Evaluación del conocimiento en atención farmacéutica a personas con discapacidad visual en estudiantes de regencia de farmacia de una universidad de Colombia / Evaluation of knowledge in pharmaceutical care for people with visual disabilities in students of pharmacy regency of a university of Colombia

En la formación académica y profesional del personal de farmacia sean desde el punto de vista técnico, tecnológico o profesional incluyendo a la Química farmacéutica, no solo se debe centralizar en cúmulo de conocimientos y practicas formativas sino que además debemos contemplar aspectos socio-morales como el de tener profesionales los mas completos formativos como para una atención farmacéutica para personal con discapacidades visuales, físicas o neurológicas ( dependiendo del grado debcomplejidad);donde el poder de su rehabilitación radica en su independencia y habilidad de desenvolverse por sí solos autosuficientes. Por todo lo anterior se requiere que dentro del plan educativo institucional o llamados pensul académicosbse contemple en las clases socio -éticas formación de lenguaje de señas o capacitaciones para atención ambulatoria y Clinicas a este tipo de población que tienen los mismos derechos y deberes ciudadanosbde sus congéneres. (AU)

In the academic and professional training of pharmacy personnel, whether from a technical, technological or professional point of view, including Pharmaceutical Chemistry, not only should the accumulation of knowledge and training practices be centralized, but we should also contemplate socio-moral aspects such as to have professionals with the most complete training such as pharmaceutical care for personnel with visual, physical or neurological disabilities (depending on the degree of complexity); where the power of their rehabilitation lies in their independence and ability to function on their own, self-sufficient. For all of the above, it is required that within the institutional educational plan or called academic pensul, socio-ethical classes provide sign language training or training for outpatient care and clinics for this type of population that have the same rights and duties as citizens of their congeners. (AU)

Moral reasoning among Dutch community pharmacists: testing the applicability of the Australian Professional Ethics in Pharmacy test.

Background Moral reasoning competency is essential in healthcare practice, especially in situations of moral dilemmas when a professional has to choose a morally justifiable action among several suboptimal action options. The Australian Professional Ethics in Pharmacy test (PEP test) measures moral reasoning among pharmacists. In Australia three levels of moral reasoning (schemas) were measured (1) business orientation (2) rules and regulations, and (3) patient rights (i.e. most advanced schema). Objective To test the applicability of the PEP test to pharmacists working in the Netherlands. Setting Dutch community pharmacy. Methods The PEP test consists of 36 statements (items) accompanying 3 moral dilemma scenarios. It was translated into Dutch and completed by 390 pharmacists. Principle component analysis (PCA) was used to investigate construct validity and Cronbach's Alpha was used to indicate internal consistency of the Dutch version of the PEP test. The eligible grouped statements and perceived possible moral reasoning schemas were compared to the Australian findings. Main outcome measure Moral reasoning schemas. Results The PCA analysis resulted in 3 components (i.e. possible moral reasoning schemas) that together accounted 27% variance in the data. The statements that represented the moral reasoning schemas 'business orientation' and 'rules and regulations' were somewhat similar when comparing these with the statements that represented these schemas in the PEP test study. The most advanced moral reasoning schema identified in Dutch pharmacists contained different statements compared to the statements that represented that schema among Australian pharmacists. This schema was labelled 'professional ethics'. Conclusion The PEP test needs further adaptation to the Dutch pharmacy practice context: especially the statements that should reflect the most advanced moral reasoning schema, need more accurate representations of professional pharmacy ethics that guide pharmacists in the Netherlands. Moral reasoning tests for a specific professional setting or country should be developed and adapted by experts who share the same professional values and practice as the respondents.

Community pharmacy ethical practice in Jordan: assessing attitude, needs and barriers

Background: Having a local code of ethics, based on moral obligations and virtues, known to all practicing pharmacists is important in order to guide them in relationships with patients, health professionals, and society. Objective: To investigate pharmacists' attitude and barriers towards applying the ethical principles published by the Jordanian Pharmacists Association in the Jordanian code of ethics. Methods: The study objectives were addressed in a cross-sectional study completed by a convenience sample of community pharmacists, in both cities; Amman and Irbid A questionnaire was used to achieve the study objective. The questionnaire was developed and validated, investigating pharmacists' socio-demographic and practice characteristics, perceived attitude toward certain practice scenarios, and perceived barriers towards applying the locally published ethical principles while dealing with their patients. The questionnaire was self-completed by pharmacists between January and August 2017. Collected data was analyzed using SPSS version 21. Descriptive statistics and parametric tests were used with p<0.05 set a priori as significant. Results: Seven hundred and four pharmacists (Amman n=486; Irbid n=218) responded to the questionnaire, providing completely answered questionnaires with a response rates of 69.4% in Amman and 99.6% in Irbid. Pharmacists from both cities revealed that they use the Internet as their main resource to obtain ethical information when they need it, to help them deal with their patients (34.0% from Amman and 31.5% from Irbid). More pharmacists in Amman (57.0%) had access to resources regarding ethical information at their practice sites compared to pharmacists in Irbid (24.0%). Significant differences in attitude was found between pharmacists practicing in both cities, as significantly less pharmacists from Amman (37.8%) declared that they would sell a medication for an unreported indication according to national and international guidelines, if recommended by the consultant, compared to pharmacists from Irbid (77.7%, p<0.001). Conclusions: Despite having ethical guidance from the Jordanian Pharmacists Association, the majority of pharmacists in Jordan do not use this resource; instead, most choose to access ethical guidance on-line. Pharmacists from the capital, Amman, reported to adhere more with the guidelines when selling a medication for an unreported indication compared to pharmacists from the smaller city, Irbid. Results of this study call for more actions from the authorities in the country responsible for setting and enforcing the pharmaceutical Code of Ethics

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Pharmacists' Assessment of the Difficulty and Frequency of Ethical Issues Encountered in Community Pharmacy Settings.

Researching ethical problems and their frequency could give us a complex picture and greater insight into the types of ethical issues that pharmacists face in providing health care. The overall aim of this study was to assess the pharmacist's perception of difficulty and frequency of selected ethical issues encountered by the community pharmacists in their everyday practice. A quantitative cross sectional multicenter study was performed using a validated survey instrument - Ethical Issue Scale for Community Pharmacy (EISP). The results of the analysis of 690 completely filled out instruments (response rate 78.49%) showed the difference between the ethical issues which always occurred ("A pharmacist is prevented from dispensing a medicine to the patient due to an administrative error in the prescription"), and the ones that pharmacists found most difficult ("A pharmacist dispenses a medicine he/she personally considers inadequate for the therapeutic treatment of the patient, in order to avoid any conflicts with the physician" and "A pharmacist is considering violating the rules and regulations in order to perform an act of humanity"). The majority of respondents (84.78%) were familiar with the Code of Ethics but the correlation between the familiarity and the perceived usefulness of the code in resolving problems in everyday practice was negative (ρ = -0.17, p < 0.001). Results showed that patients' well-being had a high influence on pharmacists' behavior. The results provided quantitative data by the examination of specific ethical issues and their occurrence. Further empirical research is recommended in order to systematically identify the ethical issues faced by community pharmacists.

Moral dilemmas reflect professional core values of pharmacists in community pharmacy.

OBJECTIVES: The aim was to recognise the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customise the descriptions of these values for community pharmacy practice. METHODS: The narratives of 128 moral dilemmas, collected from Dutch PharmD students and early career pharmacists who experienced these dilemmas in practice, were qualitatively analysed. An expert panel deductively coded relevant portions of these narratives with the core values as formulated by the Royal Dutch Pharmacists Association. Other values that emerged were inductively coded and if possible used to further customise the respective core values. KEY FINDINGS: The expert panel identified all four professional core values, that is, commitment to the patient's well-being (117, 91.4%), reliable and caring (116, 90.6%), pharmaceutical expertise (72, 56.2%) and responsibility to society (30, 23.4%) in the 128 moral dilemma narratives. Thirteen other values that emerged in the analysis could all be used for the customisation of the professional core values in descriptions that better reflect community pharmacy practice. CONCLUSIONS: Professional core values were identified in moral dilemma narratives of pharmacists in community pharmacy and customised for their practice. These customised core values can enable pharmacists to better recognise moral dilemmas in practice. This can add to the advancement of the profession as a pharmaceutical care practice.

A practical approach toward teaching ethics to community pharmacists.

Background Pharmacists as highly qualified professionals face ethical dilemmas and conflicts in their daily practice. These issues manifest themselves in the daily practice of pharmacists, which require pharmacists to have the competencies to manage these dilemmas but there is limited formal training in ethical decision making during undergraduate pharmacy education. Objective To describe the implementation and evaluation of a methodological approach to managing ethical dilemma workshop for community pharmacists in Malaysia. Setting Community pharmacists in Klang Valley, Malaysia. Method During the workshop, pharmacists were provided insights into how they could use and apply a methodological approach towards managing a dilemma, followed by a case study and panel discussion. All participants were invited to complete a pre- and post-workshop questionnaire Main outcome measure Number and proportion of respondents answering questions related to practice of ethics and workshop effectiveness Results A total of 37 participants attended the workshop. Most of the participants reported that they had no formal training in professional ethics and often used their own approach to solve an ethical issue. Some of the most common issues mentioned include changing medication to generic. More than three quarter of participants agreed and strongly agreed the content was relevant to their job and they will be able to use what they learned in the program. Conclusion The evidence suggests that a module in ethical decision making should be introduced to community pharmacists in Malaysia. This module can be easily adapted for use in other countries and will help ensure that pharmacist can make a good professional judgement and deliver the deeds of beneficence to all their patients.

Ethical responsibilities of pharmacists when selling complementary medicines: a systematic review.

OBJECTIVE: The widespread sale of complementary medicines in community pharmacy raises important questions regarding the responsibilities of pharmacists when selling complementary medicines. This study reviews the academic literature that explores a pharmacist's responsibilities when selling complementary medicines. METHODS: International Pharmaceutical Abstracts, Embase, PubMed, Cinahl, PsycINFO and Philosopher's index databases were searched for articles written in English and published between 1995 and 2017. Empirical studies discussing pharmacists' practices or perceptions, consumers' expectations and normative studies discussing ethical perspectives or proposing ethical frameworks related to pharmacists' responsibilities in selling complementary medicines were included in the review. KEY FINDINGS: Fifty-eight studies met the inclusion criteria. The majority of the studies discussing the responsibilities of pharmacists selling complementary medicines had an empirical focus. Pharmacists and consumers identified counselling and ensuring safe use of complementary medicines as the primary responsibilities of pharmacists. No formal ethical framework is explicitly employed to describe the responsibilities of pharmacists selling complementary medicines. To the degree any ethical framework is employed, a number of papers implicitly rely on principlism. The studies discussing the ethical perspectives of selling complementary medicines mainly describe the ethical conflict between a pharmacist's business and health professional role. No attempt is made to provide guidance on appropriate ways to resolve the conflict. CONCLUSION: There is a lack of explicit normative advice in the existing literature regarding the responsibilities of pharmacists selling complementary medicines. This review identifies the need to develop a detailed practice-specific ethical framework to guide pharmacists regarding their responsibilities when selling complementary medicines.

Moral dilemmas of community pharmacists: a narrative study.

Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing. Objective To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy. Methods Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure Themes of moral dilemmas. Results Twenty-two themes were identified in 128 narratives. These moral dilemmas arose predominantly during pharmacists' contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators. Conclusion The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.

An Ethical Issue Scale for Community Pharmacy Setting (EISP): Development and Validation.

Many problems that arise when providing pharmacy services may contain some ethical components and the aims of this study were to develop and validate a scale that could assess difficulties of ethical issues, as well as the frequency of those occurrences in everyday practice of community pharmacists. Development and validation of the scale was conducted in three phases: (1) generating items for the initial survey instrument after qualitative analysis; (2) defining the design and format of the instrument; (3) validation of the instrument. The constructed Ethical Issue scale for community pharmacy setting has two parts containing the same 16 items for assessing the difficulty and frequency thereof. The results of the 171 completely filled out scales were analyzed (response rate 74.89%). The Cronbach's α value of the part of the instrument that examines difficulties of the ethical situations was 0.83 and for the part of the instrument that examined frequency of the ethical situations was 0.84. Test-retest reliability for both parts of the instrument was satisfactory with all Interclass correlation coefficient (ICC) values above 0.6, (for the part that examines severity ICC = 0.809, for the part that examines frequency ICC = 0.929). The 16-item scale, as a self assessment tool, demonstrated a high degree of content, criterion, and construct validity and test-retest reliability. The results support its use as a research tool to asses difficulty and frequency of ethical issues in community pharmacy setting. The validated scale needs to be further employed on a larger sample of pharmacists.

Estudio piloto en una farmacia comunitaria sobre la eficiencia y la efectividad de la prescripción de estatinas / A pilot study in a community pharmacy to determine the efficiency and the effectiveness of statin prescriptions

ANTECEDENTES: La eficacia de las estatinas para reducir los niveles de LDL-colesterol es elevada, aunque sus costes son importantes y su efectividad en ámbitos reales, limitada. OBJETIVO: Analizar la eficiencia y la efectividad de las prescripciones de estatinas y su relación con características del paciente en un estudio piloto en una farmacia comunitaria. DISEÑO: Estudio transversal. Emplazamiento: Farmacia comunitaria. Prescripciones procedentes de 2 Centros de Salud de Lorca (Área III del Sistema Murciano de Salud). PARTICIPANTES: Ciento cuarentaiún pacientes y 32 médicos. MEDICIONES PRINCIPALES: Se recogieron variables sociodemográficas y clínicas de los pacientes, e información sobre el tipo y la dosis de estatina. En cada paciente se determinó: efectividad del tratamiento, en función del RCV y niveles de LDL-colesterol previos al tratamiento, y eficiencia, comparando el coste de la estatina prescrita con el de aquellas de igual potencia famacológica. RESULTADOS: El 57,4% de las prescripciones fueron de atorvastatina. El 63,9% de las prescripciones se consideraron ineficientes y el 17,3% inefectivas. En el análisis bivariado, los pacientes con eventos cardiovasculares previos (8/38; 21% vs.41/103; 39,8%, p = 0,040) y los fumadores (42/114; 36,8% vs.4/23; 17,4%, p = 0,047) tenían más riesgo de recibir una prescripción ineficiente. En el análisis multivariable, los fumadores tenían más probabilidad de recibir prescripciones ineficientes comparados con los no fumadores (OR ajustada 3,76; IC del 95%, 1,03-0,77; p = 0,012). CONCLUSIONES: Los pacientes alcanzaron mayoritariamente los objetivos de LDL-colesterol propuestos, aunque más de la mitad de las prescripciones se consideraron ineficientes

BACKGROUND: The efficacy of statins to reduce LDL-cholesterol serum levels is high, but effectiveness is limited and costs are elevated. OBJECTIVE: The efficiency and effectiveness of prescriptions were analyzed in a pilot study in a community pharmacy. DESIGN: A cross-sectional study. LOCATION: Community pharmacy. Prescriptions from two Murcian Health Service Centers in Lorca, Murcia (Spain). PARTICIPANTS: A total of 141 patients and 32 general practitioners were included. The efficiency was analyzed in 141 and effectiveness in 110 PATIENTS: MAIN MEASUREMENTS: Socio-demographic characteristics and clinical history of patients and information about statin type and dosage were collected. Each patient was analyzed to determine the effectiveness of treatment according to cardiovascular risk and previous LDL-cholesterol level, and efficiency comparing the statin prescribed against other statins with equal pharmacological power. RESULTS: The most prescribed statin was atorvastatin (57.4%). Almost two-thirds (63.9%) of prescriptions were inefficient, and 17.3% were ineffective. In a bivariate analysis, patients with previous cardiovascular events (8/38; 21% vs 41/103; 39.8%. P=.040) and smokers (42/114; 36.8% vs 4/23; 17.4%, P=.047) were more likely to receive an inefficient prescription than patients with no cardiovascular events and non-smokers. In a multivariate analysis, smokers were more likely to receive an inefficient prescription than non-smokers (OR ajusted 3.76; 95% CI;1.03-0.77, P=.012). CONCLUSIONS: Most of the participants reached therapeutic objectives for LDL-Cholesterol levels, but more than half of the prescriptions were considered inefficient

Benzodiazepinas en ancianos: a propósito de un caso / Benzodiazepines in aged patients: a case report

Las benzodiazepinas son los fármacos hipnótico-sedantes más consumidos, sobre todo entre la población geriátrica. En la presente publicación se describe el caso clínico de un paciente que ha sufrido una caída con consecuencia de rotura de fémur y que se encontraba en tratamiento con dos benzodiazepinas a dosis mayores a las recomendadas para ancianos, en el momento de sufrir la caída. Dichos fármacos fueron ketazolam y lorazepam, a dosis de 30 mg y 5 mg, respectivamente. Recalcamos la importancia de prestar especial atención a la dosificación de estos fármacos en los ancianos y de seguir las recomendaciones de elegir benzodiazepinas de vida media corta o ultracorta, a la menor dosis posible y durante el menor periodo de tiempo necesario

Benzodiazepines are the most consumed sedative-hypnotic drugs, especially among geriatric population. In this publication, we report the case of a patient who suffered a fall and broked his femur and who was treated with two benzodiazepines at higher doses tan recommended for elderly patients, at the time of suffering the fall. Such drugs were ketazolam and lorazepam, prescribed at 30 mg/ day and 5 mg/day respectively. We emphasize the need of pay special attention to the dosage of these drugs in the elderly and to follow the recommendations of choicing those ones of short or ultrashorthalf-life, at the lowest dose possible and for the shortest time necessary

The conflicts between professional and non-professional work of community pharmacists in Indonesia / Conflictos entre el trabajo profesional y no profesional de los farmacéuticos comunitarios en Indonesia

Objectives: The study aimed to determine the type of professional and non professional work of community pharmacists in Surabaya Indonesia and find the difference between time spent for performing both works in actual (current) situation and ideal (expected) situation. Methods: A cross sectional study was conducted by combining purposive sampling for selecting the community pharmacists. Afterwards, the data was analyzed using SPSS v16 to provide the descriptive results and completed with Wilcoxon signed rank test to find the difference between time spent in actual and ideal situation. The sample size was 100 respondents of 300 pharmacists who have been practicing in Surabaya. Results: From 100 participants just 30 participants gave response to the questionnaire, 67% was female who 20-30 years old at most (53%) with working experience as pharmacist less than 3 years (60%) and working 30 hours per week (60%) in pharmacy. Significant difference between time spent in actual and ideal situation was found. Discussion: The time spent for performing professional and non professional work in ideal situation was significantly higher than in actual situation except for preparing medicines activity. This finding illustrated that the respondents did not have adequate time to provide ideal services in their daily practice. Therefore, they expected to improve their time and level of work in more professional manner. Surprisingly, they were also willing to provide more time and higher level of work in some non professional work. Conclusions: The Indonesian community pharmacists spent little time on both professional work and non-professional work in their daily activities. This indicated that the pharmacists did not focus on delivering quality professional work (AU)

Objetivos: El estudio trató de determinar el tipo de trabajos profesionales y no profesionales de los farmacéuticos comunitarios en Surabaya, Indonesia, y encontrar las diferencias entre el tiempo dedicado a realizar ambos tipos de trabajo en la situación real (actual) e ideal (esperada). Métodos: Se realizó un estudio transversal combinando muestras propositadas de farmacéuticos comunitarios seleccionados. Después, se analizaron los datos usando SPSS v16 para proporcionar los resultados descriptivos y se completaron con un test de los signos de Wilcoxon para encontrar la diferencias entre los tiempos en la situación real e ideal. El tamaño de muestra fue de 100 respondentes de los 300 farmacéuticos que estaban en ejercicio en Surabaya. Resultados: De los 100 participantes, solo 30 dieron respuesta al cuestionario, siendo el 67% mujeres, con 20-30 años de edad (53%), con una experiencia como farmacéuticos de menos de 3 años (60%) y trabajando 30 horas por semana (60%). Apareció diferencia significativa entre los tiempos en la situación real e ideal. El tiempo dedicado a realizar trabajos profesionales y no profesionales en la situación ideal era significativamente mayor que en la situación real, excepto para la actividad de preparar medicamentos. Este resultado ilustró que los respondentes no tienen suficiente tiempo para proporcionar los servicios ideales en su práctica diaria. Por tanto, esperan mejorar su tiempo y nivel de trabajo de un modo más profesional. Sorprendentemente, deseaban dedicar más tiempo y subir el nivel de trabajo en algunos trabajos no profesionales. Conclusión: Los farmacéuticos comunitarios indonesios pasan poco tiempo, tanto en trabajos profesionales como no profesionales en sus actividades diarias. Esto indica que los farmacéuticos no se centran en realizar trabajo de calidad profesional (AU)

Days lost due to disability of diclofenac-induced adverse drug reactions / Días perdidos debido a discapacidad por reacciones adversas inducidas por diclofenaco

Disability Adjusted Life Years (DALY) is a widely used measure to quantify the burden of diseases or illness. DALYs for a disease is calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the equivalent healthy Years Lost due to Disability (YLD). The only difference from the YLD and Days Lost due to Disability (DLD) calculation is that instead of considering the duration of Adverse Drug Reaction (ADR) in years, it is calculated in days. Objective: DLD was measured for diclofenac tablets to prepare the ADR profile. Methods: The study was done on the patients (18-65 years old) attending the community pharmacy at Kasaragod district, South India, with prescription of diclofenac tablets. Patients reported ADRs on their next visit to the pharmacy or they had called to the provided phone number and reported it. Disability Weight (DW) was calculated in an analogue scale from 0-1. Zero represent complete health and 1 represent death or equivalent condition. DW was multiplied with occurrence and duration of ADRs in days. Results: About 943 patients received diclofenac tablets in 1000 prescriptions were successfully followed up for possible, probable and definite ADRs. A total of 561 reactions reported in 2010 for diclofenac tablet in the study population. There were 34 different types of ADRs under 12 physiological systems/organs. Most common reactions were on gastrointestinal (GI) system (48%), followed by skin (14%), Central Nervous System (10%), renal (7%), and cardiovascular (7%). Abdominal pain, cramps or flatulence was the highest occurring GI ADR (107), followed by 43 rashes, 42 nausea/vomiting, 37 indigestion, 34 peptic ulcers, 31 edema etc. DLD for peptic ulcer was considerably high (0.078) per 1000 of the study population on diclofenac. The most damaging ADR were peptic ulcer with or without perforation, followed by rash 0.036 DLD and edema 0.027 DLD. There was considerable DLD by acute renal failure (0.012) Steven-Johnson syndrom (0.013) even though few cases were reported. Conclusion: Diclofenac has a complex adverse drug profile. Around 34 types of reactions were reported. Diclofenac was widely prescribed because of the experiential belief of comparative safety with other NSAIDs. The study shows the importance of pharmacovigilance even on the most prescribed medicine. Most disabling ADR for the study population was peptic ulcer with or without perforation. YLD or DLD are useful measures of calculating disability caused by ADRs. Future studies could focus on improving the usefulness & precision of DLD (AU)

Los años de vida ajustados a la discapacidad (DALY) es una medida ampliamente usada para cuantificar el daño de la enfermedad. Los DALY para una enfermedad se calculan por la suma de los años de vida perdidos (YLL) debido a mortalidad prematura en la población y el equivalente años de vida saludable perdidos por la discapacidad (YDL). La única diferencia en el cálculo de los YLD y los días perdidos por discapacidad (DLD) es que en lugar de considerar la duración de la reacción adversa en años, se calcula en días. Objetivo: Se midió los DLD por el diclofenaco tabletas para preparar el perfil de RAM. Métodos: El estudio se realizó en pacientes (18-65 años) que visitaron la farmacia comunitaria del distrito de Kasaragod, Sur-India, con una receta de diclofenac en tabletas. Los pacientes comunicaron las RAM en su posterior visita a la farmacia o llamaron o se les llamó por teléfono y las comunicaron. El peso de la discapacidad (DW) se calculó en una escala de 0-1. Cero representaba la salud completa y 1 representaba la muerte o situación equivalente. El DW se multiplicaba por la aparición y duración en días de las RAM. Resultados: Unos 943 pacientes que recibieron diclofenac tabletas en 1000 recetas fueron seguidos con éxito para sus RAM posibles, probables y confirmadas. Durante 2010 se comunicó un total de 561 reacciones en la población en estudio. Hubo 34 tipos diferentes de RAM sobre 12 órganos o sistemas diferentes. Las reacciones más comunes fueron en el sistema gastrointestinal (48%), seguidas de piel (14%), sistema nervioso central (10%), renal (7%), y cardiovascular (7%). Dolor abdominal, calambres o flatulencia fueron las RAM GI más frecuentes, seguidas de 43 irritaciones, 42 nauseas/vómitos, 37 indigestiones, 34 úlceras pépticas, y 31 edemas. Los DLD para úlcera péptica fueron considerablemente elevados (0,078) por 1000 individuos en estudio con diclofenac. La RAM más dañina fue la úlcera péptica con o sin perforación, seguida de la irritación con 0,036 DLD y el edema con 0,027 DLD. Hubo considerables DLD por fallo renal agudo (0,012) e incluso se comunicaron algunos casos de síndrome de Steven-Johnson (0,013). Conclusión: El diclofenac tiene un perfil de reacciones adversas complejo. Se comunicaron 34 tipos de reacciones. El diclofenac era ampliamente prescrito por la creencia empírica de la seguridad comparativa contra otros AINE. El estudio demuestra la importancia de la farmacovigilancia, incluso en los fármacos más prescritos. La RAM más incapacitante para la población de estudio fue la úlcera péptica con o sin perforación. Los YLD o los DLD son medidas útiles para calcular la incapacidad causada por RAM. Futuros estudios podrían centrarse en mejorar la utilidad y precisión de los DLD (AU)

Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India.

WHAT IS KNOWN AND OBJECTIVE: The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level. METHODS: Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory. RESULTS AND DISCUSSION: Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes. WHAT IS NEW AND CONCLUSIONS: Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.

Interacciones entre fármacos en una oficina de farmacia comunitaria / No disponible

Objetivo: cuantificar, valorar y analizar las interacciones farmacológicas en los pacientes que acuden a una oficina de farmacia.Método: Estudio transversal de un año en una oficina de farmacia de Valencia. Las interacciones se detectaron con el programa BotPlus del Consejo General de Colegios Oficiales de Farmacéuticos.Resultados: El 63,64% de las interacciones se produjeron en mujeres. Más del 63% aparecieron en mayores de 56 años. El 57,94% fueron de tipo farmacodinámico. El 69,16% fueron importantes o potencialmente importantes. El 57,01% afectaban a la seguridad. En un 69,16% se recomendaba un control clínico del paciente. La interacción de antiinflamatorios no esteroideos y diuréticos fue la que apareció con una mayor frecuencia.Conclusiones: Es necesario establecer un plan de actuación con protocolos normalizados de trabajo ante posibles interacciones y con intervenciones en la educación de los pacientes para minimizar la aparición de problemas relacionados con medicamentos(AU)

Objective: To quantify, to value and to analyze the pharmacological interactions in the patients who come to a community pharmacy.Method: Cross-sectional study of one year in a community pharmacy of Valencia. The interactions were detected by the program BotPlus of the General Council of Pharmacists’ Official Colleges.Results: 63,64 % of the interactions took place in women. More than 63 % appeared in major of 56 years. 57,94 % were pharmacodinamic type. 69,16 % were important or potentially important. 57,01 % were concerning the safety. In 69,16 % a clinical control of the patient was recommended. The interaction of anti-inflammatories-non-steroidal and diuretics it was the one that appeared with a major frequency.Conclusions: It is necessary to establish an action plan with standard operating protocols to possible interactions and interventions in the education of patients to minimize the occurrence of drug-related problems(AU)

Professional values in community and public health pharmacy.

General practice (community) pharmacy as a healthcare profession is largely devoted to therapeutic treatment of individual patients whether in dispensing medically authorised prescriptions or by providing members of the public with over-the-counter advice and service for a variety of common ailments. Recently, community pharmacy has been identified as an untapped resource available to undertake important aspects of public health and in particular health promotion. In contrast to therapeutic treatment, public health primarily concerns the health of the entire population, rather than the health of individuals (Childress et al. in J Law Med Ethics 30:170-178, 2002). Thus, an important question for the profession is whether those moral and professional values that are appropriate to the therapeutic care of individual patients are relevant and adequate to support the additional public health role.

Los Inicios de la Sociedad Farmacéutica del Mediterráneo Latino: II Reunión de la Sociedad Farmacéutica del Mediterráneo Latino, celebrada en 1956 / The beginnings of the Sociedad Farmacéutica del Mediterráneo Latino: II Meeting of the Sociedad Farmacéutica del Mediterráneo latino, held in 1956

INTRODUCCIÓN: La segunda reunión internacional de la sociedad tuvo lugar en Barcelona en unos momentos en que la internacionalización de la farmacia española era mínima, tras la Guerra Civil y el ostracismo al que se vio sometida España tras la Segunda Guerra Mundial, por lo que una reunión de estas características supuso una novedad para los profesionales farmacéuticos, docentes y la farmacia en general; la celebración del congreso significó la consolidación de la Sociedad, tres años después de su fundación como una sección más de la Unión Médica Mediterránea y permitió el contacto de los farmacéuticos españoles con sus colegas de Francia e Italia. OBJETIVO: Determinar la procedencia de los asistentes a la reunión y los principales temas de las comunicaciones presentadas y de la posible repercusión social de la reunión. Comparación de los estatutos de la Sociedad en 1956 con los actuales METODOLOGÍA: Consulta del fichero en que constan los asistentes a la reunión y de las revistas en las que se publicaron las comunicaciones y de otras publicaciones de la época, así como de los estatutos de la Sociedad CONCLUSIÓN /DISCUSIÓN: En aquellos tiempos las comunicaciones se agruparon en tres secciones, de Ciencias Físico-Químico-Farmacéuticas y Toxicológicas, de Ciencias Biológicas y de Asuntos Profesionales, Industriales e Historia de la Farmacia La evolución de las comunicaciones publicadas y de los estatutos de la sociedad permite ver la evolución de las principales preocupaciones en los países participantes hacia la farmacia comunitaria y la apertura de la farmacia a otros profesionales de la salud, así como un mayor protagonismo de la mujer en la farmacia(AU)

INTRODUCTION: The second international meeting of the Society took place in Barcelona at a time in which the internationalization of Spanish pharmacy was minimal after the Civil War and the ostracism to which Spain was subjected after World War II, and made a novelty of a meeting of these features for pharmacists, educators and pharmacy in general. The conference marked the consolidation of the Society, three years after its founding as a section of the Unión Medica Mediterránea and allowed the contact of the Spanish pharmacists with their colleagues from France and Italy. OBJECTIVE: To determine the origin of the participants in the meeting and major topics of papers and the potential social impact of the meeting. Comparison of the by laws in 1956 to current ones METHODS: A search of the records containing the name and data of the participants in the meeting and the journals that published papers and other publications of the period, as well as the by laws CONCLUSION / DISCUSSION: In those days, papers were grouped into three sections, Physico-Chemical- Pharmaceutical Sciences and Toxicology, Life Sciences and Professional Affairs, Industrial and History of Pharmacy. The changes in the published papers and the by laws of the society allow to see the evolution of the main concerns in the participating countries towards community pharmacy and the receptiveness to other health professionals, as well as a greater role for women in pharmacy(AU)

Sistema de registro de las actuaciones profesionales demandadas en la Farmacia comunitaria / Registration system of professional performances defendants in Community Pharmacy

INTRODUCCION: El diseño de una herramienta o sistema de registro de todas las actuaciones profesionales (AP) quedemanda el usuario en la farmacia comunitaria, en el mostrador, donde el farmacéutico realiza lamayor parte de su labor, es imprescindible para entender la barrera de falta de "tiempo" para implantar o desarrollar servicios cognitivos en la farmacia comunitaria. MATERIAL Y METODO: El equipo investigador del estudio diseñó la herramienta de registro utilizando como soporte informático el sistema de gestión disponible en las farmacias participantes en el estudio(FARMATCR). Después de un pilotaje de 15 días y de los ajustes necesarios se creó la herramienta definitiva. Los requisitos básicos que se persiguieron para el diseño de la herramienta, fueron: Registrar todas las AP demandadas en el mostrador de la farmacia comunitaria. Recopilar la máxima información para cada una de las AP. Mantener la agilidad en la resolución de las mismas. Se decide hacer un control de calidad de la herramienta para saber si satisface las necesidades para lo que se ha diseñado. RESULTADO: herramienta FINAL. La herramienta consiste en la introducción en el sistema informático (FARMATCR,) de una serie de códigos de trabajo nuevos (artículos, aportaciones y desplegables). DISCUSION: Es difícil encontrar un equilibrio entre agilidad y rigor del registro. La herramienta es capaz de cuantificar las AP que se realizan en el mostrador, pero con limitaciones

INTRODUCCION: Designing a tool or registration system for all professional activities requested by all user over the counter in the community pharmacy, where the pharmacist conducts most of its work, is essential to enable the understanding of the barrier of "lack of time" in order to establish or develop cognitive services in the community pharmacy. METHOD: The research team working on this survey, designed the registered tool using the management system available in all pharmacies participants in the survey, as a computerized record (FARMATICR). The ultimate tool was created after 15 days of pile work and needed adjustments. The basic requirements pursued for the design of the tool were: The recording of all professional activities requested at the counter in pharmacies. The compiling of all information for each of the professional activities to maintain the flexibility in the resolutions of these. It was decided to have constant feedback of the quality of the tool to see if it met the requirements for its designed purpose. RESULTS: The tool is the introduction into the computer system (FARMATICR), of a series of new labor codes (articles, transfers and leaflets). DISCUSSION: It is difficult to find a balance between the speed and the inflexibility of the record. The tool is able to quantify the professional activities carried out in the pharmacy counter, but with its limitations