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

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health car

Biopsychosocial factors related to the length of hospital stay in older people

This study aimed to know what variables influence increased length of hospital stay. A descriptive, cross-sectional study was conducted through an integrated geriatric assessment of 81 people over 65 years of age, admitted to a tertiary acute care hospital. Data were collected through the Pfeiffer Scale, Barthel Index, Goldberg Questionnaire, Family APGAR and Gijón Scale. The length of hospital stay increased in people over 80 years, people living alone or in a retirement home, patients with great physical dependence and those with a risk or problem of social exclusion. The most influential variable for longer hospitalization was cognitive impairment (pEste estudio tuvo como objetivo conocer qué variables influyen en el aumento de la duración de la estancia hospitalaria. Se trata de un estudio descriptivo transversal en el que se realizó una Valoración Geriátrica Integral a 81 personas mayores de 65 años de edad que ingresaron en un hospital de agudos de tercer nivel. Para ello, los datos fueron recogidos por medio de la Escala de Pfeiffer, el Índice de Barthel, el Cuestionario de Goldberg, el APGAR familiar y la Escala de Gijón. Se observó un aumento de la duración de la estancia hospitalaria entre los mayores de 80 años, las personas que vivían solas o en una residencia geriátrica, los pacientes que presentaban gran dependencia física y también, entre quienes tenían un riesgo o problema de exclusión social. La variable que más influyó en la mayor duración de la hospitalización fue el deterioro cognitivo (pEste estudo teve como objetivo conhecer quais as variáveis que influenciam o aumento do tempo de internação hospitalar. Trata-se de estudo descritivo e transversal, conduzido mediante ampla avaliação geriátrica de 81 pessoas com mais de 65 anos, internadas em hospital terciário de cuidados agudos. Os dados foram coletados através da Escala Pfeiffer, Índice de Barthel, Questionário de Goldberg, Apgar da Família e Escala de Gijón. Observou-se aumento no tempo de internação entre pessoas com mais de 80 anos, pessoas que vivem sozinhas ou em lar de idosos, pacientes que tinham grande dependência física, e entre aqueles com algum risco ou problema de exclusão social. A variável mais influente, para a maior duração da hospitalização, foi a deterioração cognitiva (p<0,05), em comparaç��o à maior colaboração do paciente sem essa condição ou ao seu desejo de superar a fase aguda da patologia que levou à internação hospitalar

Recommendations for the Treatment of Anti-Melanoma Differentiation-Associated Gene 5-positive Dermatomyositis-Associated Rapidly Progressive Interstitial Lung Disease

Objectives: The study aimed to develop evidence-based recommendations for the treatment of rapidly progressive interstitial lung disease (RPILD) associated with the anti-Melanoma Differentiation-Associated Gene 5-positive dermatomyositis (DM) syndrome. Methods: The task force comprised an expert panel of specialists in rheumatology, intensive care medicine, pulmonology, immunology, and internal medicine. The study was carried out in two phases: identifying key areas in the management of DM-RPILD syndrome and developing a set of recommendations based on a review of the available scientific evidence. Four specific questions focused on different treatment options were identified. Relevant publications in English, Spanish or French up to April 2018 were searched systematically for each topic using PubMed (MEDLINE), EMBASE, and Cochrane Library (Wiley Online). The experts used evidence obtained from these studies to develop recommendations. Results: A total of 134 studies met eligibility criteria and formed the evidentiary basis for the recommendations regarding immunosuppressive therapy and complementary treatments. Overall, there was general agreement on the initial use of combined immunosuppressive therapy. Combination of high-dose glucocorticoids and calcineurin antagonists with or without cyclophosphamide is the first choice. In the case of calcineurin antagonist contraindication or treatment failure, switching or adding other immunosuppressants may be individualized. Plasmapheresis, polymyxin B hemoperfusion and/or intravenous immunoglobulins may be used as rescue options. ECMO should be considered in life-threatening situations while waiting for a clinical response or as a bridge to lung transplant. Conclusions: Thirteen recommendations regarding the treatment of the anti-MDA5 positive DM-RPILD were developed using research-based evidence and expert opinion.This project was supported by Spanish Rheumatology Society and Spanish Society of Internal Medicine (GEAS, Study Group on Autoimmune Diseases)

Randomized clinical trial to evaluate the effect of fecal microbiota transplant for initial Clostridium difficile infection in intestinal microbiome

Objective The aim of this study was to evaluate the impact of fecal donor-unrelated donor mix (FMT-FURM) transplantation as first-line therapy for C. difficile infection (CDI) in intestinal microbiome. Methods We designed an open, two-arm pilot study with oral vancomycin (250mg every 6 h for 10–14 days) or FMT-FURM as treatments for the first CDI episode in hospitalized adult patients in Hospital Universitario “Dr. Jose Eleuterio Gonzalez”. Patients were randomized by a closed envelope method in a 1: 1 ratio to either oral vancomycin or FMT-FURM. CDI resolution was considered when there was a reduction on the Bristol scale of at least 2 points, a reduction of at least 50% in the number of bowel movements, absence of fever, and resolution of abdominal pain (at least two criteria). From each patient, a fecal sample was obtained at days 0, 3, and 7 after treatment. Specimens were cultured to isolate C. difficile, and isolates were characterized by PCR. Susceptibility testing of isolates was performed using the agar dilution method. Fecal samples and FMT-FURM were analyzed by 16S rRNA sequencing. Results We included 19 patients; 10 in the vancomycin arm and 9 in the FMT-FURM arm. However, one of the patients in the vancomycin arm and two patients in the FMT-FURM arm were eliminated. Symptoms resolved in 8/9 patients (88.9%) in the vancomycin group, while symptoms resolved in 4/7 patients (57.1%) after the first FMT-FURM dose (P = 0.26) and in 5/7 patients (71.4%) after the second dose (P = 0.55). During the study, no adverse effects attributable to FMT-FURM were observed in patients. Twelve isolates were recovered, most isolates carried tcdB, tcdA, cdtA, and cdtB, with an 18-bp deletion in tcdC. All isolates were resistant to ciprofloxacin and moxifloxacin but susceptible to metronidazole, linezolid, fidaxomicin, and tetracycline. In the FMT-FURM group, the bacterial composition was dominated by Firmicutes, Bacteroidetes, and Proteobacteria at all-time points and the microbiota were remarkably stable over time. The vancomycin group showed a very different pattern of the microbial composition when comparing to the FMT-FURM group over time. Conclusion The results of this preliminary study showed that FMT-FURM for initial CDI is associated with specific bacterial communities that do not resemble the donors’ sample.Peer reviewedFinal Published versio

Magnetic Coupling in the Quiet Solar Atmosphere

Three kinds of magnetic couplings in the quiet solar atmosphere are highlighted and discussed, all fundamentally connected to the Lorentz force. First the coupling of the convecting and overshooting fluid in the surface layers of the Sun with the magnetic field. Here, the plasma motion provides the dominant force, which shapes the magnetic field and drives the surface dynamo. Progress in the understanding of the horizontal magnetic field is summarized and discussed. Second, the coupling between acoustic waves and the magnetic field, in particular the phenomenon of wave conversion and wave refraction. It is described how measurements of wave travel times in the atmosphere can provide information about the topography of the wave conversion zone, i.e., the surface of equal Alfv\'en and sound speed. In quiet regions, this surface separates a highly dynamic magnetic field with fast moving magnetosonic waves and shocks around and above it from the more slowly evolving field of high-beta plasma below it. Third, the magnetic field also couples to the radiation field, which leads to radiative flux channeling and increased anisotropy in the radiation field. It is shown how faculae can be understood in terms of this effect. The article starts with an introduction to the magnetic field of the quiet Sun in the light of new results from the Hinode space observatory and with a brief survey of measurements of the turbulent magnetic field with the help of the Hanle effect.Comment: To appear in "Magnetic Coupling between the Interior and the Atmosphere of the Sun", eds. S.S. Hasan and R.J. Rutten, Astrophysics and Space Science Proceedings, Springer-Verlag, Heidelberg, Berlin, 200

Transcriptome profiling of grapevine seedless segregants during berry development reveals candidate genes associated with berry weight

Indexación: Web of Science; PubMedBackground Berry size is considered as one of the main selection criteria in table grape breeding programs. However, this is a quantitative and polygenic trait, and its genetic determination is still poorly understood. Considering its economic importance, it is relevant to determine its genetic architecture and elucidate the mechanisms involved in its expression. To approach this issue, an RNA-Seq experiment based on Illumina platform was performed (14 libraries), including seedless segregants with contrasting phenotypes for berry weight at fruit setting (FST) and 6–8 mm berries (B68) phenological stages. Results A group of 526 differentially expressed (DE) genes were identified, by comparing seedless segregants with contrasting phenotypes for berry weight: 101 genes from the FST stage and 463 from the B68 stage. Also, we integrated differential expression, principal components analysis (PCA), correlations and network co-expression analyses to characterize the transcriptome profiling observed in segregants with contrasting phenotypes for berry weight. After this, 68 DE genes were selected as candidate genes, and seven candidate genes were validated by real time-PCR, confirming their expression profiles. Conclusions We have carried out the first transcriptome analysis focused on table grape seedless segregants with contrasting phenotypes for berry weight. Our findings contributed to the understanding of the mechanisms involved in berry weight determination. Also, this comparative transcriptome profiling revealed candidate genes for berry weight which could be evaluated as selection tools in table grape breeding programs.http://bmcplantbiol.biomedcentral.com/articles/10.1186/s12870-016-0789-

Hemodynamic impact of isobaric levobupivacaine versus hyperbaric bupivacaine for subarachnoid anesthesia in patients aged 65 and older undergoing hip surgery

BackgroundThe altered hemodynamics, and therefore the arterial hypotension is the most prevalent adverse effect after subarachnoid anesthesia. The objective of the study was to determine the exact role of local anesthetic selection underlying spinal anesthesia-induced hypotension in the elderly patient. We conducted a descriptive, observational pilot study to assess the hemodynamic impact of subarachnoid anesthesia with isobaric levobupivacaine versus hyperbaric bupivacaine for hip fracture surgery.DescriptionHundred twenty ASA status I-IV patients aged 65 and older undergoing hip fracture surgery were enrolled. The primary objective of our study was to compare hemodynamic effects based on systolic blood pressure (SBP) and dyastolic blood pressure (DBP) values, heart rate (HR) and hemoglobin (Hb) and respiratory effects based on partial oxygen saturation (SpO2%) values. The secondary objective was to assess potential adverse events with the use of levobupivacaine versus bupivacaine. Assessments were performed preoperatively, at 30 minutes into surgery, at the end of anesthesia and at 48 hours and 6 months after surgery.Among intraoperative events, the incidence of hypotension was statistically significantly higher (p <0.05) in group BUPI (38.3%) compared to group LEVO (13.3%). There was a decrease (p <0.05) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 30 minutes intraoperatively (19% in group BUPI versus 17% in group LEVO). SpO2% increased at 30 minutes after anesthesia onset (1% in group BUPI versus 1.5% in group LEVO). Heart rate (HR) decreased at 30 minutes after anesthesia onset (5% in group BUPI versus 9% in group L). Hemoglobin (Hb) decreased from time of operating room (OR) admission to the end of anesthesia (9.3% in group BUPI versus 12.5% in group LEVO). The incidence of red blood cell (RBC) transfusion was 13.3% in group BUPI versus 31.7% in group LEVO, this difference was statistically significant. Among postoperative events, the incidence of congestive heart failure (CHF) was significantly higher in group BUPI (8,3%). At 6 months after anesthesia, no differences were found.ConclusionsGiven the hemodynamic stability and lower incidence of intraoperative hypotension observed, levobupivacaine could be the agent of choice for subarachnoid anesthesia in elderly patients

Reliability of infrared thermography in skin temperature evaluation of wheelchair users

To examine the reliability of infrared thermography (IRT) in wheelchair users (WCUs), as a noninvasive and risk-free technique to detect the natural thermal radiation emitted by human skin and to allow subsequent interpretations of temperature distributions