Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care

Background Pharmacists-led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta-analysis was to analyze the impact of pharmacist-led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs. Methods and Results Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist-led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta-analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta-analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05-7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17-5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05-3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low-density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present. Conclusions Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities

Promoción de la salud y entornos saludables

A forestar forestalAplicación de un programa educativo participativo en salud  bucal a una comunidad de adultos mayoresBiblioteca móvil y su implementación en el hospital Padre HurtadoConsumo de riesgo de alcohol en Chile: una propuesta innovadora de intervenciónDiseño de un programa interactivo de promoción de la salud vocal para NB1Encuentro formativo en promoción de salud y gestión de entornos saludables para TenoExperiencia docente: programa intersectorial de promoción/prevención en preescolares de comunas vulnerables, Región MetropolitanaFiltrado glomerular, método preventivo aparición de fibrosis sistémica nefrogénica por gadolinio en examen de RMImplementación de consejerías en vida sana en APS, Región de los RíosMedicina preventiva en feria libre de la población San Gregorio: Cecof San Gregorio, Contagiando SaludMetodología innovadora en la enseñanza de una ectoparasitosisPrevención de accidentes por monóxido de carbono en edificios, Providencia 2002-2009Programa de promoción y prevención en salud bucal para preescolaresPromoviendo hábitos saludables en los vecinos de Reñaca Alto, Viña del Mar, 2009Rol de la capacitación en la implementación de acciones para la prevención de la obesidadSatisfacción usuaria en el Cesfam Natales a un año de su funcionamientoTres estrategias publicitarias y de comunicación aplicadas al consumo de alcohol de bajo riesgoTropa de la salud: uso de los medios como forma de promover la salu

Inefficient Chronic Activation of Parietal Cells in Ae2(a,b)(−/−) Mice

In parietal cells, basolateral Ae2 Cl(−)/HCO(3)(−) exchanger (Slc4a2) appears to compensate for luminal H(+) pumping while providing Cl(−) for apical secretion. In mouse and rat, mRNA variants Ae2a, Ae2b1, Ae2b2, and Ae2c2 are all found in most tissues (although the latter at very low levels), whereas Ae2c1 is restricted to the stomach. We studied the acid secretory function of gastric mucosa in mice with targeted disruption of Ae2a, Ae2b1, and Ae2b2 (but not Ae2c) isoforms. In the oxyntic mucosa of Ae2(a,b)(−/−) mice, total Ae2 protein was nearly undetectable, indicating low gastric expression of the Ae2c isoforms. In Ae2(a,b)(−/−) mice basal acid secretion was normal, whereas carbachol/histamine-stimulated acid secretion was impaired by 70%. These animals showed increased serum gastrin levels and hyperplasia of G cells. Immunohistochemistry and electron microscopy revealed baseline activation of parietal cells with fusion of intracellular H(+)/K(+)-ATPase-containing vesicles with the apical membrane and degenerative changes (but not substantial apoptosis) in a subpopulation of these cells. Increased expression of proliferating cell nuclear antigen in the oxyntic glands suggested enhanced Ae2(a,b)(−/−) parietal cell turnover. These data reveal a critical role of Ae2a-Ae2b1-Ae2b2 isoforms in stimulated gastric acid secretion whereas residual Ae2c isoforms could account to a limited extent for basal acid secretion