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

Objetivo: Explorar la percepcion de Formadores Colegiales con experiencia previa sobre su formacion y sus funciones futurasen la implantacion y sostenibilidad del servicio de Seguimiento Farmacoterapeutico en el ambito de la farmacia comunitariaespanola. Metodo: Estudio cualitativo mediante la tecnica del grupo focal. El coordinador de la reunion focal utilizo un guion tematicopreviamente elaborado que permitia explorar la opinion de los Formadores Colegiales sobre sus experiencias y percepciones acercadel futuro de esta nueva figura profesional. El contenido de la conversacion fue registrado en una grabadora, transcrito en su totalidady posteriormente analizado mediante analisis de contenido. Resultados: La reunion grupal celebrada en la sede del Consejo General de Colegios Oficiales de Farmaceuticos, en Madrid, tuvo unaduracion de 95 minutos. Participaron seis Formadores Colegiales. En funcion de los temas tratados se identificaron dos dimensiones;una primera que abarca las funciones que debe desempenar un Formador Colegial (resaltando la funcion de motivador, facilitadorde la comunicacion y formador metodologico y clinico) y una segunda en las que se describen las caracteristicas que ese profesionaldebe tener para poder realizar su papel facilitador (entre las que destacan que debe ser un profesional contratado por el Colegio deFarmaceuticos correspondiente, con lugar fisico de trabajo dentro del mismo, y con jornada laboral completa y flexible, entre otrascaracteristicas). Conclusiones: El presente articulo aporta informacion relevante sobre la figura innovadora del Formador Colegial, describiendo lascaracteristicas intrinsecas necesarias para desarrollar su labor y las funciones a desempenar. Dicha informacion deberia ser utilizadapor aquellos Colegios Oficiales de Farmaceuticos provinciales que deseen implantar Servicios Profesionales Farmaceuticos, talescomo el servicio de Seguimiento Farmacoterapeutico.

Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy

Objetivo: Identificar, mediante el modelo PRECEDE, los factores predisponentes, facilitadores y reforzantes que influian en la participacion de un grupo de farmaceuticos en el proyecto AFasma Metodo: Estudio cualitativo mediante entrevistas semiestructuradas y observacion participante de los farmaceuticos incluidos en el grupo de intervencion del estudio AFasma Resultados: Los factores predisponentes motivantes para el farmaceutico fueron: formacion en asma, realizacion profesional, fidelizacion del paciente y valoracion de la farmacia Los factores desmotivantes fueron: dedicacion de tiempo, ausencia de relacion farmaceutico-medico, falta de personal y de publicidad, y dificultades para ofrecer el servicio Los factores facilitadores presentes fueron: habilidades de comunicacion farmaceutico-paciente, cumplimentacion correcta de las hojas de recogida de datos, uso correcto del inhalador y pago por servicio Por el contrario, se detecto: baja capacidad para ofertar el servicio, ausencia de una zona de atencion personalizada, dudas con la valoracion de la tecnica de inhalacion y educacion en asma, y ausencia de implicacion de todo el personal de la farmacia Los factores reforzantes identificados con mayor frecuencia a favor de la realizacion del estudio fueron: satisfaccion personal y profesional, mejora de la relacion farmaceutico-paciente y actualizacion en farmacologia, mientras que entre los identificados en contra el mas frecuente fue la alta dedicacion de tiempo requerida Conclusiones: La utilizacion del modelo PRECEDE logro identificar los factores predisponentes, facilitadores y reforzantes que condicionaron la participacion de un grupo de farmaceuticos en el estudio AFasma Con los resultados obtenidos se podria disenar un conjunto de estrategias para apoyar la realizacion de estudios similares y facilitar una posible implantacion del servicio

https://pharmcareesp.com/index.php/PharmaCARE/article/download/11/10

Factores que influyen en la participación de farmacéuticos comunitarios en un servicio de atención farmacéutica para pacientes asmáticos

Costs' identification of the sustainable provision of the Medication Management Service

Correspondencia: Miguel Ángel Rodríguez Chamorro. Luxemburgo, 5, 2.o B. 10005 Cáceres Correo electrónico: miguelrodriguez@redfarma.org Influencia de las características sociodemográficas y clínicas en la adherencia al tratamiento farmacológico de pacientes con riesgo cardiovascular Infl uence of sociodemographics and clinical characteristics in the adherence of pharmacological treatment of patients with cardiovascular risk

Influencia de las características sociodemográficas y clínicas en la adherencia al tratamiento farmacológico de pacientes con riesgo cardiovascular Infl uence of sociodemographics and clinical characteristics in the adherence of pharmacological treatment of patients with cardiovascular risk

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every fi ve. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming.

https://www.pharmcareesp.com/index.php/PharmaCARE/article/download/89/83

Fernando Martínez-Martínez

Papers

Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy

Factores que influyen en la participación de farmacéuticos comunitarios en un servicio de atención farmacéutica para pacientes asmáticos

Costs' identification of the sustainable provision of the Medication Management Service

Influencia de las características sociodemográficas y clínicas en la adherencia al tratamiento farmacológico de pacientes con riesgo cardiovascular Infl uence of sociodemographics and clinical characteristics in the adherence of pharmacological treatment of patients with cardiovascular risk

Actuaciones profesionales realizadas en la farmacia comunitaria Professional services carried out in the community pharmacy