Assessment of community pharmacists´ counselling skills on headache management by using the simulated patient approach: a pilot study

Background: Headache, or cephalalgia, is one of the 20 most disabling diseases in the world and affects a large portion of the world´s population. People generally use over-the-counter medications to treat headaches and other minor symptoms. A pharmacist should help patients choose the most effective, safe, and convenient pharmacotherapeutic option. Objective: To assess the counselling skills of community pharmacists for headache management by using the simulated patient approach. Methods: A cross-sectional study was conducted from March 2010 to July 2010. Data were obtained from a convenience sample consisting of one pharmacist from each of the 24 participating community pharmacies. In order to evaluate the pharmacists´ counselling skills, a simulated patient role played a standardized headache case requesting self-medication. The interactions of the simulated patient with the pharmacists were audiovisually recorded using a hidden micro camera, and these recordings were analysed using a validated questionnaire. Results: Of the 24 evaluated pharmacists, 19 (79.1%) were women. Information was spontaneously provided by 15 (62.5%) pharmacists. At least one question was asked by the pharmacist to assess the signs and symptoms. Most pharmacists (n=17, 70.8%) recommended sodium dipyrone, either alone or in combination with other drugs. The most discussed items in the simulation visits were contraindications (n=17, 70.8%), indications (n=10, 41.6%), and drug administration times (n=8, 33.3%). None of the pharmacists recommended any non-pharmacological therapeutic alternatives. The overall impressions of the pharmacists professional counselling skills ranged from poor to fair. Conclusion: This study showed that the pharmacists counselling skills and the guidance provided by the pharmacists to the simulated patient were insufficient for the satisfactory management of headache.Antecedentes: El dolor de cabeza o cefalea es una de las 20 enfermedades más incapacitantes en el mundo y afecta a una gran parte de la población mundial. La gente utiliza generalmente medicamentos OTC para tratar los dolores de cabeza y otros síntomas menores. Un farmacéutico debería ayudar a los pacientes a elegir la opción farmacoterapéutica más efectiva, segura y conveniente. Objetivo: Evaluar las habilidades de los farmacéuticos comunitarios para el manejo del dolor de cabeza utilizando un abordaje de paciente simulado. Métodos: Se realizó un estudio transversal entre marzo 2010 y julio 2010. Se obtuvieron datos de una muestra de conveniencia consistente en un farmacéutico de cada 24 farmacias comunitarias participantes. Para evaluar las habilidades de asesoramiento de los farmacéuticos, un paciente simulado recreó un caso estandarizado de dolor de cabeza solicitando auto-medicación. Las interacciones del paciente simulado con el farmacéutico fueron audiovisualmente grabadas utilizando una micro-cámara oculta, y estas grabaciones fueron analizadas utilizando un cuestionario validado. Resultados: De los 24 farmacéuticos evaluados, 19 (79,1%) eran mujeres. 15 farmacéuticos (62,5%) proporcionaron información espontáneamente. El farmacéutico pregunto al menos una pregunta para evaluar los síntomas. La mayoría de los farmacéuticos (n=17, 70,8%) recomendó dipirona sódica, sóla o en combinación con otros medicamentos. Los ítems más discutidos en las visitas simuladas fueron las contraindicaciones (n=17, 70,8%), la indicación (n=10, 41,6%), y la frecuencia de administración (n=8, 33,3%). Ninguno de los farmacéuticos recomendó alguna alternativa terapéutica no farmacológica. La impresión general de las habilidades de asesoramiento profesional delos farmacéuticos osciló entre pobre y moderada. Conclusión: Este estudio mostró que las habilidades de asesoramiento de los farmacéuticos y los consejos proporcionados al paciente simulado fueron insuficientes para el manejo satisfactorio del dolor de cabeza

N-Acetyl Cysteine Attenuated the Deleterious Effects of Advanced Glycation End-Products on the Kidney of Non-Diabetic Rats

Aim: To assess the renal effects of chronic exposure to advanced glycation end-products (AGEs) in the absence of diabetes and the potential impact of concomitant treatment with the antioxidant N-acetyl cysteine (NAC). Methods: Wistar rats received intraperitoneally 20 mg/kg/day of albumin modified (AlbAGE) or not (AlbC) by advanced glycation for 12 weeks and oral NAC (600mg/L; AlbAGE+NAC and AlbC+NAC, respectively). Biochemical, urinary and renal morphological analyses; carboxymethyl-lysine (CML, an AGE), CD68 (macrophage infiltration), and 4-hydroxynonenal (4-HNE, marker of oxidative stress) immunostaining; intrarenal mRNA expression of genes belonging to pathways related to AGEs (Ager, Ddost, Nfkb1), renin-angiotensin system (Agt, Ren, Ace), fibrosis (Tgfb1, Col4a1), oxidative stress (Nox4, Txnip), and apoptosis (Bax, Bcl2); and reactive oxidative species (ROS) content were performed. Results: AlbAGE significantly increased urine protein-to-creatinine ratio; glomerular area; renal CML content and macrophage infiltration; expression of Ager, Nfkb1, Agt, Ren, Tgfb1, Col4a1, Txnip, Bax/Bcl2 ratio; and 4-HNE and ROS contents. Some of these effects were attenuated by NAC concomitant treatment. Conclusion: Because AGEs are highly consumed in modern diets and implicated in the progression of different kidney diseases, NAC could be a therapeutic intervention to decrease renal damage, considering that long-term restriction of dietary AGEs is difficult to achieve in practice