[Quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors]. / Calidad de vida en pacientes con artritis reumatoide en tratamiento ambulatorio con anti-TNF.

OBJECTIVE: To assess the quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors (etanercept and adalimumab). METHOD: Observational, descriptive and multi-centre study. A specific validated questionnaire was used (QOL-RA Scale) in its Spanish version, with complete confidentiality ensured. To measure the reliability of the results, the Cronbach Alpha Coefficient was used. A descriptive analysis was carried out to compare the results obtained with those obtained from studies in the USA and Colombia. RESULTS: A total of 82 patients were selected who mainly consisted of married housewives who had not undergone any previous studies. The average amount of years from diagnosis was 11.81 years (SD: 7.30) and the average duration of treatment with TNF inhibitors was 1.71 years (SD: 1.03). The results of the questionnaire were: physical ability 5.42 (SD: 1.67), pain 5.10 (SD: 1.83), social life 7.08 (SD: 1.96), support 7.45 (SD: 2.10), mood 6.02 (SD: 2.03), stress 5.50 (SD: 2.01), arthritis 5.15 (SD: 1.86), health 5.50 (SD: 1.77). The results obtained were similar to those from the USA, although they showed a lower score for mood and stress categories. However, the high score in the support and social-life categories was more similar to that obtained with the Colombian questionnaire. All patients considered their quality of life to have improved with the use of TNF inhibitors. CONCLUSIONS: The quality of life in patients with Rheumatoid Arthritis is low, determined by pain and symptoms of depression. The patients believe that TNF inhibitors have improved their quality of life.

Calidad de vida en pacientes con artritis reumatoide en tratamiento ambulatorio con anti-TNF / Quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors

Objetivo: Evaluar la calidad de vida en pacientes con artritis reumatoideen tratamiento ambulatorio con anti-TNF (etanercept y adalimumab).Método: Estudio observacional, descriptivo y multicéntrico. Se utilizóun cuestionario específico validado (QOL-RA Scale) en su versión enespañol, manteniendo la confidencialidad al máximo. Para medir lafiabilidad de los resultados se utilizó el coeficiente alfa de Cronbach.Se ha realizado un análisis descriptivo para comparar los resultadosobtenidos con estudios realizados en la población estadounidense ycolombiana.Resultados: Se seleccionaron 82 pacientes. Destacó el perfil de amade casa, casada y con ningún estudio o estudios primarios. La mediade años de diagnóstico fue 11,81 ± 7,30 años y la de tratamiento conanti-TNF fue de 1,71 ± 1,03 años. Los resultados para la encuesta fueron:habilidad física 5,42 ± 1,67), dolor 5,10 ± 1,83, vida social 7,08± 1,96, apoyo 7,45 ± 2,10), estado de ánimo 6,02 ± 2,03, tensiónnerviosa 5,50 ± 2,01, artritis 5,15 ± 1,86), salud 5,50 ± 1,77. Los resultadosobtenidos fueron similares a los encontrados en la poblaciónestadounidense, aunque destaca una menor puntuación en elánimo y la tensión nerviosa. Sin embargo, la alta puntuación en lo referenteal apoyo y la vida social fue más parecida a la obtenida en lapoblación colombiana. Todos los pacientes consideraron que su calidadde vida había mejorado con la medicación anti-TNF.Conclusiones: La calidad de vida en pacientes con artritis reumatoidees baja, determinada por el dolor y los síntomas depresivos. Lospacientes tienen la percepción de que los anti-TNF han mejorado sucalidad de vida

Objective: To assess the quality of life of patients with rheumatoidarthritis undergoing out-patient treatment with TNF inhibitors (etanerceptand adalimumab).Method: Observational, descriptive and multi-centre study. A specificvalidated questionnaire was used (QOL-RA Scale) in its Spanish version,with complete confidentiality ensured. To measure the reliabilityof the results, the Cronbach Alpha Coefficient was used. A descriptiveanalysis was carried out to compare the results obtained withthose obtained from studies in the USA and Colombia.Results: A total of 82 patients were selected who mainly consisted ofmarried housewives who had not undergone any previous studies.The average amount of years from diagnosis was 11.81 years (SD:7.30) and the average duration of treatment with TNF inhibitors was1.71 years (SD: 1.03). The results of the questionnaire were: physicalability 5.42 (SD: 1.67), pain 5.10 (SD: 1.83), social life 7.08 (SD:1.96), support 7.45 (SD: 2.10), mood 6.02 (SD: 2.03), stress 5.50(SD: 2.01), arthritis 5.15 (SD: 1.86), health 5.50 (SD: 1.77). The resultsobtained were similar to those from the USA, although they showeda lower score for mood and stress categories. However, the highscore in the support and social-life categories was more similar tothat obtained with the Colombian questionnaire. All patients consideredtheir quality of life to have improved with the use of TNF inhibitors.Conclusions: The quality of life in patients with Rheumatoid Arthritisis low, determined by pain and symptoms of depression. The patientsbelieve that TNF inhibitors have improved their quality of life

[Current research status in pharmaceutical care]. / Estado actual de la investigación en atención farmacéutica.

OBJECTIVE: A systematic review of studies on pharmaceutical care research from June 1999 to June 2004 was carried out. METHOD: Medline, Current Contents, Cochrane Library, IDIS, and Teseo were used as data sources. Works were categorized according to evidence levels and recommendation grades in clinical practice guidelines. The JADAD method was used for quality quantification. RESULTS: In all, 129 references were found; 19.4% (n = 25) were randomized studies; 2.3% (n = 3) had blinded assessors; losses to follow-up were documented in 7.8% (n = 10); 4.7% (n = 6) had a Jadad score= 3; 8.5% (n = 11), 14.7% (n = 19), 5.4% (n = 7), and 20.9% (n = 27) had evidence levels Ia, Ib, IIa, and IIb, respectively; 44.2% (n = 57) and 6.2% (n = 8) had levels III and IV, respectively; 23.3% (n = 30) had a recommendation grade A; 26.4% (n = 34) had a grade B; 44% (n = 55) had C and 6.2% (n = 8) had D. Most common study types included: descriptive (39.5%), trials including patients (32.6%), and reviews (17.8%); 59.5% of reviewed clinical trials were controlled, randomized clinical trials (CRCTs). Studies were double-blind in 7.1% of cases. Discontinuations and exclusions were recorded in 23.8% of cases. Randomization was appropriate in 11.9% of cases; 14.3% of clinical trials had 3 points, and 85.7% of studies were of poor quality. CONCLUSIONS: Work methodology should be more rigorous. The use of universally accepted methods is needed to enhance the quality of studies (Jadad system, Consort list). The performance of observational, prospective, multicenter investigations allowing the effectiveness and efficiency of pharmaceutical care to be measured would be most beneficial. Works should measure health-related quality of life (SF-36 questionnaire) and patient satisfaction.

Estado actual de la investigación en atención farmacéutica / Current research status in pharmaceutical care

Objetivo: Realizar una revisión sistemática de los estudios sobre investigación en atención farmacéutica entre junio de 1999 y junio de 2004. Método: Se utilizaron como fuentes de datos Medline, Current Contents, Cochrane Library, IDIS y Teseo. Se categorizaron los trabajos según los niveles de evidencia y grados de recomendación de las guías de práctica clínica. Para cuantificar la calidad de los estudios se empleó el método Jadad. Resultados: Se encontraron 129 referencias. El 19,4% (n=25) fueron estudios randomizados; el 2,3% (n=3) tuvieron evaluadores ciegos; en el 7,8% (n=10) se documentaron las pérdidas de seguimiento. El 4,7% (n=6) tuvo una puntuación de Jadad=3. El 8,5% (n=11), el 14,7% (n=19), el 5,4% (n=7) y el 20,9% (n=27) tuvieron niveles de evidencia Ia, Ib, IIa y IIb, respectivamente. El 44,2% (n=57) y el 6,2% (n=8) fueron III y IV, respectivamente. El 23,3% (n=30) tuvieron grado de recomendación A; el 26,4% (n=34) B; el 44% (n=55) C y el 6,2% (n=8) D. Los tipos de estudio más frecuentes fueron: descriptivo (39,5%), ensayos con pacientes (32,6%) y las revisiones (17,8%). El 59,5% de los ensayos clínicos revisados fueron controlados y aleatorizados (ECCA). El estudio fue doble ciego en el 7,1% de los casos. Se registraron los abandonos y exclusiones en el 23,8%. La aleatorización fue adecuada en el 11,9%. El 14,3% de los ensayos clínicos tuvo 3 puntos y el 85,7% de los estudios fueron de baja calidad. Conclusiones: La metodología de los trabajos debería ser más rigurosa. Es necesario utilizar métodos universalmente aceptados para aumentar la calidad de los estudios (sistema Jadad, lista Consort). Sería conveniente realizar trabajos observacionales, prospectivos multicéntricos, que permitan medir la efectividad y la eficiencia de la atención farmacéutica. Los trabajos deberían medir la calidad de vida relacionada con la salud de los pacientes (cuestionario SF-36) y el grado de satisfacción de los mismos

Objective: A systematic review of studies on pharmaceutical care research from June 1999 to June 2004 was carried out. Method: Medline, Current Contents, Cochrane Library, IDIS, and Teseo were used as data sources. Works were categorized according to evidence levels and recommendation grades in clinical practice guidelines. The JADAD method was used for quality quantification. Results: In all, 129 references were found; 19.4% (n=25) were randomized studies; 2.3% (n=3) had blinded assessors; losses to follow-up were documented in 7.8% (n=10); 4.7% (n=6) had a Jadad score=3; 8.5% (n=11), 14.7% (n=19), 5.4% (n=7), and 20.9% (n=27) had evidence levels Ia, Ib, IIa, and IIb, respectively; 44.2% (n=57) and 6.2% (n=8) had levels III and IV, respectively; 23.3% (n=30) had a recommendation grade A; 26.4% (n=34) had a grade B; 44% (n=55) had C and 6.2% (n=8) had D. Most common study types included: descriptive (39.5%), trials including patients (32.6%), and reviews (17.8%); 59.5% of reviewed clinical trials were controlled, randomized clinical trials (CRCTs). Studies were double-blind in 7.1% of cases. Discontinuations and exclusions were recorded in 23.8% of cases. Randomization was appropriate in 11.9% of cases; 14.3% of clinical trials had 3 points, and 85.7% of studies were of poor quality. Conclusions: Work methodology should be more rigorous. The use of universally accepted methods is needed to enhance the quality of studies (Jadad system, Consort list). The performance of observational, prospective, multicenter investigations allowing the effectiveness and efficiency of pharmaceutical care to be measured would be most beneficial. Works should measure health-related quality of life (SF-36 questionnaire) and patient satisfaction

[A review on Hansen's disease]. / Revisión de la enfermedad de Hansen.

Hansens disease or leprosy is considered a pre-eradicated condition in Spain, with a prevalence rate of 0.1 cases per 10,000 inhabitants (below 1 case per 10,000 inhabitants, which was the World Health Organizations health goal worldwide for year 2000). The purpose of this review was to study this disease with a particular focus on its clinical aspects (diagnosis, forms, complications, etc.) and drug therapy. Main sources used for this review included Micromedex Healthcare System, PudMed, Cochrane Library, and World Health Organization recommendations. Leprosy is characterized by the existence of various clinical forms, among which tuberculoid leprosy and lepromatous leprosy stand out, even though a wide variety of intermediate forms may appear between these two extremes. The high complexity and variability of forms and clinical pictures, together with epidemiology and drug accessibility- since the disease shows a high prevalence in a number of developing countries-results in various treatment regimens being currently used. This makes eradication difficult and contributes to the existence of many different treatments following different recommendations on leprosy, as is the case with WHO-delivered guidelines. However, current treatments share a common base made up of several combined drugs, particularly rifampicin, dapsone, and clofazimin. Active principles most recently added to the multitherapy of leprosy include fluoroquinolones, tetracyclines, and macrolides. The most significant conclusion on this disease is that leprosy is currently considered a scarcely transmitted (natural resistance in 95% of the population), easily diagnosed, and good prognosis condition when early diagnosis and adequate treatment occur. Patient contagiousness disappears within a few weeks after treatment onset, and a normal community life may be led.