Development and validation of a tool to measure collaborative practice between community pharmacists and physicians from the perspective of community pharmacists: the professional collaborative practice tool.

BACKGROUND: Collaborative practice between community pharmacists and physicians is becoming increasingly common. Although tools and models to explore collaborative practice between both health care professionals have been developed, very few have been validated for their use in clinical practice. The objective of this study was to develop and validate a tool for measuring collaborative practice between community pharmacists and physicians from the perspective of community pharmacists. METHODS: The DeVellis method was used to develop and validate the Professional Collaborative Practice Tool. A pool of 40 items with Likert frequency scales was generated based on previous literature and expert opinion. This study was undertaken in Spain. A sample of community pharmacists providing medication reviews with follow-up and a random sample of pharmacists providing usual care were invited to participate. Exploratory and confirmatory factor analysis was used to assess the tool's reliability and content validity. RESULTS: Three hundred thirty-six pharmacists were invited with an overall response rate of 84.8%. The initial 40 items selected were reduced to 14 items. Exploratory Factor Analysis provided a 3-factor solution explaining 62% of the variance. Confirmatory Factor Analysis confirmed the three factors "Activation for collaborative professional practice," the "Integration in collaborative professional practice," and the "Professional acceptance in collaborative professional practice." The tool demonstrated an adequate fit (X2/df = 1.657, GFI = 0.889 and RMSEA = 0.069) and good internal consistency (Cronbach's alpha = 0.924). CONCLUSIONS: The Professional Collaborative Practice Tool has shown good internal reliability and criterion validity. The tool could be used to measure the perceived level of collaborative practice between community pharmacists and physicians and monitor changes over time. Its applicability and transferability to other settings should be evaluated

Informational Literacy And Information And Communication Technologies Use By Secondary Education Students In Spain: A Descriptive Study

Informational literacy and the use of technologies by Secondary Education students in Spain: A descriptive study. The development of Information and Communication Technologies (ICTs), together with their application to research carried out on educational areas, are factors which contribute to the promotion of a new educative model constructed on literacy-based competences and skills, and which sets technologies as essential tools for a life-long learning process (Unesco, 2005). This is the framework where we can insert the research that we are currently carrying out, funded by the research Program I+D+I of the Spanish Ministry of Education, and in the frame of which we are developing a diagnostic assessment of informational literacy competence in students between 14 and 16 years (Secondary Education), based on the fact that one of the main aspects in knowledge generation and acquisition is the capacity to use information extracted from documents and electronic resources, available in informational networks in a correct way. In this paper we present the results obtained from evidences on the contrast existing between the level of use of technologies (videogames, social networks...) and the level of informational literacy shown by students. The data were gathered from a sample of more than 1000 Secondary Education students who are around 15 years old

Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program

© 2015, Springer International Publishing Switzerland. Background: The concept of pharmaceutical care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. Objective: The objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies against the alternative of having their medication dispensed normally. Methods: The study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of 6 months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Cost-utility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as quality-adjusted life-years (QALYs). In order to analyze the uncertainty of ICER results, we performed a non-parametric bootstrapping with 5000 replications. Results: A total of 1403 older adults, aged between 65 and 94 years, were enrolled in the study: 688 in the intervention group (IG) and 715 in the control group (CG). By the end of the follow-up, both groups had reduced the mean number of prescribed medications they took, although this reduction was greater in the IG (0.28 ± 1.25 drugs; p < 0.001) than in the CG (0.07 ± 0.95 drugs; p = 0.063). Older adults in the IG saw their quality of life improved by 0.0528 ± 0.20 (p < 0.001). In contrast, the CG experienced a slight reduction in their quality of life: 0.0022 ± 0.24 (p = 0.815). The mean total cost was €977.57 ± 1455.88 for the IG and €1173.44 ± 3671.65 for the CG. In order to estimate the ICER, we used the costs adjusted for baseline medications and QALYs adjusted for baseline utility score, resulting in a mean incremental total cost of −€250.51 ± 148.61 (95 % CI −541.79 to 40.76) and a mean incremental QALY of 0.0156 ± 0.004 (95 % CI 0.008–0.023). Regarding the results from the cost-utility analysis, the MRF service emerged as the dominant strategy. Conclusion: The MRF service is an effective intervention for optimizing prescribed medication and improving quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that the MRF service is cost effective

Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial

BackgroundNon-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD).MethodsA 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data.ResultsNinety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, pConclusionsA community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice.Trial registration numberACTRN12618000410257

Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy.

Background: It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods: The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be € 27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of € 1,494.82/QALY. In the complete case, the service resulted in an ICUR of € 2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of € 20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion: The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective

Intrinsic Deviation from the Tri-bimaximal Neutrino Mixing in a Class of A_4 Flavor Models

It is well known that the tri-bimaximal neutrino mixing pattern V_0 can be derived from a class of flavor models with the non-Abelian A_4 symmetry. We point out that small corrections to V_0, which are inherent in the A_4 models and arise from both the charged-lepton and neutrino sectors, have been omitted in the previous works. We show that such corrections may lead the 3 \times 3 neutrino mixing matrix V to a non-unitary deviation from V_0, but they cannot result in a nonzero value of \theta_13 or any new CP-violating phases. Current experimental constraints on the unitarity of V allow us to constrain the model parameters to some extent.Comment: 11 pages, no figures; a reference added, accepted for publication in Phys. Lett.

Recovery of early meteorological records from Extremadura region (SW Iberia): The ''CliPastExtrem'' (v1.0) database

In this work, we provide instrumental meteorological data recovered for the Extremadura region (interior SW Iberia), from 1826 to mid-20th century. Meteorological variables such as air temperature, atmospheric pressure, precipitation, wind direction and humidity, among others, were retrieved. In total, more than 750 000 instrumental data in 157 meteorological series belonging to 131 different locations throughout Extremadura were rescued. It must be noted that daily resolution data constitutes 80% of the database. This great effort of digitization and data collection has been carried out with the aim of contributing to a significant expansion of the length of the databases with meteorological information in this region. Therefore, this database will provide a better understanding of climate variability, trends and extreme events of the Extremadura region

Genotyping of Human Papillomavirus in cervical Squamous Intraepitelial Lesions in Méxica Women

Approximately 40 genotypes of the human papillomavirus (HPV) have been identified in cervical mucosa. In particular, HPV-16 and HPV-18 have been associated with cervical neoplasia. Squamous intraepithelial lesions (SILs) are precursors of cervical cancer. This study aimed to identify the HPV by genotype in SILs using a line ar array genotyping test in a population in the State of México. We performed a cross-sectional study of 129 patients (women of the State of México) who completed a risk factor questionnaire and were diagnosed as being with or without SIL by colposcopy. We obtained cervical swab samples from these patients and genotyped them using a Linear Array HPV Genotyping assay from ROCHE®. Forty-nine (37.98%) samples were positive for the HPV, and 24 genotypes were found among these samples. The most common genotype was HPV-16. The 12 genotypes found in both high- and low-grade SILs were HPV-6, 16, 31, 39, 51, 52, 53, 58, 59, 61, 67, and 84, 7 of which were high risk: HPV-16, 31, 39, 51, 52, 58, and 59. In the population studied, the most frequent genotype was HPV-16, multiple infections were found, and four patients without injury tested positive for the HPV

Chemical composition, physicochemical evaluation and sensory analysis of yogurt added with extract of polyphenolic compounds from Quercus crassifolia oak bark

Introduction: A diet high in calories and saturated fats has been associated with health problems that have been increasing worldwide. Therefore, it is required to increase the number of formulated foods that generate well-being to health. Yogurt is a widely consumed food by all sectors of the population and it can be used as a vehicle to incorporate bioactive compounds. The phenolic compounds present in forest residues, such as those from oak bark, can be used and incorporated into yogurt, to increase its benefits as a functional food. Objective: The objective of this study was to develop a multifunctional yogurt enriched with vegetable oil (2.3% w/w) as a source of omega 6 and 3 and adding nanocapsules (24.5% w/w) of an extract of oak bark from Quercus crassifolia, rich in in phenolic compounds and high antioxidant capacity. Methods: Three yogurt formulations were prepared: F1: yogurt was made with non-fat milk, used as a control, F2: yogurt was prepared with non-fat milk and added with vegetable palm oil, and F3: non-fat yogurt was added with vegetable oil and nanoencapsulated oak bark phenolic extract. The yogurts were characterized in their chemical composition, microbiological analysis, and sensory analysis. Results: The multifunctional product F3 and product F2 presented lactic acid bacteria in concentration of 3.01X106 and 4.73x106, respectively, preserving characteristics of probiotic food. Product F3 presented low levels of syneresis (7.34%) and it was significantly different from the control yogurt (9.01%). The viscosity increased from 150 cP in the control yogurt to 341 cP in F3, due to the increase in the concentrations of solids by nanoencapsulating the phenolic. The wall material used for nanoencapsulation was sodium caseinate and mantodextrin. However, this increase in viscosity did not affect the sensory evaluation of the product. There were no significant differences between the control yogurt and the F2 and F3 products. Conclusion: A yogurt added with vegetable oil and nanoencapsulated oak bark phenolic extract was obtained. It was enhanced by the presence of probiotics, bioactive compounds, and essential fatty acids, and then evaluated and accepted by a sensory panel. Nanoencapsulation is a viable alternative to mask the characteristic astringent taste of phenolic compounds because it was not detected by the panelists