The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

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European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.

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What is polypharmacy? A systematic review of definitions

Mental health issues often co-occur with other problems such as substance abuse, and they can take an enormous toll on individuals and impact a college or university in many ways. There are staff and departments both onand off-campus who are concerned about the well-being of students and the impact of mental health issues, so partnerships around mental health promotion and suicide prevention make good sense.

전자/제조업의 Collaboration 전략

The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.

Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association.

Background
Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing.

Objectives
This review sought to determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people.

Search methods
In November 2013, for this first update, a range of literature databases including MEDLINE and EMBASE were searched, and handsearching of reference lists was performed. Search terms included 'polypharmacy', 'medication appropriateness' and 'inappropriate prescribing'.

Selection criteria
A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people 65 years of age and older in which a validated measure of appropriateness was used (e.g. Beers criteria, Medication Appropriateness Index (MAI)).

Data collection and analysis
Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study-specific estimates were pooled, and a random-effects model was used to yield summary estimates of effect and 95% confidence intervals (CIs). The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to assess the overall quality of evidence for each pooled outcome.

Main results
Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists. Appropriateness of prescribing was measured using validated tools, including the MAI score post intervention (eight studies), Beers criteria (four studies), STOPP criteria (two studies) and START criteria (one study). Interventions included in this review resulted in a reduction in inappropriate medication usage. Based on the GRADE approach, the overall quality of evidence for all pooled outcomes ranged from very low to low. A greater reduction in MAI scores between baseline and follow-up was seen in the intervention group when compared with the control group (four studies; mean difference -6.78, 95% CI -12.34 to -1.22). Postintervention pooled data showed a lower summated MAI score (five studies; mean difference -3.88, 95% CI -5.40 to -2.35) and fewer Beers drugs per participant (two studies; mean difference -0.1, 95% CI -0.28 to 0.09) in the intervention group compared with the control group. Evidence of the effects of interventions on hospital admissions (five studies) and of medication-related problems (six studies) was conflicting.

Authors' conclusions
It is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing.

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Interventions to improve the appropriate use of polypharmacy for older people

Iconography : Effect of a pharmacist intervention on asthma control. A cluster randomised trial

Resumen Objetivo Determinar la percepcion del farmaceutico comunitario sobre el uso de analgesicos y evaluar la practica farmaceutica en dolor leve-moderado prestada en farmacias comunitarias espanolas. Diseno Se realizo un estudio observacional transversal, metodo encuesta, entre abril y septiembre de 2013. Emplazamiento Un total de 696 farmacias comunitarias de 20 comunidades autonomas espanolas. Participantes Farmaceuticos comunitarios con experiencia profesional minima de un ano. Mediciones principales Caracterizacion de la demanda de analgesicos, del usuario de analgesicos y de la intervencion farmaceutica en dolor leve-moderado desde la perspectiva del farmaceutico comunitario. Resultados En base a la practica farmaceutica el 45% de los pacientes con dolor acuden a la farmacia a retirar un medicamento con receta medica. La patologia mas consultada es el dolor de cabeza (35%). El 21% de los usuarios de analgesicos se automedican. El ibuprofeno y el paracetamol son los farmacos mas utilizados. El 39% de los farmaceuticos afirman seguir un protocolo de indicacion. Se encontro correlacion entre la experiencia profesional del farmaceutico y los indicadores de proceso de indicacion (Fisher p  Conclusiones Se diferencian 3 grupos mayoritarios de usuarios de analgesicos segun solicite el servicio de indicacion, dispensacion o se automedique. Se requiere una mayor formacion de los farmaceuticos en protocolos de dolor individualizados a los perfiles de pacientes identificados y en criterios de derivacion al medico, que permitan asegurar de manera sistematica la utilizacion correcta de analgesicos y la obtencion de resultados clinicos positivos.

Percepción farmacéutica del uso de analgésicos y su práctica en dolor leve-moderado. Encuesta DOLOR-OFF

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Therapy of secondary cutaneous toxicity as a result of radioterapic treatment, with a sH oligopeptide-1 cream based (epidermal growth factor-egf): a pilot study

Objectives To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT). Setting Community pharmacies in Spain. Participants 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over. Intervention The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators. Primary and secondary outcome measures The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT. Results 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed. Conclusions The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete. Trial registration number CGFTRA-2017-01.

https://bmjopen.bmj.com/content/bmjopen/10/9/e036669.full.pdf

Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice

Introduccion: Para la realizacion del estudio principal del programa conSIGUE se han desarrollado dos fases prepiloto (Murcia y Granada) y una fase piloto (Cadiz), en las que han participado sesenta farmacias. Objetivos: Explorar la percepcion de los farmaceuticos participantes en estas fases sobre su experiencia como proveedores de seguimiento farmacoterapeutico, sobre las dificultades encontradas y las areas de mejora identificadas, en el contexto del programa conSIGUE. Metodo: Para la obtencion de informacion se eligio el grupo focal.Todos los grupos focales tuvieron lugar en las sedes de lostres colegios de farmaceuticos, y en todos los casos participaronel mismo coordinador y la misma observadora. Las reuniones segrabaron y se transcribieron integramente. Se realizo un analisisde contenido utilizando el software NVivo®. Resultados: Se realizaron un total de ocho grupos focales. Las mayores dificultades para la realizacion del servicio son la falta de tiempo, de personal y la falta de formacion y experiencia clinica para realizar las diferentes intervenciones. El seguimiento permite mejorar la organizacion interna de la farmacia, la relacion entre los miembros del equipo, conocer mejor Bot Plus, superar el miedo a relacionarse con los medicos y modificar el tipo de relacion con los pacientes. Ademas, produceuna importante satisfaccion personal. Los formadores colegialesson valorados muy positivamente. Conclusiones: La figura del formador colegial es de gran interes tanto en los momentos iniciales de implantacion del servicio como en su sostenibilidad en el tiempo, ya que permite solucionar los problemas que surgen en la practica del seguimiento.

https://www.pharmcareesp.com/index.php/PharmaCARE/article/download/56/55

Exploración de las percepciones de los farmacéuticos comunitarios en la práctica del seguimiento farmacoterapéutico dentro del contexto del programa conSIGUE

Fernando Martínez-Martínez

Papers

Iconography : Effect of a pharmacist intervention on asthma control. A cluster randomised trial

Percepción farmacéutica del uso de analgésicos y su práctica en dolor leve-moderado. Encuesta DOLOR-OFF

Therapy of secondary cutaneous toxicity as a result of radioterapic treatment, with a sH oligopeptide-1 cream based (epidermal growth factor-egf): a pilot study

Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice

Exploración de las percepciones de los farmacéuticos comunitarios en la práctica del seguimiento farmacoterapéutico dentro del contexto del programa conSIGUE