Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

BACKGROUND: Hospital drug formularies are reduced lists of drugs designed to optimise inpatient care. Adherence to the drugs included in such formularies is not always 100% but is generally very high. Little research has targeted the impact of a change in these formularies on outpatient drug prescriptions. This study therefore sought to evaluate the impact of a change affecting bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions in a region in north-western Spain. Two new drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention. METHODS: We used a natural before-after quasi-experimental design with control group based on monthly data. The intervention evaluated was the modification of a hospital drug formulary, which involved withdrawing salmeterol/fluticasone in order to retain formoterol/budesonide as the sole inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). Using official data sources, we extracted the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed-days, and cost per DDD. RESULTS: Intra-hospital use showed a 173.2% rise (95% CI 47.3-299.0%) in the medication retained in the formulary, formoterol/budesonide, and a 94.9% drop (95% CI 77.9-111.9%) in the medication withdrawn from the formulary, salmeterol/fluticasone. This intervention led to an immediate reduction of 75.9% (95% CI 82.8-68.9%) in the intra-hospital cost per DDD of ICS/LABA. No significant changes were observed in out-of-hospital use. CONCLUSIONS: Although this intervention was cost-effective in the intra-hospital setting, the out-of-hospital impact of a change in the drug formulary cannot be generalised to all types of medications and situations

Impact of a health alert and its implementation on flutamide prescriptions for women: an interrupted time series analysis.

BACKGROUND: Off-label drug use among ambulatory patients is often based on little or no scientific support. This paper reports the impact of a health warning about the risks of off-label flutamide use by women and the actions subsequently implemented by the public health service targeting such use. METHOD: The study was undertaken in a region in north-west Spain. We designed a segmented regression model of an interrupted time series, in which the dependent variable was the monthly value of defined daily doses of flutamide per 1000 inhabitants/day (DDD/TID), both total and stratified by sex. The following two data sources were used: flutamide prescriptions billed to the Spanish National Health Service; and flutamide deliveries made by wholesale drug distributors to pharmacies. The intervention assessed consisted of the issue of an official health warning and the actions subsequently taken to implement it. RESULTS: There was an immediate reduction of 49.33% in DDD/TID billed to the Spanish National Health Service in respect of women; the mean value of the population percentage of DDD/TID of flutamide billed in respect of women fell from 34.4% pre-intervention to 23.72% post-intervention. There was an immediate reduction of 19.92% (95%CI: 6.68-33.15%) in total DDD/TID invoiced. There were no significant changes in DDD/TID billed in respect of men or in flutamide use in the private medical sector. CONCLUSIONS: Off-label drug misuse is a reality among ambulatory patients, even after actions are implemented following a toxicity warning issued by the competent Health Authority

Per capita de água frente as condições climáticas Cuiabá-MT, Brasil

O estudo teve por objetivo a determinação da intensidade de interveniência das variáveis climáticas sobre a quota per capita de água, bem como sua forma de comportamento frente a diferentes condições climáticas na cidade de Cuiabá, estado de Mato Grosso, Brasil. A metodologia empregada fundamentou-se na coleta de uma serie histórica de dados junto a diversas instituições do estado de Mato Grosso, no tratamento dos dados, proposição de modelos de regressão com diferentes modelos (lineares, polinomiais, exponenciais de natureza logarítmica e aritmética), analise de trajetórias e analise fatorial. Os resultados indicaram a não associação entre as variáveis originais, no entanto, verificou-se fraco intercorrelacionamento intrínseco entre as variáveis de clima e consumo per capita de água.Peer Reviewe

Desarrollo del medicamento gen?rico en el Per?

Durante la ?ltima d?cada, el sector farmac?utico mundial ha experimentado un cambio importante en su estructura competitiva, y la industria de gen?ricos contin?a ganando mayor participaci?n en varios pa?ses, lo que ha hecho m?s accesibles los medicamentos para la poblaci?n, pues los gen?ricos son productos de bajo precio relativo respecto de los medicamentos de marca. En nuestro pa?s, en cambio, el mercado farmac?utico se caracteriza por el alto precio promedio de los medicamentos, el bajo consumo per? c?pita y el poco desarrollo del medicamento gen?rico. La mala percepci?n que tienen tanto el consumidor como el m?dico de la calidad y la posibilidad de intercambiabilidad real entre un medicamento gen?rico y un medicamento de marca hace que este tipo de producto se recete menos y tenga una participaci?n menor en las ventas totales en comparaci?n con Chile y Colombia. Esta investigaci?n se centra en el estudio del mercado farmac?utico peruano, en el segmento correspondiente al medicamento gen?rico en el sector privado, en el cual el consumidor hace un gasto directo b?sicamente a trav?s de las farmacias, por ello se excluye el consumo a trav?s de seguros privados y empresas prestadoras de salud. Entre las medidas propuestas para mejorar el acceso a los medicamentos en general, especialmente a los gen?ricos, se se?ala el papel fundamental del Estado, que debe generar el marco legal y las condiciones para propiciar el desarrollo de los medicamentos gen?ricos, as? como la participaci?n del conjunto de la sociedad civil para el logro de este objetivo

Plan de negocios para la implementaci?n de una empresa que brinde un portal web que permita la compra colectiva de bienes

Se presenta la elaboraci?n, dise?o y evaluaci?n del Plan de Negocios para la implementaci?n de una empresa que brinde un portal web de compras colectivas de bienes. El an?lisis ser? realizado para Lima Metropolitana. La propuesta de negocio ofrece al consumidor una opci?n adicional para realizar sus compras. Utilizando el modelo de compras colectivas y las tecnolog?as de informaci?n brinda al consumidor una nueva experiencia de compra con precios competitivos, productos de calidad y seguridad. De esta forma se puede observar que existe un mercado potencial para desarrollar un portal web de compras colectivas en el pa?s, el cual ofrezca productos tecnol?gicos de calidad a precios rebajados, juntando grupos de usuarios que buscan un mismo producto. Para tal fin se han establecido los siguientes objetivos: - Realizar el an?lisis del mercado - Detallar el entorno estrat?gico - Dise?ar el modelo de negocio - Elaborar el plan de Marketing para el negocio - Elaborar el plan de Recursos Humanos para el negocio - Elaborar el plan de Operaciones para el negocio - Elaborar el plan Econ?mico y Financiero del negocio

Identificaci?n y an?lisis de conflictos entre los actores de la cadena de suministros de la leche en el Per?

Para 2018, la producci?n mundial de leche se estim? en 827 millones de TM, lo que representar?a un incremento de 2% con relaci?n al a?o anterior. Para 2030 se estima que alcance las 1,268 TM que representar?a un incremento de 2.3% promedio anual. Sin embargo, el principal eslab?n est? fragmentado puesto que el 85.9% de los actores tiene menos de diez vacas. A esto se suma que la mayor?a de organizaciones de productores ganaderos carecen de una gesti?n adecuada lo que reduce su poder de negociaci?n y su capacidad de insertarse en el mercado. Frente a ellos, est? la gran industria, integrada b?sicamente por tres grandes empresas: Laive SA, Nestl? Per? SA y Leche Gloria SA. En el Per?, los conflictos de mayor envergadura dan motivo a disputas administrativas que se ventilan en las salas y tribunal del organismo regulador denominado INDECOPI que interviene s?lo ante fallas de mercado que lesionen intereses p?blicos. Para este estudio, se revisaron las resoluciones emitidas desde 2006 A trav?s de la relectura de los expedientes seleccionados, se identificaron los siguientes conflictos: 1. Reconstituci?n de leche en polvo importada; 2. Baja calidad de la leche fresca; 3. Bajos precios al productor; y 4. Ejercicio de la posici?n de dominio de los procesadores

Incorporation of Tb and Gd improves the diagnostic functionality of magnetotactic bacteria

Magnetotactic bacteria are envisaged as potential theranostic agents. Their internal magnetic compass, chemical environment specificity and natural motility enable these microorganisms to behave as nanorobots, as they can be tracked and guided towards specific regions in the body and activated to generate a therapeutic response. Here we provide additional diagnostic functionalities to magnetotactic bacteria Magnetospirillum gryphiswaldense MSR 1 while retaining their intrinsic capabilities. These additional functionalities are achieved by incorporating Tb or Gd in the bacteria by culturing them in Tb Gd supplemented media. The incorporation of Tb provides luminescence properties, enabling potential applications of bacteria as biomarkers. The incorporation of Gd turns bacteria into dual contrast agents for magnetic resonance imaging, since Gd adds T1 contrast to the existing T2 contrast of unmodified bacteria. Given their potential clinical applications, the diagnostic ability of the modified MSR 1 has been successfully tested in vitro in two cell models, confirming their suitability as fluorescent markers Tb MSR 1 and dual contrast agents for MRI Gd MSR

A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population

Background: Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. Methods: Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the "data warehouse of the Galician Healthcare Service" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. Results: A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83+/-10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA2DS2-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707+/-103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality. Conclusion: AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect

The subpopulation pattern of eel sperm is affected by post-activation time, hormonal treatment and thermal regime

[EN] There has been a marked reduction in natural stocks of eels (genus Anguilla) over the past 60 years, and the culture of eels is still based on the capture of very large quantities of juveniles. It is necessary to close the life cycle in captivity in order to ease the pressure on wild populations. The aims of the present study were to evaluate sperm subpopulations (through cluster analysis of computer-aided sperm analysis data) in the European eel (Anguilla anguilla) and to assess the effects of motility acquisition time after activation (i.e. at 30, 60 and 90 s), the thermal regimen (i.e. 10 degrees C (T10) or 15 degrees C (T15) and up to 20 degrees C, or constant at 20 degrees C (T20)) and hormonal treatments (i.e. human chorionic gonadotropin (hCG), recombinant (r) hCG or pregnant mare serum gonadotropin (PMSG)) on these subpopulations. In all cases, we obtained three subpopulations of spermatozoa: low velocity and linear (S1); high velocity with low linearity (S2); and high velocity and linear (S3; considered high quality). Total motility and S1 were affected by acquisition time; thus, 30 s is recommended as the standard time for motility acquisition. When eels were kept at 20 degrees C (T20), motility data fitted quadratic models, with the highest motility and proportion of S3 between Weeks 8 and 12 after the first injection. Lower temperatures (T10, T15) delayed spermiation and the obtaining of high-quality spermatozoa (S3), but did not seem to alter the spermiation process (similar subpopulation pattern). Conversely, the hormonal treatments altered both the dynamics of the subpopulation pattern and the onset of spermiation (with PMSG delaying it). Total motility and the yield of S3 with the widely used hCG treatment varied throughout the spermiation period. However, using rhCG allowed us to obtain high-quality and constant motility for most of the study (Weeks 7-20), and the S3 yield was also higher overall (61.8 +/- 1.3%; mean +/- s.e.m.) and more stable over time than the other hormonal treatments (averaging 53.0 +/- 1.4%). Using T20 and rhCG would be more economical and practical, allowing us to obtain a higher number of S3 spermatozoa over an extended time.This study was funded by the European Community's 7th Framework Program under the Theme 2 'Food, Agriculture and Fisheries, and Bio-technology', grant agreement no. 245257 (PRO-EEL) and Generalitat Valenciana (ACOMP/2012/086). VG and MCV have predoctoral grants from the Spanish Ministry of Economy and Competitiveness (AGL2010-16009) and Universitat Politecnica de Valencia (UPV) PAID Program (2011-S2-02-6521), respectively. DSP was supported by a contract cofinanced by Ministry of Science and Innovation (MICINN) and UPV (PTA2011-4948-I). FM-P was supported by the Ramon y Cajal program (MICINN, RYC-2008-02560).Gallego Albiach, V.; Vilchez Olivencia, MC.; Peñaranda, D.; Pérez Igualada, LM.; Herraez, MP.; Asturiano Nemesio, JF.; Martinez-Pastor, F. (2015). The subpopulation pattern of eel sperm is affected by post-activation time, hormonal treatment and thermal regime. Reproduction, Fertility and Development. 27(3):529-543. https://doi.org/10.1071/RD13198S52954327