Mercadeo farmacéutico de productos bajo prescripción: efectos de las estrategias Direct-to-Consumer-Advertising en el comportamiento de los consumidores y de prescripción de los médicos

Este proyecto se origina en el interés de analizar las estrategias actuales de promoción de productos farmacéuticos, en el marco del debate sobre el efecto persuasivo o informativo que la publicidad directa tiene sobre los consumidores. El objetivo es determinar el efecto de las estrategias de promoción directa para consumidores (Direct to Consumer Advertising [DTCA]) sobre el comportamiento de compra de pacientes y las prescripciones que formulan los médicos en el mercado de productos bajo receta en Estados Unidos. Para tal fin se propuso realizar una monografía que incluyera una revisión de literatura de carácter argumentativo, consultando información de nivel secundario en bases de datos científicas cuyos contenidos obedecieran a criterios metodológicos determinados por la naturaleza argumentativa del estudio. Adicionalmente, se analizó el debate sobre estos anuncios a la luz de dos estudios realizados a pacientes con cáncer de seno, próstata y colon, liderados por el Pennsylvania Cancer Registry con los productos biofarmacéuticos Avodart® y Flomax®. Finalmente, la investigación se fundamentó en la relación del mercado farmacéutico en Estados Unidos con cada uno de los agentes que interactúan en él; consumidores, médicos prescriptores y empresas farmacéuticas, así como el valor que estos comparten través de dichas interacciones. Se concluye que el comportamiento de compra de los consumidores está determinado por la naturaleza de la patología que padecen y el comportamiento de los profesionales que prescriben a sus pacientes se ve influenciado por los anuncios DTCA.

Incidencia de síndrome de abstinencia secundario a opioides y/o benzodiacepinas en dos unidades de cuidados intensivos pediátricos

• Introducción: El síndrome de abstinencia (SA) es el conjunto de síntomas y signos que se producen al suspender bruscamente la administración de un fármaco una vez se haya establecido dependencia física. • Objetivos: Caracterizar los pacientes que presentan SA secundario a opiodes (OP) y/o benzodiacepinas(BZ) durante la hospitalización en las unidades de cuidados intensivos pediátricos de la Clínica Infantil Colsubsidio (CIC) y Hospital del Niño de Panamá (HDN) del 1 de abril al 30 de septiembre del 2016. • Materiales y métodos: se realizó un estudio descriptivo, longitudinal, prospectivo. Incluimos 189 pacientes en la CIC y 144 pacientes en el HDN. Se utilizó la escala SOPHIA para el diagnóstico de SA, las escalas COMFORT para evaluar la sedación en pacientes ventilados no relajados y la escala FLACC para evaluar la analgesia. Se utilizó software StataV12® para el análisis estadístico. • Resultados: se reportó una incidencia global de SA de 6.1/100 días personas. La incidencia acumulada de SA fue de 56.08% y 29.86% para la CIC y el HDN respectivamente. En la CIC el 69.81% de los pacientes que requirieron infusión de OP y BZ desarrollaron SA. Se reportó una dosis acumulada de fentanyl de 530.34 ± 276.49 mcg/kg. Con respecto al HDN, de los pacientes que recibieron opioides y benzodiacepinas el 53.49 % desarrollaron SA. • Conclusión: El SA secundario a opioides y/o benzodiacepinas es frecuente en nuestras unidades con una incidencia variable, es mayor la presentación del SA al usar ambos fármacos, mayores dosis acumuladas y más días de infusión continua.

Spatial distribution patterns of the non-native European catfish, Silurus glanis, from multiple online sources - a case study for the River Tagus (Iberian Peninsula)

Effective management of invasive fishes depends on the availability of updated information about their distribution and spatial dispersion. Forensic analysis was performed using online and published data on the European catfish, Silurus glanis L., a recent invader in the Tagus catchment (Iberian Peninsula). Eighty records were obtained mainly from anglers’ fora and blogs, and more recently from www.youtube.com. Since the first record in 1998, S. glanis expanded its geographic range by 700 km of river network, occurring mainly in reservoirs and in high-order reaches. Human-mediated and natural dispersal events were identified, with the former occurring during the first years of invasion and involving movements of >50 km. Downstream dispersal directionality was predominant. The analysis of online data from anglers was found to provide useful information on the distribution and dispersal patterns of this non-native fish, and is potentially applicable as a preliminary, exploratory assessment tool for other non-native fishes.

Environmental assessment for commercial buildings: Stakeholder requirements and tool characteristics

The Cooperative Research Centre for Construction Innovation (CRC CI) is a national research, development and implementation centre focused on the needs of the property, design, construction and facility management sectors. Established in 2001 and headquartered at Queensland University of Technology as an unincorporated joint venture under the Australian Government's Cooperative Research Program, the CRC CI is developing key technologies, tools and management systems to improve the effectiveness of the construction industry. The CRC CI is a seven year project funded by a Commonwealth grant and industry, research and other government support. More than 150 researchers and an alliance of 19 leading partner organisations are involved in and support the activities of the CRC CI

Student self-assessment of performance : a useful learning tool for students and instructors?

Assurance of Learning is a focus for many Business Schools to meet AACSB requirements. Prior research has examined student self-assessment as a measure of learning in this context, but we propose instead that this is a useful ‘learning tool’ for students and instructors that can help improve student performance and curricula. We examined self-assessment in a third year undergraduate e-marketing course and found a positive, though weak relationship between student self-assessment and instructor ratings on intended learning goals and criteria for a written assignment. Students who self-assessed tended to perform better in the assessment item and course than those who did not self-assess. But less competent students were more inaccurate in their self-assessment, suggesting a need to enhance understanding of marking criteria and performance standards within this group. Implications for educators are discussed.

Development of the Rapid Assessment, Prioritisation and Referral Tool (RAPaRT) for multidisciplinary teams in emergency care settings

Objective This investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care settings to develop and validate a Rapid Assessment Prioritisation and Referral Tool (RAPaRT). This instrument is intended for use among patients (with non-life threatening acuity) presenting to emergency care settings to indicate when referral to an allied member of the multidisciplinary team is warranted. Method This three stage instrument development and validation study included: a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing (stage 1); a prospective cohort of consecutive admissions (n=153) to investigate item sensitivity and specificity and retain only the most suitable items (stage 2); then final consultation with the Delphi panel to ensure the final instrument was clinically amenable (stage 3). Results 23 potential items were identified following stage 1. At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel, seven items were retained in the instrument. Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted. Final consultation with the Delphi panel members also resulted in the addition of an open ended (eighth) item to allow description of any infrequent, but important, reason for referral. Conclusions The RAPaRT has demonstrated substantial promise as an efficient clinically amenable instrument to assist multidisciplinary teams in emergency care settings. Further research to investigate the wider implementation of the RAPaRT is warranted.

OSCE online : making assessment of clinical competencies transparent, accountable & authentic

Creating an authentic assessment which at once assesses competencies, scene management, communication and overall patient care is challenging in the competitive tertiary education market. Increasing student numbers and the cost of evaluating scenario based competencies serve to ensure the need for consistent objectivity and need for timely feedback to students on their performance. Objective structured clinical examination (OSCE) is currently the most flexible approach to competency based formative and summative assessment and widely used within paramedic degree programs. Students are understandably compelled to perform well and can be frustrated by not receiving timely and appropriate feedback. Increasingly a number of products aimed at providing a more efficient and paperless approach have begun to enter the market. These products, it is suggested are aimed at medicine programs and not at allied health professions and limited to one operating system and therefore ignore issues surrounding equity and accessibility. OSCE Online aims to address this gap in the market and is tailored to these disciplines. The application will provide a service that can be both tailored and standardised from a pre-written bank, depending upon requirement to fit around the needs of clinical competency assessment. Delivering authentic assessments to address student milestones in their training to become paramedics is the cornerstone of OSCE Online. By not being restricted to a specific device it will address issues of functionality, adaptability, accessibility, authenticity and importantly: transparency and accountability by producing contemporaneous data allowing issues to be easily identified and rectified.

Mobile medical applications for melanoma risk assessment: False assurance or valuable tool?

With the smartphone revolution, consumer-focused mobile medical applications (apps) have flooded the market without restriction. We searched the market for commercially available apps on all mobile platforms that could provide automated risk analysis of the most serious skin cancer, melanoma. We tested 5 relevant apps against 15 images of previously excised skin lesions and compared the apps' risk grades to the known histopathologic diagnosis of the lesions. Two of the apps did not identify any of the melanomas. The remaining 3 apps obtained 80% sensitivity for melanoma risk identification; specificities for the 5 apps ranged from 20%-100%. Each app provided its own grading and recommendation scale and included a disclaimer recommending regular dermatologist evaluation regardless of the analysis outcome. The results indicate that autonomous lesion analysis is not yet ready for use as a triage tool. More concerning is the lack of restrictions and regulations for these applications.

Rapid recreation assessment: a tool to assess visitor use and associated impacts at coastal and marine protected areas

As more people discover coastal and marine protected areas as destinations for leisure-time pursuits, the task of managing coastal resources while providing opportunities for high quality visitor experiences becomes more challenging. Many human impacts occur at these sites; some are caused by recreation and leisure activities on-site, and others by activities such as agriculture, aquaculture, or residential and economic development in surrounding areas. Coastal management professionals are continually looking for effective ways to prevent or mitigate negative impacts of visitor use. (PDF contains 8 pages) Most coastal and marine protected area managers are challenged with balancing two competing goals—protection of natural and cultural resources and provision of opportunities for public use. In most cases, some level of compromise between the goals is necessary, where one goal constrains or “outweighs” the other. Often there is a lack of clear agreement about the priority of these competing goals. Consequently, while natural resource decisions should ultimately be science-based and objective, such decisions are frequently made under uncertainty, relying heavily upon professional judgment. These decisions are subject to a complex array of formal and informal drivers and constraints—data availability, timing, legal mandate, political will, diverse public opinion, and physical, human, and social capital. This paper highlights assessment, monitoring, and planning approaches useful to gauge existing resource and social conditions, determine feasibility of management actions, and record decision process steps to enhance defensibility. Examples are presented from pilot efforts conducted at the Rookery Bay National Estuarine Research Reserve (NERR) and Ten Thousand Islands National Wildlife Refuge (NWR) in South Florida.

Assessment of fibronectin as a potential new clinical tool in andrology.

In this prospective clinical study, 892 patients with normal and impaired semen were examined in order to investigate the correlation between the concentration of fibronectin in seminal plasma and the motility of spermatozoa. The fibronectin concentration in seminal plasma, total sperm motility and linear sperm motility were measured. We report here a significant negative correlation between the fibronectin concentration in seminal plasma and total sperm motility (r=-0.3474). There was no link between varicocele and vasectomy, or between varicocele and variation in the concentration of fibronectin. It is concluded that higher concentrations of the acute-phase protein fibronectin may be a cause of severe reduction in sperm motility. The investigation of fibronectin concentrations in seminal fluid could be a new and helpful clinical tool in the assessment of male fertility.