El paper del farmacèutic comunitari davant l'incompliment farmacològic del pacient

L'èxit d'una teràpia farmacològica el determinen principalment quatre factors: reconeixement de l'existència de la malaltia, diagnòstic correcte, prescripció adequada i compliment del tractament per part del pacient. Normalment, es dediquen molts esforços i recursos als tres primers factors1 sense tenir en compte que si no hi ha un compliment adequat tot l'esforç és inútil. Així, l'incompliment és la principal causa del fracàs dels tractaments farmacològics (i no farmacològics) 2 i és un fenomen molt estès que afecta especialment les malalties cròniques que necessiten tractaments continuats. No es coneix la taxa real d'incomplidors. En la literatura es poden trobar xifres tan diferents com el 20 i el 80 %3,

Prevenció d'RNM causats per PRM de seguretat: ajust posològic de medicaments en ancians polimedicats amb funció renal disminiuïda atesos a les farmàcies comunitàries

El creixement constant de la població de gent gran ha portat un increment de l'ús dels medicaments i ha originat la denominada polimedicació, principalment a causa del nombre de malalties cròniques associades a aquesta franja d'edat i del deteriorament fisiològic i natural de l'organisme. (1) El càlcul és que l'any 2015, a Catalunya, el percentatge de persones de més de 65 anys superarà el 18,5% i les persones de més de 80 anys seran aproximadament un 5,6% de la població. (2) La mitjana del nombre de medicaments utilitzats per les persones grans oscil·la entre 2 i 5 i pot augmentar si tenim en compte els medicaments que no necessiten prescripció mèdica. (3) Es calcula que un 65% de la gent gran té prescrits tres o més medicaments i un 30% més de cinc. (4) Si bé els medicaments estan formulats amb criteris de protecció i seguretat, els riscos associats a la utilització sempre són presents. La utilització correcta requereix un balanç favorable i individual de la relació benefici i risc que aquests medicaments poden produir. La seguretat n'és una part primordial i defineix en sentit positiu l'absència de toxicitat o de riscos. (5) Actualment, la seguretat del pacient es considera un tret essencial de la qualitat assistencial i la manca d'aquest tret podria comprometre negativament dimensions com l'efectivitat terapèutica..

Screening premorbid metabolic syndrome in community pharmacies: a cross-sectional descriptive study

Background: Premorbid metabolic syndrome (pre-MetS) is a cluster of cardiometabolic risk factors characterised by central obesity, elevated fasting glucose, atherogenic dyslipidaemia and hypertension without established cardiovascular disease or diabetes. Community pharmacies are in an excellent position to develop screening programmes because of their direct contact with the population. The main aim of the study was to determine the prevalence of pre-MetS in people who visited community pharmacies for measurement of any of its five risk factors to detect the presence of other risk factors. The secondary aims were to study the presence of other cardiovascular risk factors and determine patients" cardiovascular risk. Methods: Cross-sectional, descriptive, multicentre study. Patients meeting selection criteria aged between 18 and 65 years who visited participating community pharmacies to check any of five pre-MetS diagnostic factors were included. The study involved 23 community pharmacies in Catalonia (Spain). Detection criteria for pre-MetS were based on the WHO proposal following IDF and AHA/NHBI consensus. Cardiovascular risk (CVR) was calculated by Regicor and Score methods. Other variables studied were smoking habit, physical activity, body mass index (BMI), and pharmacological treatment of dyslipidemia and hypertension. The data were collected and analysed with the SPSS programme. Comparisons of variables were carried out using the Student"s T-test, Chi-Squared test or ANOVA test. Level of significance was 5% (0.05). Results: The overall prevalence of pre-MetS was 21.9% [95% CI 18.7-25.2]. It was more prevalent in men, 25.5% [95% CI 22.1-28.9], than in women, 18.6% [95% CI 15.5-21.7], and distribution increased with age. The most common risk factors were high blood pressure and abdominal obesity. About 70% of people with pre-MetS were sedentary and over 85% had a BMI ≥25 Kg/m2 . Some 22.4% had two metabolic criteria and 27.2% of patients with pre-MetS had no previous diagnosis. Conclusions: The prevalence of pre-MetS in our study (21.9%) was similar to that found in other studies carried out in Primary Care in Spain. The results of this study confirm emergent cardiometabolic risk factors such as hypertension, obesity and physical inactivity. Our study highlights the strategic role of the community pharmacy in the detection of pre-MetS in the apparently healthy population

Integración del farmacéutico comunitario en un equipo de atención domiciliaria: estudio de costes de una experiencia piloto.

Objetivo: Estimar la carga económica que suponen los pacientes adscritos al servicio de atención domiciliaria de atención primaria y el coste que supondría incluir un farmacéutico en este equipo. Método: Estudio descriptivo prospectivo de evaluación de la carga económica del programa de atención domiciliaria. Emplazamiento: CAP Montnegre de una ABS urbana de la ciudad de Barcelona. Participantes: Pacientes adscritos al servicio de atención domiciliaria que fueron atendidos entre enero y junio de 2014 por la enfermera gestora de casos del centro. Las farmacéuticas revisaron la medicación de los pacientes para identificar problemas relacionados con la medicación y proponer intervenciones al equipo de atención domiciliaria. Mediciones principales: Revisando los historiales clínicos de los pacientes, se recogieron los costes en atención primaria, especializada, urgencias, ingresos y pruebas en 6 meses. Se estimó necesaria una visita del farmacéutico cada 6 meses para evaluar el plan de actuación. Se calcularon los costes medios para cada nivel asistencial. Resultados: Participaron 50 pacientes que generaron un coste medio total en 6 meses de 3174,5¿, siendo el 29% la atención primaria y el 66% la atención secundaria. El coste medio por paciente de la intervención farmacéutica fue de 116,4¿ (lo que supondría un incremento del 3,7% de los costes generados por estos pacientes)

Using biomarkers to predict TB treatment duration (Predict TB): a prospective, randomized, noninferiority, treatment shortening clinical trial

Background : By the early 1980s, tuberculosis treatment was shortened from 24 to 6 months, maintaining relapse rates of 1-2%. Subsequent trials attempting shorter durations have failed, with 4-month arms consistently having relapse rates of 15-20%. One trial shortened treatment only among those without baseline cavity on chest x-ray and whose month 2 sputum culture converted to negative. The 4-month arm relapse rate decreased to 7% but was still significantly worse than the 6-month arm (1.6%, P<0.01).  We hypothesize that PET/CT characteristics at baseline, PET/CT changes at one month, and markers of residual bacterial load will identify patients with tuberculosis who can be cured with 4 months (16 weeks) of standard treatment.Methods: This is a prospective, multicenter, randomized, phase 2b, noninferiority clinical trial of pulmonary tuberculosis participants. Those eligible start standard of care treatment. PET/CT scans are done at weeks 0, 4, and 16 or 24. Participants who do not meet early treatment completion criteria (baseline radiologic severity, radiologic response at one month, and GeneXpert-detectable bacilli at four months) are placed in Arm A (24 weeks of standard therapy). Those who meet the early treatment completion criteria are randomized at week 16 to continue treatment to week 24 (Arm B) or complete treatment at week 16 (Arm C). The primary endpoint compares the treatment success rate at 18 months between Arms B and C.Discussion: Multiple biomarkers have been assessed to predict TB treatment outcomes. This study uses PET/CT scans and GeneXpert (Xpert) cycle threshold to risk stratify participants. PET/CT scans are not applicable to global public health but could be used in clinical trials to stratify participants and possibly become a surrogate endpoint. If the Predict TB trial is successful, other immunological biomarkers or transcriptional signatures that correlate with treatment outcome may be identified. TRIAL REGISTRATION: NCT02821832

Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.post-print2.282 K

Guia de medicaments d’Atenció Primària que requereixen una vigilància especial per la seva dispensació en pacients amb funció renal disminuïda.

Projecte: AVCRI 279 Requeriments tècnics: L’entorn és l’EXCEL de Microsoft. L'accés al codi no estarà disponible fins la fi de la data d'embargament. Si esteu interessats a accedir-hi, contacteu amb idea(at)fbg.ub.eduAquesta Base de Dades (Guia de Medicaments) recull informació per tal d’indicar quins medicaments són susceptibles d'ajustos de dosi per evitar la iatrogènia medicamentosa en pacients amb deteriorament de la funció renal. Aquesta informació s'ha consensuat entre farmacèutics i metges nefròlegs a partir de la informació disponible en diferents bases de dades nacionals i internacionals. Per agilitzar l'ús de la Guia s'ha consensuat categoritzar en nivell baix, moderat o alt el risc que suposa pel pacient l’ús d'aquests medicaments segons el seu filtrat glomerular. A més la Guia recull els ajustos de dosi a realitzar, les interaccions medicamentoses i la simptomatologia per sobre dosificació en pacients amb funció renal disminuïda. A partir d'aquesta Base de Dades, s'ha dissenyat una aplicació web que facilita al professional sanitari la presa de decisions per a l'ajust de dosis de medicaments en funció del filtrat glomerular del pacient

Plasticity of the Mycobacterium tuberculosis respiratory chain and its impact on tuberculosis drug development.

The viability of Mycobacterium tuberculosis (Mtb) depends on energy generated by its respiratory chain. Cytochrome bc1-aa3 oxidase and type-2 NADH dehydrogenase (NDH-2) are respiratory chain components predicted to be essential, and are currently targeted for drug development. Here we demonstrate that an Mtb cytochrome bc1-aa3 oxidase deletion mutant is viable and only partially attenuated in mice. Moreover, treatment of Mtb-infected marmosets with a cytochrome bc1-aa3 oxidase inhibitor controls disease progression and reduces lesion-associated inflammation, but most lesions become cavitary. Deletion of both NDH-2 encoding genes (Δndh-2 mutant) reveals that the essentiality of NDH-2 as shown in standard growth media is due to the presence of fatty acids. The Δndh-2 mutant is only mildly attenuated in mice and not differently susceptible to clofazimine, a drug in clinical use proposed to engage NDH-2. These results demonstrate the intrinsic plasticity of Mtb's respiratory chain, and highlight the challenges associated with targeting the pathogen's respiratory enzymes for tuberculosis drug development