Investigación y conocimiento en Atención Farmacéutica: un binomio inseparable

La investigación constituye la principal herramienta para la ampliación y el progreso del conocimiento de cualquier disciplina científica. Con otras palabras, se trata de utilizar el método científico,realizando actividades intelectuales y experimentales de modo sistemático, con el propósito de construir los conocimientos sobre una determinada materia.Lógicamente, estos principios también son aplicables a la Atención Farmacéutica o Farmacia Práctica. Sin embargo, dada la corta trayectoria de esta disciplina, no solo en nuestro país (a donde llegó hace apenas 15 años), sino a nivel internacional, es preciso entender que el conocimiento enAtención Farmacéutica o Farmacia Práctica,generado en torno a la investigación,es aún escaso. Hasta el momento, buena parte del conocimiento ha sido fundado o adaptado, con criterio, a partir de otras disciplinas sanitarias.El profesional farmacéutico es consciente de que la prestación de servicios orientados a preservar o mejorar la salud y/o calidad de vida de los pacientes constituye un elemento clave para el futuro de la profesión. De ahí que la consolidación de esta disciplina (y su integración en la actividad diaria) se haga cada vez más necesaria y, por tanto, también la investigación.La ventaja o el inconveniente, según quiera entenderse, de investigar en Atención Farmacéutica o Farmacia Práctica radica en la innumerable cantidad de cuestiones que aún quedan por abordar y resolver, es decir, sobre las que aún existe “vacío de conocimiento”. La amplitud de la investigación en Atención Farmacéutica o Farmacia Prácticaderiva de la propia naturaleza de una actividad que se puede ver influida por las condiciones del entornodonde se desarrolla, implica la interacción profesional entredistintos actores implicados en el proceso sanitario (incluido el paciente), supone la aplicación de conocimientos específicos, el desarrollo de habilidades, etc., todo ello en pro de evaluar y mejorar la salud y/o calidad de vida de los pacientes. Así, la investigación en Atención Farmacéutica o Farmacia Práctica puede abarcar aspectos como,por ejemplo, el impacto de los distintos servicios que puedan considerarse sobre resultados en salud (clínicos, humanísticos o económicos), la integración de estos servicios en el conjunto de la asistencia sanitaria, la implantación de los servicios en la actividad diaria de los servicios de farmacia, la utilidad de nuevos métodos para la prestación de los servicios, etc.En la actualidad, es posible encontrar un gran número de trabajos que abordan algunas de estas cuestiones y empiezan a fundar los cimientos del conocimientoen Atención Farmacéutica o Farmacia Práctica. Sin embargo, es preciso señalar que no todos los estudios realizados hasta el momento han servido para tal propósito, ya que no presentan la calidad metodológica adecuada para generar una evidencia sólida. En este punto, es preciso entender que de nada sirve poner en marcha iniciativas y utilizar recursos (económicos, humanos, materiales, etc.) si la validez de la investigación no está garantizada y, por tanto, los resultados finales pueden ser cuestionables.En relación a lo anterior, también cabe señalar que, dado que el propósito último cuando se genera el conocimiento es poder aplicarlo, tampoco sirve de mucho hacer investigación de calidad si finalmente ésta no se difunde. Y no solo se trata de difundirla a la comunidad científica sino también a la comunidad de profesionales que después deben trasladarla a la práctica y generalizar estas experiencias aisladas al conjunto de la población (donde deben ser nuevamente investigadas). En definitiva, se pretende que la investigación realizada en Atención Farmacéutica o Farmacia Práctica genere conocimiento y este luego se traduzca en la prestación de servicios farmacéuticos viables, de calidad, bien integrados en el conjunto de la actividad sanitaria y aceptados por la sociedady, por supuesto, efectivos (y seguros).Para promover la investigación en Atención Farmacéutica o Farmacia Práctica es necesaria la implicación de cualquier entidad relacionada con el mundo de la farmacia (universidades,instituciones políticas, sociedades científicas, organizaciones colegiales, etc.). No obstante, es importante que cada cual conozca el papel que puedejugar en las diferentes etapas del proceso de la investigación, el cual abarca el diseño hasta la aplicación práctica.Así, por ejemplo, la Universidad podría asumir el reto de responsabilizarse del diseño de los estudios (asegurando su validez) y la difusión de los resultados a la comunidad científica. Por su parte, las sociedades científicas podrían colaborar con las universidades en su cometido y, además, contribuir en la coordinación de los estudios, buscar alianzas con otras sociedades de otras disciplinas o cualificar a sus miembros para que posteriormente estos sean quienes ejecuten la investigación de la forma más adecuada. En última instancia, las instituciones (profesionales, políticas, etc.) más cercanas a la profesión, encargas de promover/forzar cambios en ella, deben de tener la capacidad de conocer y entender la trascendencia de la nueva evidencia que se genere y posteriormente mover los hilos necesarios para que el colectivo profesional incorpore los cambios. Finalmente, todas ellas deben implicarse en la búsqueda de los fondos que permitan cubrir los gatos de la investigación

Effect of pharmaceutical intervention on medication adherence and blood pressure control in treated hypertensive patients: Rationale, design and methods of the AFenPA pilot study.

Objetivo: Evaluar el efecto de una intervención farmacéutica protocolizada sobre el control de la presión arterial y la adherencia al tratamiento farmacológico en pacientes usuarios de farmacias comunitarias.Material y métodos: Estudio cuasi-experimental con grupo control en el que se comparará el efecto de una intervención farmacéutica (grupo intervención) con el proceso de atención habitual (grupo control), sobre la presión arterial y la adherencia al tratamiento de pacientes hipertensos tratados farmacológicamente en farmacias comunitarias. Los pacientes serán distribuidos de forma equitativa en ambos grupos (n control = n intervención) y serán seguido durante 6 meses. El programa de la intervención farmacéutica constará de tres partes fundamentales: 1) educación/información al paciente sobre aspectos relacionados con la hipertensión y adherencia al tratamiento farmacológico, 2) automonitorización de la presión arterial y, 3) interacción con el médico mediante informes personalizados cuando la media de las cifras de presión arterial realizadas en el domicilio superen el objetivo terapéutico acorde con la situación clínica del paciente. Para evaluar el efecto de la intervención farmacéutica sobre la adherencia terapéutica y la presión arterial se obtendrán medidas de presión arterial en la farmacia y porcentaje de cumplimiento terapéutico mediante recuento de comprimidos en ambos grupos al principio y al final del estudio.Discusión: Según nuestros conocimientos, éste es el primer estudio que se realiza en farmacia comunitaria en España para probar la efectividad de una intervención farmacéutica conjuntamente con la automedida de la presión arterial sobre el control de la presión arterial. Además, la intervención farmacéutica se ha diseñado de forma que pueda integrase como práctica habitual enmarcada dentro de la Atención Farmacéutica.Objective: To assess the effect of a protocol-based pharmacist intervention on blood pressure control and medication adherence among treated hypertensive patients who are users of community pharmacies.Methods: A quasi experimental study design with control group has been designed to compare the effect of pharmaceutical intervention (intervention group) versus the standard healthcare procedure (control group) on blood pressure and medication adherence among hypertensive patients receiving drug therapy in community pharmacies. The patients will be allocated evenly between the two groups (ncontrol = nintervention), with a 6-month follow-up. The pharmaceutical intervention program will comprise three main parts: 1) patient education / information on issues relating to hypertension and medication adherence; 2) self-monitoring of blood pressure; and 3) interaction with the physician through personalized reports when the mean blood pressure values recorded at home exceed the treatment goal according to the clinical condition of the patient. In order to evaluate the effect of the pharmaceutical intervention upon medication adherence and blood pressure, blood pressure recordings will be made in the pharmacy, while percent medication adherence will be established based on pill count in both groups at the start and end of the study.Discussion: To our knowledge, this is the first study in the community pharmacy setting in Spain to evaluate the effectiveness of pharmaceutical intervention in combination with home blood pressure monitoring on blood pressure control. In addition, the pharmaceutical intervention has been designed for inclusion as standard practice in the context of Pharmaceutical Care

Available measurement methods of blood pressure at the community pharmacy for the screening and follow up of hypertension

The blood pressure (BP) measurement in the physician's office has been for many years the gold standard for diagnosis, monitoring and making clinical decisions in the management of hypertension. On the other hand, few studies analyze the usefulness of the community pharmacy BP measurement method, which remains unknown in clinical practice. Home and ambulatory BP monitoring (HBPM and ABPM, respectively) have overcome many of the inherent limitations of the BP measurement at the physician's office, mainly providing multiple BP readings exempt from the white coat effect. Additionally, these methods have shown to be better predictors of end-organ damage and cardiovascular outcome than BP measured in the physician's office. Finally, the use of HBPM or ABPM enables a more accurate assessment and an improved management of hypertension. This article provides an overview update on the interest of the different BP measurement methods available in the community pharmacy for the screening and monitoring of hypertensive patients

Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies

© 2016 Elsevier España, S.L.U. Objectives To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. Design Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. Location Spanish Community Pharmacies. Participants There were 323 patients in the control group, from the 640 who completed the study. Main measurements Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. Results For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). Conclusions According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity

Expression of ZIC family genes in meningiomas and other brain tumors

<p>Abstract</p> <p>Background</p> <p>Zic zinc finger proteins are present in the developing rodent meninges and are required for cell proliferation and differentiation of meningeal progenitors. Although human <it>ZIC </it>genes are known to be molecular markers for medulloblastomas, their expression in meningioma has not been addressed to date.</p> <p>Methods</p> <p>We examined the mRNA and protein expression of human <it>ZIC1</it>, <it>ZIC2</it>, <it>ZIC3</it>, <it>ZIC4 </it>and <it>ZIC5 </it>genes in meningiomas in comparison to other brain tumors, using RT-PCR, analysis of published microarray data, and immunostaining.</p> <p>Results</p> <p><it>ZIC1</it>, <it>ZIC2 </it>and <it>ZIC5 </it>transcript levels in meningiomas were higher than those in whole brain or normal dura mater, whereas all five <it>ZIC </it>genes were abundantly expressed in medulloblastomas. The expression level of <it>ZIC1 </it>in public microarray data was greater in meningiomas classified as World Health Organization Grade II (atypical) than those classified as Grade I (benign). Immunoscreening using anti-ZIC antibodies revealed that 23 out of 23 meningioma cases were ZIC1/2/3/5-immunopositive. By comparison, nuclear staining by the anti-ZIC4 antibody was not observed in any meningioma case, but was strongly detected in all four medulloblastomas. ZIC-positive meningiomas included meningothelial, fibrous, transitional, and psammomatous histological subtypes. In normal meninges, ZIC-like immunoreactivities were detected in vimentin-expressing arachnoid cells both in human and mouse.</p> <p>Conclusions</p> <p>ZIC1, ZIC2, and ZIC5 are novel molecular markers for meningiomas whereas <it>ZIC4 </it>expression is highly selective for medulloblastomas. The pattern of <it>ZIC </it>expression in both of these tumor types may reflect the properties of the tissues from which the tumors are derived.</p

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)

Citrobacter freundii infection after acute necrotizing pancreatitis in a patient with a pancreatic pseudocyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>Infections are the most frequent and severe complications of acute necrotizing pancreatitis with a mortality rate of up to 80 percent. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is controversial.</p> <p>Case presentation</p> <p>We describe a <it>Citrobacter freundii </it>isolation by endoscopy ultrasound fine needle aspiration in a 80-year-old Caucasian man with pancreatic pseudocyst after acute necrotizing pancreatitis.</p> <p>Conclusion</p> <p>Our case report confirms that this organism can be recovered in patients with a pancreatic pseudocyst. On-site cytology feedback was crucial to the successful outcome of this case as immediate interpretation of the fine needle aspiration sample directed the appropriate cultures and, ultimately, the curative therapy. To the best of our knowledge, this is the first reported case of isolated pancreatic <it>C. freundii </it>diagnosed by endoscopy ultrasound fine needle aspiration.</p

The LOFAR Two-metre Sky Survey: Deep Fields data release 1. V. Survey description, source classifications, and host galaxy properties

Source classifications, stellar masses, and star-formation rates are presented for ≈80 000 radio sources from the first data release of the Low Frequency Array Two-metre Sky Survey (LoTSS) Deep Fields, which represents the widest deep radio survey ever undertaken. Using deep multi-wavelength data spanning from the ultraviolet to the far-infrared, spectral energy distribution (SED) fitting is carried out for all of the LoTSS Deep host galaxies using four different SED codes, two of which include modelling of the contributions from an active galactic nucleus (AGN). Comparing the results of the four codes, galaxies that host a radiative AGN are identified, and an optimized consensus estimate of the stellar mass and star-formation rate for each galaxy is derived. Those galaxies with an excess of radio emission over that expected from star formation are then identified, and the LoTSS Deep sources are divided into four classes: star-forming galaxies, radio-quiet AGN, and radio-loud high-excitation and low-excitation AGN. Ninety-five per cent of the sources can be reliably classified, of which more than two-thirds are star-forming galaxies, ranging from normal galaxies in the nearby Universe to highly-starbursting systems at z > 4. Star-forming galaxies become the dominant population below 150-MHz flux densities of ≈1 mJy, accounting for 90 per cent of sources at S150MHz ∼ 100 μJy. Radio-quiet AGN comprise ≈10 per cent of the overall population. Results are compared against the predictions of the SKADS and T-RECS radio sky simulations, and improvements to the simulations are suggested

Cancer incidence among the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK.

Few studies have examined epidemiological differences between ethnic groups for children and young adults with cancer