Análisis de registros de dispensación en antiinflamatorios no esteroideos dentro del programa D-Valor

Objetivo: Analizar y evaluar los datos obtenidos durante la dispensación de antiinflamatorios no esteroideos (AINE) dentro del programa D-Valor. Método: Se trabajó con un diseño de estudio multicéntrico, observacional y prospectivo de registros de datos de dispensación de medicamentos de grupos terapéuticos definidos. Resultados: En el 23% de las dispensaciones, el paciente utilizaba además otro medicamento susceptible de interacción. Más del 60% de los pacientes no conocía el uso adecuado del medicamento. El principio activo más dispensado fue ibuprofeno (38%). Conclusiones: Los AINE están entre los medicamentos más utilizados, pero debe mejorarse el conocimiento sobre su utilización. El diálogo con el paciente en el momento de la dispensación de AINE facilita la detección de situaciones de riesgo relacionadas

Análisis de registros de dispensación en antiinflamatorios no esteroideos dentro del programa D-Valor

Objetivo: Analizar y evaluar los datos obtenidos durante la dispensación de antiinflamatorios no esteroideos (AINE) dentro del programa D-Valor. Método: Se trabajó con un diseño de estudio multicéntrico, observacional y prospectivo de registros de datos de dispensación de medicamentos de grupos terapéuticos definidos. Resultados: En el 23% de las dispensaciones, el paciente utilizaba además otro medicamento susceptible de interacción. Más del 60% de los pacientes no conocía el uso adecuado del medicamento. El principio activo más dispensado fue ibuprofeno (38%). Conclusiones: Los AINE están entre los medicamentos más utilizados, pero debe mejorarse el conocimiento sobre su utilización. El diálogo con el paciente en el momento de la dispensación de AINE facilita la detección de situaciones de riesgo relacionadas

Programa D-VALOR, análisis de registros de dispensación. Benzodiazepinas

Objetivo: El objetivo del presente trabajo dentro del programa D-VALOR consiste en la evaluación de las dispensaciones de benzodiazepina (BZD), así como su registro, y comprobar si el paciente tiene conocimiento acerca de los medicamentos que recibe, si los usa de forma correcta y si observa las precauciones necesarias que requiere el grupo terapéutico. Método: Se trata de un estudio multicéntrico, observacional y prospectivo de registros de dispensaciones. Se registraron 47.829 dispensaciones. Resultados: En todas las edades la mujer usa más este tipo de medicación que el hombre. El 82,10% de los tratamientos son de continuación; un 51% de los pacientes desconocen la duración del tratamiento en los de inicio, y un 44% en los de continuación. Esto es preocupante, pues los problemas que presentan los tratamientos con BZD y sus análogos (caídas, fracturas y efectos sobre la psicomotricidad) están relacionados con su uso prolongado. En cuanto al conocimiento de los pacientes sobre el medicamento, sólo un 54% tienen un conocimiento global del tratamiento en lo que se refiere a la posología, la pauta de uso y su duración. Un 23% de pacientes manifiestan no estar satisfechos con su tratamiento, de los cuales un 6% declaran estarlo parcialmente tras haber sufrido resultados negativos asociados a la medicación. Las BZD más demandadas fueron lorazepam (11.862 casos), alprazolam (9.131) y lormetazepam (6.339), y de entre sus análogos zolpidem fue el más solicitado (3.331). Conclusiones: Dada la falta de conocimientos del paciente, especialmente en lo que se refiere a la duración del tratamiento con BZD y las precauciones que lleva asociadas su administración, una correcta dispensación puede ser de gran ayuda al paciente para que el tratamiento farmacológico se lleve a cabo de forma segura y eficaz

Embedding expert opinion in a Bayesian network model to predict wheat yield from spring-summer weather

Wheat yield is highly dependent on weather, Therefore, predicting its effect can improve crop management decisions. Various modelling approaches have been used to predict wheat yield including process-based modelling, statistical models, and machine learning. However, these models typically require a large data set for training or fitting. They often also have a limited ability in capturing the effects of small-scale variability, time, and duration of extreme weather events. Here, we develop a Bayesian Network (BN) model by interviewing experts including farmers, embedding their knowledge from years of experience within a quantitative model. These experts identified the period from the beginning of anthesis to the end of grain filling stage as a critical period and maximum temperature, mean temperature and precipitation as key weather variables for inclusion in the BN. To keep the time input from experts manageable, the conditional probability table for the BN was constructed based on their anticipated impact on the mean yield of different weather conditions. The model predicted the yield in the same or neighbouring class (very low, low, medium, high and very high) as the reported yield with low error rate ranging from 9.1 to 15.2% and, when used to estimate the median predicted yield, R2 ranging from 41 to 52%. Interestingly, model successfully predicted the yield in years 1998, 2007, 2012 and 2020 which had the most extreme weather events. Additionally, the more recent data, from 2012 to 2022 was predicted more accurately, especially 2022 season which was not sown yet when eliciting information and recently added to the testing data. Little difference was observed between the predictions made using model parameters based only the opinion of the farm manager from which the test data originated, and the predictions made using the average opinion of a group of 9 experts. The inclusion of causal variables in the model also provided insight into the experts’ rationale, allowing unexpected results to be explored. This methodology provides a means to rapidly develop a successful predictive model of wheat yield with limited (or no) data using expert understanding. This model could be tuned and updated with data as it becomes available

Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis

OBJECTIVE: To examine how the population with fractured neck of femur has changed over the last decade and determine whether they have evolved to become a more physically and socially dependent cohort. DESIGN: Retrospective cohort study of prospectively collected Standardised Audit of Hip Fractures of Europe data entered on to an institutional hip fracture registry. PARTICIPANTS: 10 044 consecutive hip fracture admissions (2000–2012). SETTING: A major trauma centre in the UK. RESULTS: There was a generalised increase in the number of admissions between 2000 (n=740) and 2012 (n=810). This increase was non-linear and best described by a quadratic curve. Assuming no change in the prevalence of hip fracture over the next 20 years, our hospital is projected to treat 871 cases in 2020 and 925 in 2030. This represents an approximate year-on-year increase of just over 1%. There was an increase in the proportion of male admissions over the study period (2000: 174 of 740 admissions (23.5%); 2012: 249 of 810 admissions (30.7%)). This mirrored national census changes within the geographical area during the same period. During the study period there were significant increases in the numbers of patients admitted from their own home, the proportion of patients requiring assistance to mobilise, and the proportion of patients requiring help with basic activities of daily living (all p<0.001). There was also a twofold to fourfold increase in the proportion of patients admitted with a diagnosis of cardiovascular disease, renal disease, diabetes and polypharmacy (use of >4 prescribed medications; all p<0.001). CONCLUSIONS: The expanding hip fracture population has increasingly complex medical, social and rehabilitation care needs. This needs to be recognised so that appropriate healthcare strategies and service planning can be implemented. This epidemiological analysis allows projections of future service need in terms of patient numbers and dependency

When a Palearctic bacterium meets a Nearctic insect vector: Genetic and ecological insights into the emergence of the grapevine Flavescence dorée epidemics in Europe

Flavescence dorée (FD) is a European quarantine grapevine disease transmitted by the Deltocephalinae leafhopper Scaphoideus titanus. Whereas this vector had been introduced from North America, the possible European origin of FD phytoplasma needed to be challenged and correlated with ecological and genetic drivers of FD emergence. For that purpose, a survey of genetic diversity of these phytoplasmas in grapevines, S. titanus, black alders, alder leafhoppers and clematis were conducted in five European countries. Out of 132 map genotypes, only 11 were associated to FD outbreaks, three were detected in clematis, whereas 127 were detected in alder trees, alder leafhoppers or in grapevines out of FD outbreaks. Most of the alder trees were found infected, including 8% with FD genotypes M6, M38 and M50, also present in alders neighboring FD-free vineyards and vineyard-free areas. The Macropsinae Oncopsis alni could transmit genotypes unable to achieve transmission by S. titanus, while the Deltocephalinae Allygus spp. and Orientus ishidae transmitted M38 and M50 that proved to be compatible with S. titanus. Variability of vmpA and vmpB adhesin-like genes clearly discriminated 3 genetic clusters. Cluster Vmp-I grouped genotypes only transmitted by O. alni, while clusters Vmp-II and -III grouped genotypes transmitted by Deltocephalinae leafhoppers. Interestingly, adhesin repeated domains evolved independently in cluster Vmp-I, whereas in clusters Vmp-II and-III showed recent duplications. Latex beads coated with various ratio of VmpA of clusters II and I, showed that cluster II VmpA promoted enhanced adhesion to the Deltocephalinae Euscelidius variegatus epithelial cells and were better retained in both E. variegatus and S. titanus midguts. Our data demonstrate that most FD phytoplasmas are endemic to European alders. Their emergence as grapevine epidemic pathogens appeared restricted to some genetic variants pre-existing in alders, whose compatibility to S. titanus correlates with different vmp gene sequences and VmpA binding properties

Personal mental health navigator: Harnessing the power of data, personal models, and health cybernetics to promote psychological well-being

Current digital mental healthcare solutions conventionally take on a reactive approach, requiring individuals to self-monitor and document existing symptoms. These solutions are unable to provide comprehensive, wrap-around, customized treatments that capture an individual's holistic mental health model as it unfolds over time. Recognizing that each individual requires personally tailored mental health treatment, we introduce the notion of Personalized Mental Health Navigation (MHN): a cybernetic goal-based system that deploys a continuous loop of monitoring, estimation, and guidance to steer the individual towards mental flourishing. We present the core components of MHN that are premised on the importance of addressing an individual's personal mental health state. Moreover, we provide an overview of the existing physical health navigation systems and highlight the requirements and challenges of deploying the navigational approach to the mental health domain

Response-adapted treatment with rituximab, bendamustine, mitoxantrone, and dexamethasone followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma after first-line immunochemotherapy: Results of the RBMDGELTAMO08 phase II trial

Background Consensus is lacking regarding the optimal salvage therapy for patients with follicular lymphoma who relapse after or are refractory to immunochemotherapy. Methods This phase II trial evaluated the efficacy and safety of response-adapted therapy with rituximab, bendamustine, mitoxantrone, and dexamethasone (RBMD) in follicular lymphoma patients who relapsed after or were refractory to first-line immunochemotherapy. Sixty patients received three treatment cycles, and depending on their response received an additional one (complete/unconfirmed complete response) or three (partial response) cycles. Patients who responded to induction received rituximab maintenance therapy for 2 years. Results Thirty-three (55%) and 42 (70%) patients achieved complete/unconfirmed complete response after three cycles and on completing induction therapy (4-6 cycles), respectively (final overall response rate, 88.3%). Median progression-free survival was 56.4 months (median follow-up, 28.3 months; 95% CI, 15.6-51.2). Overall survival was not reached. Progression-free survival did not differ between patients who received four vs six cycles (P = .6665), nor between patients who did/did not receive rituximab maintenance after first-line therapy (P = .5790). Median progression-free survival in the 10 refractory patients was 25.5 months (95% CI, 0.6-N/A) and was longer in patients who had shown progression of disease after 24 months of first-line therapy (median, 56.4 months; 95% CI, 19.8-56.4) than in those who showed early progression (median, 42.31 months; 95% CI, 24.41-NA) (P = .4258). Thirty-six (60%) patients had grade 3/4 neutropenia. Grade 3/4 febrile neutropenia and infection were recorded during induction (4/60 [6.7%] and 5/60 [8.3%] patients, respectively) and maintenance (2/43 [4.5%] and 4/43 [9.1%] patients, respectively). Conclusions This response-adapted treatment with RBMD followed by rituximab maintenance is an effective and well-tolerated salvage treatment for relapsed/refractory follicular lymphoma following first-line immunochemotherapy