Evaluation of Cardiovascular Pharmacotherapy Guideline Adherence and Risk Factor Control in Portuguese Community Pharmacy Patients.

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Assessing the patients' CVD risk, controlling the risk factors, and ensuring the guideline-adherent cardiovascular pharmacotherapy are crucial interventions to improve health outcomes. This study aimed to evaluate the potential of pharmacists to improve the adherence to pharmacotherapy guidelines and the achievement of risk factor goals among patients who attended a community pharmacy. METHODS: We conducted a single-center cross-sectional study. We performed in-pharmacy point-of-care testing, blood pressure and anthropometric measurements, and reviewed patients' pharmacotherapy, based on European Society of Cardiology guidelines. RESULTS: Of the 333 patients, 63.1% were in the high/very high risk category, 91.9% showed at least two modifiable risk factors, and in 61.9% of patients the cardiovascular pharmacotherapy was non-adherent to the current guidelines, failing to reach treatment goals. The lipid-lowering therapy was the least guideline adherent, with a suboptimal use of statins. However, we found no statistically significant difference between the guideline-adherent and the non-adherent group in terms of risk factor control. The pharmacist recommended 603 interventions to adhere to the guidelines. CONCLUSIONS: Community pharmacists are able to identify opportunities to optimize cardiovascular pharmacotherapy and support the patients to achieve cardiovascular risk factor goals, based on evidence-based guidelines, contributing to the improvement of CVD management.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies.

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs. OBJECTIVE: To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability. METHODS: A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants' data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines. RESULTS: Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD. CONCLUSIONS: We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies

Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs. Objective: To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability. Methods: A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines Results: Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD (AU)

The role of internal auditing in promoting accountability in Higher Education Institutions / El papel de la auditoría interna en la promoción de la accountability en las Instituciones de Educación Superior / O papel da auditoria interna na promoção da accountability nas Instituições de Ensino Superior

Abstract This paper discusses the link between accountability and internal auditing, particularly analyzing the extent to which the latter contributes to improve the former, in Higher Education Institutions (HEIs). This study applied a questionnaire to the management boards of a sample of HEIs, to empirical analyze the relationship between internal auditing and accountability. The main focus was on internal auditing carried out by the offices or departments in those institutions. The paper contributes to understand how management boards perceive internal auditing to foster transparency and accountability in HEIs, allowing to corroborate that auditing, and particularly internal auditing, favors the institutions' accountability. In effect, it promotes the principles underlying accountability practices. The information provided in the scope of internal audits is acknowledged as contributing to improve management effectiveness and helping in decision-making. HEIs wanting to create an internal auditing office or to enhance the role of an existing one, should develop this office's activities so that it becomes an instrument to support accountability and good governance of the organization. The sample consisted of Portuguese public HEIs, universities and polytechnics. Despite a certain international convergence regarding this type of public sector organizations, and regarding their purposes and governance, certain contextual specificities might limit the generalization of the findings for other jurisdictions.

Resumen Este artículo discute la asociación entre la accountability y la auditoría interna, en particular analizando hasta qué punto esta última contribuye a mejorar la primera, en las Instituciones de Educación Superior (IES). Para analizar empíricamente la relación entre la auditoría interna y la accountability, el estudio se basa en los resultados de una encuesta enviada a los consejos de administración de una muestra de IES, con el enfoque principal en la auditoría interna realizada por las oficinas o departamentos en esas instituciones. El artículo contribuye a comprender cómo los consejos de administración perciben la auditoría interna para fomentar la transparencia y accountability en las IES, lo que permite corroborar que la auditoría, y particularmente la auditoría interna, sirve a la accountability. De hecho, ella promueve los principios subyacentes a las prácticas de accountability. Se reconoce que la información proporcionada en el ámbito de las auditorías internas contribuye a mejorar la efectividad de la gestión y ayuda en la toma de decisiones. Las IES que desean crear una oficina de auditoría interna o mejorar el papel de una existente, deben desarrollar las actividades de esta oficina para que se convierta en un instrumento de apoyo a la accountability y al buen gobierno de la organización. La muestra consistió en IES públicas portuguesas, universidades y politécnicos. A pesar de una cierta convergencia internacional con respecto a este tipo de organizaciones, así como con respecto a sus propósitos y gobernanza, ciertas especificidades contextuales pueden limitar la generalización de los resultados a otras jurisdicciones.

Resumo Este artigo discute a associação entre accountability e auditoria interna, analisando particularmente até que ponto a última contribui para melhorias na primeira, nas Instituições de Ensino Superior (IES). Para analisar empiricamente a relação entre auditoria interna e accountability, o estudo baseia-se nos resultados de um questionário enviado aos órgãos de gestão de uma amostra de IES, com o foco principal na auditoria interna desenvolvida pelos gabinetes ou departamentos nessas instituições. O artigo contribui para entender como os órgãos de gestão percebem a auditoria interna para promover a transparência e a accountability nas IES, permitindo corroborar que a auditoria e, principalmente, a auditoria interna, serve a accountability. Com efeito, ela promove os princípios subjacentes às práticas de accountability. A informação proporcionada no âmbito das auditorias internas é reconhecida como contribuindo para melhorar a eficácia da gestão e ajudar na tomada de decisões. As IES que desejem criar um gabinete de auditoria interna ou aprimorar o papel de um gabinete já existente, devem desenvolver as atividades desse serviço de modo a que se torne um instrumento para apoiar a accountability e a boa governança da organização. A amostra foi constituída por IES públicas portuguesas, universidades e institutos politécnicos. Apesar de existir uma certa convergência internacional em relação a este tipo de organizações do setor público, bem como em relação aos seus propósitos e governança, certas especificidades contextuais podem limitar a generalização dos resultados desta pesquisa, para outras jurisdições.

Immobilization of drugs for glaucoma treatment.

Recently there have been some developments in the preparation of controlled drug delivery systems for glaucoma. Many materials are being used in this area, namely gelatine and chitosan. Both of them present high levels of biocompatibility and biodegradability. In this paper, we wish to report the work we have been doing on the preparation and characterization of hydrogels based on gelatine and chitosan. The crosslinking agents used were 1-(3-(Dimethylamino)propyl)-3-Ethylcarbodiimide hydrocholide (CDI), 1,4-Butanodiol diglycidyl ether (epoxyde 1), Ethylene glycol diglycidyl ether (epoxyde 2) and genipin. The results obtained showed that all of the films were hydrogels. The surface and transversal cut showed a porous surface in all the films. The thermal analysis proved the modifications in the polymeric chains, with the stabilization of all of them by the crosslinking agents. The release pattern indicates that the gelatine films were the best since they release the adequate proportion of drug. Finally, the cytotoxicity showed that the gelatine films were all biocompatible, specially the ones crosslinked with one of the Epoxydes.

Evaluation of membrane bioreactor process capabilities to meet stringent effluent nutrient discharge requirements.

A six-stage membrane bioreactor (MBR) pilot plant was operated to determine and demonstrate the capability of this process to produce a low-nutrient effluent, consistent with the nutrient reduction goals for the Chesapeake Bay. Biological nitrogen removal was accomplished using a multistage configuration with an initial anoxic zone (using the carbon in the influent wastewater), an aerobic zone (where nitrification occurred), a downstream anoxic zone (where methanol was added as a carbon source), and the aerated submerged membrane zone. The capability to reliably reduce effluent total nitrogen to less than 3 mg/L as nitrogen (N) was demonstrated. A combination of biological (using an initial anaerobic zone) and chemical (using alum) phosphorus removal was used to achieve effluent total phosphate concentrations reliably less than 0.1 mg/L as phosphorus (P) and as low as 0.03 mg/L as P. Alum addition also appeared to enhance the filtration characteristics of the MBR sludge and to reduce membrane fouling. Aeration of the submerged membranes results in thickened sludge with a high dissolved oxygen concentration (approaching saturation), which can be recycled to the main aeration zone rather than to an anoxic or anaerobic zone to optimize biological nutrient removal. Biological nutrient removal was characterized using the International Water Association Activated Sludge Model No. 2d. The stoichiometry of chemical phosphorus removal was also consistent with conventional theory and experience. The characteristics of the solids produced in the MBR were compared with those of a parallel full-scale conventional biological nitrogen removal process and were generally found to be similar. These results provide valuable insight to the design and operating characteristics of MBRs intended to produce effluents with very low nutrient concentrations.

Effect of alum addition on the performance of submerged membranes for wastewater treatment.

The effect of aluminum sulfate (alum) addition on membrane performance was investigated, with a particular focus on membrane fouling. During initial operation, alum was added and the performance monitored. After terminating alum addition, the transmembrane pressure (TMP), which is indicative of membrane resistance to flow or fouling, increased. Accompanying the increase in TMP was an increase in the organic nonsettleable fraction (colloidal + dissolved) content of the mixed liquor and deterioration of permeate quality and floc strength. Permeate polysaccharide concentrations increased significantly, suggesting a preferential binding of solution polysaccharides by alum. Upon reinitiating alum addition, the TMP only partially recovered, indicating some irreversible fouling, while mixed liquor nonsettleable organic material, permeate quality, and floc strength returned to initial levels. These results suggest that direct alum addition to membrane bioreactors can improve membrane performance by reducing the organic fouling material and improving floc structure and strength. It appears that bulk liquid polysaccharides may contribute to irreversible membrane fouling, and this fraction can be efficiently controlled through the alum addition.