Asistencia farmacéutica a la prescripción para aproximar la práctica clínica a la evidencia científica

ObjetivoEl objetivo del presente estudio es valorar la utilidad de un programa de asistencia farmacéutica a la prescripción (AFP) en cuanto a la detección de problemas relacionados con los medicamentos.DiseñoRealizamos un estudio descriptivo de los hallazgos de este programa al cabo de 6 meses de rodaje.EmplazamientoEl trabajo fue realizado en 5 centros del Distrito Bahía-Cádiz de Atención Primaria.PacientesSe estudian todos los pacientes (499) incluidos a petición y criterio de su médico, que solicita asesoramiento sobre su farmacoterapia.IntervenciónImplantamos el programa de AFP en pacientes crónicos con dos finalidades básicas:1. Asistencial: detectar problemas relacionados con medicamentos y proponer soluciones individualizadas.2. Docente: aproximar los conocimientos en farmacoterapia aplicados en la práctica clínica a la evidencia científica disponible.Mediciones y resultadosNos centramos en la detección de aquellos problemas relacionados con medicamentos más frecuentes, con incidencia directa y relevante sobre la morbimortalidad. Detectamos 236 casos (47%) de posible mejora terapéutica con implicaciones importantes sobre morbilidad asociada, de los cuales 114 (23%) tenían también implicaciones sobre mortalidad. Un 56% de los pacientes recibía más de 4 medicamentos, polimedicación que podía reducirse fácilmente en un 43,5% de ellos, evitando la utilización de medicamentos de valor intrínseco no elevado.ConclusionesLa utilidad del programa resulta muy elevada al detectar numerosos problemas de gran relevancia clínica y aportar información que puede ser útil al médico para aproximar la farmacoterapia a la evidencia científica disponible.ObjectiveThe objective of this study is to assess the usefulness of a programme of attention to pharmaceutical prescriptions (APP) so as to detect medicine-related problems.DesignA descriptive study of the findings after six months operation of this programme.SettingFive primary care centres in the Bahía-Cádiz Area.PatientsAll the patients (499) who requested advice on their drug therapy and were included at the request and on the criterion of their doctor were studied.InterventionWe introduced the APP programme for chronic patients, with two basic aims:1. Care: to detect medicine-related problems and propose individual solutions.2. Teaching: to bring drug-therapy skills used in clinical practice into line with the scientific evidence available.Measurements and resultsWe focused on the detection of problems related to the most common medicines, with direct and relevant incidence on morbidity and mortality. We detected 236 cases (47%) of possible therapeutic improvement that had important implications for associated morbidity, of which 114 (23%) also had implications for mortality. 56% of the patients took more than 4 medicines, multiple medication that could easily be reduced in 43.5% of cases, so avoiding the use of medicines of low intrinsic value.ConclusionsThe programme was very useful, as numerous very clinically relevant problems were detected and information was gained that the doctor can use to bring drug therapy into line with the available scientific evidence

Alteration of medial-edge epithelium cell adhesion in two Tgf-beta3 null mouse strains

Although palatal shelf adhesion is a crucial event during palate development, little work has been carried out to determine which molecules are responsible for this process. Furthermore, whether altered palatal shelf adhesion causes the cleft palate presented by Tgf-b3 null mutant mice has not yet been clarified. Here, we study the presence/distribution of some extracellular matrix and cell adhesion molecules at the time of the contact of palatal shelves in both wild-type and Tgf-b3 null mutant palates of two strains of mice (C57/BL/6J(C57), and MF1) that develop cleft palates of different severity. We have performed immunohistochemistry with antibodies against collagens IV and IX, laminin, fibronectin, the a5- and b1-integrins, and ICAM-1; in situ hybridization with a Nectin-1 riboprobe; and palatal shelf cultures treated or untreated with TGF-b3 or neutralizing antibodies against fibronectin or the a5-integrin. Our results show the location of these molecules in the wild-type mouse medial edge epithelium (MEE) of both strains at the time of the contact of palatal shelves; the heavier (C57) and milder (MF1) alteration of their presence in the Tgf-b3 null mutants; the importance of TGF-b3 to restore their normal pattern of expression; and the crucial role of fibronectin and the a5-integrin in palatal shelf adhesion. We thus provide insight into the molecular bases of this important process and the cleft palate presented by Tgf-b3 null mutant mice.Fondo de Investigaciones SanitariasComunidad Autónoma de MadridUniversidad ComplutenseDepto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA