Promoting clinical pharmacy services through advanced medication review in the emergency department

Objectives: To determine if an advanced medication review carried out in the emergency departmen t (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors.Methods: We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay.Results: The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached.Conclusions: An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors

Influência do modo de armazenamento na microinfiltração de dentes decíduos restaurados com diferentes sistemas adesivos: estudo in vitro

The influence of the method of storage of teeth and the effect of two kinds of dentin-bonding agents on the microleakage at the axial and cervical walls of composite restorations, in primary second molars, were evaluated. The samples were divided in three groups: Dehydrated, Hydrated and Frozen. The Dehydrated group was kept dry, the Hydrated group was stored in physiological saline solution under refrigeration, and the Frozen group was kept in the freezer, also immersed in physiological solution. The samples received two vertical slot preparations: a mesio-occlusal and a disto-occlusal one. In the mesio-occlusal cavities, Scotchbond Multi-Use adhesive system was used, whereas in the disto-occlusal cavities Prime & Bond 2.1 system was used, and all cavities were filled with Solitaire composite resin. The groups were then thermocycled and immersed in silver nitrate solution. Microleakage was measured by means of a digitized image system and the values were submitted to statistical analysis. The results showed that the method of storage had no statistically significant influence on marginal microleakage. Microleakage at the cervical wall was significantly greater than that at the axial wall, with 99,9% of certainty. The adhesive systems did not show significant influence on microleakage, in the studied methods of storage. However, there was statistical difference in the Dehydrated group samples, with the use of Prime & Bond 2.1 adhesive, when considering the margins of the restoration (axial and cervical).Foi avaliada, in vitro, a influência do modo de armazenamento e de dois tipos de adesivos dentinários sobre a microinfiltração nas paredes axiais e cervicais de dentes decíduos restaurados com resina composta. As amostras foram divididas de acordo com o modo com que foram armazenadas e os grupos foram classificados em: Congelado, Hidratado e Desidratado. O grupo Congelado foi mantido no "freezer", em solução fisiológica, o grupo Hidratado foi armazenado em solução fisiológica em geladeira e o grupo Desidratado foi mantido seco. Foram realizados preparos tipo "slots" verticais: ocluso-mesial e ocluso-distal. Nos preparos ocluso-mesiais, utilizou-se o adesivo Scotchbond Multi-Uso e nos ocluso-distais o Prime & Bond 2.1, sendo todos restaurados com resina composta Solitaire. Após termociclagem, foram imersos em corante e os valores de microinfiltração mensurados através de sistema de imagens digitalizadas e submetidos à análise de variância. Os resultados demonstraram que o modo de armazenamento não apresentou influência estatisticamente significante na microinfiltração das restaurações. A microinfiltração na parede cervical foi significantemente maior que na parede axial, com segurança de 99,9%. Os adesivos utilizados não apresentaram influência significante na microinfiltração, nas diferentes formas de armazenamento estudadas. Porém, houve diferença estatisticamente significante nas amostras do grupo Desidratado, com o adesivo Prime & Bond 2.1, considerando as margens da restauração (axial e cervical)

Case series of 103 children with SARS-CoV-2 infection in Portugal

Copyright © Ordem dos Médicos 2020Introduction: The North Lisbon University Hospital Center was activated for referral of SARS-CoV-2 infected patients on the 11th March 2020. The aim of this study is to describe the experience at the Department of Pediatrics in the approach and the clinical outcomes of infected children. Material and methods: A descriptive observational study was performed. Children and adolescents (0 to 18 years) with SARS-CoV-2 infection, diagnosed in the emergency room or admitted to the Department of Pediatrics between March 11th and June 18th, were included. Hospital records and Trace COVID-19 platform were reviewed and patient caregivers were interviewed to assess follow up. Results: Among 103 diagnosed children, 83% had a known previous contact with an infected patient, 43% presented fever and 42% presented respiratory symptoms. Ten percent had risk factors and 21% were aged under one year old. Ten percent were hospitalised, one needing intensive care, with paediatric inflammatory multisystem syndrome. Blood tests were performed in 9% and chest radiograph in 7%. No children required ventilation, antiviral therapy or underwent thoracic computed tomography scan. Eight percent of children returned to the emergency room and one child was hospitalised. The clinical outcome is known in 101 patients and is favourable in all. Discussion: Most children had an epidemiological link and little clinical repercussion, even during the first year of life. The expected mild severity in children justified the use of established clinical criteria and recommendations for similar conditions, regarding tests and hospitalizations. No antiviral treatments were given due to lack of evidence of its benefits. Conclusion: This strategy contributed to a low consumption of hospital resources and proved safe in this series.info:eu-repo/semantics/publishedVersio

Photovoltaic power plants: a multicriteria approach to investment decisions and a case study in western Spain

his paper proposes a compromise programming (CP) model to help investors decide whether to construct photovoltaic power plants with government financial support. For this purpose, we simulate an agreement between the government, who pursues political prices (guaranteed prices) as low as possible, and the project sponsor who wants returns (stochastic cash flows) as high as possible. The sponsor s decision depends on the positive or negative result of this simulation, the resulting simulated price being compared to the effective guaranteed price established by the country legislation for photovoltaic energy. To undertake the simulation, the CP model articulates variables such as ranges of guaranteed prices, tech- nical characteristics of the plant, expected energy to be generated over the investment life, investment cost, cash flow probabilities, and others. To determine the CP metric, risk aver- sion is assumed. As an actual application, a case study on photovoltaic power investment in Extremadura, western Spain, is developed in detail.Garcia-Bernabeu, A.; Benito Benito, A.; Bravo Selles, M.; Pla Santamaría, D. (2015). Photovoltaic power plants: a multicriteria approach to investment decisions and a case study in western Spain. Annals of Operations Research. 1-12. doi:10.1007/s10479-015-1836-2S112Andrews, R. W., Pollard, A., & Pearce, J. M. (2012). Improved parametric empirical determination of module short circuit current for modelling and optimization of solar photovoltaic systems. Solar Energy, 86(9), 2240–2254.Anwar, Y., & Mulyadi, M. S. (2011). Income tax incentives on renewable energy industry: Case of geothermal industry in USA and Indonesia. African Journal of Business Management, 5(31), 12264–12270.Aouni, B., & Kettani, O. (2001). Goal programming model: A glorious history and a promising future. European Journal of Operational Research, 133(2), 225–231.Ballestero, E. (1997). Selecting the CP metric: A risk aversion approach. European Journal of Operational Research, 97(3), 593–596.Ballestero, E. (2000). Project finance: A multicriteria approach to arbitration. Journal of Operational Research Society, 51, 183–197.Ballestero, E. (2007). Compromise programming: A utility-based linear-quadratic composite metric from the trade-off between achievement and balanced (non-corner) solutions. European Journal of Operational Research, 182(3), 1369–1382.Ballestero, E., Pérez-Gladish, B., Arenas-Parra, M., & BilbaoTerol, A. (2009). Selecting portfolios given multiple Eurostoxx-based uncertainty scenarios: A stochastic goal programming approach from fuzzy betas. INFOR: Information Systems and Operational Research, 47(1), 59–70.Ballestero, E., & Plà-Santamaría, D. (2003). Portfolio selection on the Madrid exchange: A compromise programming model. International Transactions in Operational Research, 10(1), 33–51.Ballestero, E., & Pla-Santamaria, D. (2004). Selecting portfolios for mutual funds. Omega, 32(5), 385–394.Ballestero, E., & Pla-Santamaria, D. (2005). Grading the performance of market indicators with utility benchmarks selected from Footsie: A 2000 case study. Applied Economics, 37(18), 2147–2160.Ballestero, E., & Romero, C. (1996). Portfolio selection: A compromise programming solution. Journal of the Operational Research Society, 47, 1377–1386.Bastian-Pinto, C., Brandão, L., & de Lemos Alves, M. (2010). Valuing the switching flexibility of the ethanol–gas flex fuel car. Annals of Operations Research, 176(1), 333–348.Branker, K., Pathak, M., & Pearce, J. M. (2011). A review of solar photovoltaic levelized cost of electricity. Renewable and Sustainable Energy Reviews, 15(9), 4470–4482.Casares, F., Lopez-Luque, R., Posadillo, R., & Varo-Martinez, M. (2014). Mathematical approach to the characterization of daily energy balance in autonomous photovoltaic solar systems. Energy, 72, 393–404.Chatterji, A. K., Levine, D. I., & Toffel, M. W. (2009). How well do social ratings actually measure corporate social responsibility? Journal of Economics & Management Strategy, 18(1), 125–169.Copeland, T. E., & Weston, J. (1988). Financial theory and corporate policy. Reading, Massachusetts: Addison-Wesley.Gallagher, K. S. (2013). Why & how governments support renewable energy. Daedalus, 142(1), 59–77.García-Cascales, M. S., Lamata, M. T., & Sánchez-Lozano, J. M. (2012). Evaluation of photovoltaic cells in a multi-criteria decision making process. Annals of Operations Research, 199(1), 373–391.Gupta, S. (2012). Financing renewable energy. In F. L. Toth (Ed.), Energy for development (pp. 171–186). Springer.Karaarslan, A. (2012). Obtaining renewable energy from piezoelectric ceramics using Sheppard–Taylor converter. International Review of Electrical Engineering, 7(2), 3949–3956.Koellner, T., Weber, O., Fenchel, M., & Scholz, R. (2005). Principles for sustainability rating of investment funds. Business Strategy and the Environment, 14(1), 54–70.Lorenzo, E., & Navarte, L. (2000). On the usefulness of stand-alone PV sizing methods. Progress in Photovoltaics: Research and Applications, 8(4), 391–409.Lüdeke-Freund, F., & Loock, M. (2011). Debt for brands: Tracking down a bias in financing photovoltaic projects in Germany. Journal of Cleaner Production, 19(12), 1356–1364.Mavrotas, G., Diakoulaki, D., & Capros, P. (2003). Combined MCDA-IP approach for project selection in the electricity market. Annals of Operations Research, 120(1–4), 159–170.Mendez-Rodriguez, P., Garcia Bernabeu, A., Hilario, A., & Perez-Gladish, B. (2013). Some effects on the efficient frontier of the investment strategy: A preliminary approach. Recta, 14, 131–144.Michelson, G., Wailes, N., Van Der Laan, S., & Frost, G. (2004). Ethical investment processes and outcomes. Journal of Business Ethics, 52(1), 1–10.Mills, S. J. (1994). Project finance for renewable energy. Renewable energy, 5(1–4), 700–708.ORourke, A. (2003). The message and methods of ethical investment. Journal of Cleaner Production, 11(6), 683–693.Pla-Santamaria, D., & Bravo, M. (2013). Portfolio optimization based on downside risk: A mean-semivariance efficient frontier from Dow Jones blue chips. Annals of Operations Research, 205(1), 189–201.Richter, N. (2009). Renewable project finance options: ITC, PTC, or cash grant? Power, 153(5), 90–92.Schrader, U. (2006). Ignorant advice-customer advisory service for ethical investment funds. Business Strategy and the Environment, 15(3), 200–214.Sitarz, S. (2013). Compromise programming with tehebycheff norm for discrete stochastic orders. Annals of Operations Research, 211(1), 433–446.van de Kaa, G., Rezaei, J., Kamp, L., & de Winter, A. (2014). Photovoltaic technology selection: A fuzzy MCDM approach. Renewable and Sustainable Energy Reviews, 32, 662–670.Yaqub, M., Shahram Sarkni, P., & Mazzuchi, T. (2012). Feasibility analysis of solar photovoltaic commercial power generation in California. Engineering Management Journal, 24(4), 36–49.Yazdani-Chamzini, A., Fouladgar, M. M., Zavadskas, E. K., & Moini, S. H. H. (2013). Selecting the optimal renewable energy using multi criteria decision making. Journal of Business Economics and Management, 14(5), 957–978.Yu, P. (1985). Multiple criteria decision making: Concepts, techniques and extensions. New York: Springer.Zeleny, M. (1982). Multiple criteria decision making (Vol. 25). New York: McGraw-Hill.Zhao, R., Shi, G., Chen, H., Ren, A., & Finlow, D. (2011). Present status and prospects of photovoltaic market in China. Energy Policy, 39(4), 2204–2207

Behavioural patterns in allergic rhinitis medication in Europe : A study using MASK-air(R) real-world data

Background Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods We analysed 2015-2020 MASK-air(R) European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H-1-antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Conclusions Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.Peer reviewe

Allergen immunotherapy in MASK-air users in real-life : Results of a Bayesian mixed-effects model

Background Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. Objective To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air(R) app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods We assessed the MASK-air(R) data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. Results We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). Conclusion In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.Peer reviewe

Development and validation of combined symptom‐medication scores for allergic rhinitis*

Background: Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air® app to generate and validate hypothesis- and data-driven CSMSs. Methods: We used MASK-air® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air® , and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results: We assessed 317,176 days of MASK-air® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). Conclusion: The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials

Development and validation of combined symptom-medication scores for allergic rhinitis*

Background Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air(R) app to generate and validate hypothesis- and data-driven CSMSs. Methods We used MASK-air(R) data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air(R) data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air(R), and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results We assessed 317,176 days of MASK-air(R) use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). Conclusion The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.Peer reviewe

Fortunella margarita Transcriptional Reprogramming Triggered by Xanthomonas citri subsp. citri

<p>Abstract</p> <p>Background</p> <p>Citrus canker disease caused by the bacterial pathogen <it>Xanthomonas citri </it>subsp. <it>citri (</it>Xcc) <it>has </it>become endemic in areas where high temperature, rain, humidity, and windy conditions provide a favourable environment for the dissemination of the bacterium. Xcc is pathogenic on many commercial citrus varieties but appears to elicit an incompatible reaction on the citrus relative <it>Fortunella margarita </it>Swing (kumquat), in the form of a very distinct delayed necrotic response. We have developed subtractive libraries enriched in sequences expressed in kumquat leaves during both early and late stages of the disease. The isolated differentially expressed transcripts were subsequently sequenced. Our results demonstrate how the use of microarray expression profiling can help assign roles to previously uncharacterized genes and elucidate plant pathogenesis-response related mechanisms. This can be considered to be a case study in a citrus relative where high throughput technologies were utilized to understand defence mechanisms in <it>Fortunella </it>and citrus at the molecular level.</p> <p>Results</p> <p><b>cDNAs from sequenced kumquat libraries (ESTs) made from subtracted RNA populations, healthy vs. infected, were used to make this microarray</b>. Of 2054 selected genes on a customized array, 317 were differentially expressed (P < 0.05) in Xcc challenged kumquat plants compared to mock-inoculated ones. This study identified components of the incompatible interaction such as reactive oxygen species (ROS) and programmed cell death (PCD). Common defence mechanisms and a number of resistance genes were also identified. In addition, there were a considerable number of differentially regulated genes that had no homologues in the databases. This could be an indication of either a specialized set of genes employed by kumquat in response to canker disease or new defence mechanisms in citrus.</p> <p>Conclusion</p> <p>Functional categorization of kumquat Xcc-responsive genes revealed an enhanced defence-related metabolism as well as a number of resistant response-specific genes in the kumquat transcriptome in response to Xcc inoculation. Gene expression profile(s) were analyzed to assemble a comprehensive and inclusive image of the molecular interaction in the kumquat/Xcc system. This was done in order to elucidate molecular mechanisms associated with the development of the hypersensitive response phenotype in kumquat leaves. These data will be used to perform comparisons among citrus species to evaluate means to enhance the host immune responses against bacterial diseases.</p

A plasmid DNA-launched SARS-CoV-2 reverse genetics system and coronavirus toolkit for COVID-19 research

The recent emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the underlying cause of Coronavirus Disease 2019 (COVID-19), has led to a worldwide pandemic causing substantial morbidity, mortality, and economic devastation. In response, many laboratories have redirected attention to SARS-CoV-2, meaning there is an urgent need for tools that can be used in laboratories unaccustomed to working with coronaviruses. Here we report a range of tools for SARS-CoV-2 research. First, we describe a facile single plasmid SARS-CoV-2 reverse genetics system that is simple to genetically manipulate and can be used to rescue infectious virus through transient transfection (without in vitro transcription or additional expression plasmids). The rescue system is accompanied by our panel of SARS-CoV-2 antibodies (against nearly every viral protein), SARS-CoV-2 clinical isolates, and SARS-CoV-2 permissive cell lines, which are all openly available to the scientific community. Using these tools, we demonstrate here that the controversial ORF10 protein is expressed in infected cells. Furthermore, we show that the promising repurposed antiviral activity of apilimod is dependent on TMPRSS2 expression. Altogether, our SARS-CoV-2 toolkit, which can be directly accessed via our website at https://mrcppu-covid.bio/, constitutes a resource with considerable potential to advance COVID-19 vaccine design, drug testing, and discovery science