapéuticos en el hospital británico. Finalmente, en Australia, el 27% de los hematólogos utilizarían factores estimulantes de colonias de granulocitos en el primer caso de los que se les presentaron (bajo riesgo de complicaciones médicas). El 7% de los oncólogos los utilizaría en su caso de bajo riesgo de complicaciones médicas y el 9% los utilizaría en el segundo caso (riesgo mayor). La duración media de la terapia en los diferentes estudios varió de 4,8 a 6 días. El efecto adverso más frecuente fue el dolor de huesos.Conclusiones: Según los resultados de esta revision, los factores estimulantes de colonias de granulocitos de uso diario se utilizaron más que el pegfilgrastim para uso terapéutico, siendo el último poco utilizado e incluso considerado una excepción. Las terapias fueron cortas y seguras.Aim: The use of granulocyte colony-stimulating factors in the therapeutic setting of febrile neutropenia is still unknown with regard to the prophylaxis one. The aim of the present work was to collect the information about this therapeutic use found out in the studies performed since 2003.Methods: Seven electronic databases were searched in May 2012. Eligibility included works published in English, French and Spanish from 2003 on. Studies that involved the therapeutic use of filgrastim or pegfilgrastim in chemotherapy-induced febrile neutropenia were sought. Reviews, meta-analysis and works published as abstracts were excluded. The search was completed by checking the reference lists from the selected studies.Results: One of them was performed in a hospital in the Lebanon, another one in a British hospital, another was a multi-centre study in Spain and the last one was performed in Australia through an electronic survey made to cancer specialists. In the Lebanon study, 59 out of 137 granulocyte colony-stimulating factors treatment courses were performed in the therapeutic setting. In the LEARN study in Spain 29.7% patients treated with daily granulocyte colony-stimulating factors used them as treatment, so did 17.3% patients receiving pegfilgrastim. 9.7% treatments with filgrastim were therapeutic in the British hospital. Finally, in Australia 27% haematologist would use granulocyte colony-stimulating factors in case 1 (low risk of medical complications). 7% oncologists would use them in their low risk case of medical complications and 9% would use them in case 2 (higher risk). The mean duration of the therapy in the different studies ranged between 4.8 and 6 days. The most frequent adverse effect was bone pain.Conclusions: The results from the present review showed that daily granulocyte colony-stimulating factors were used more than pegfilgrastim in the treatment setting, being the latter used very little and even considered an exception. Therapies were short and safe

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data