Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis

BACKGROUND: Pharmacists can play a decisive role in the management of ambulatory patients with depression who have poor adherence to antidepressant drugs. OBJECTIVE: To systematically evaluate the effectiveness of pharmacist care in improving adherence of depressed outpatients to antidepressants. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. RCTs were identified through electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, Institute for Scientific Information Web of Knowledge, and Spanish National Research Council) from inception to April 2010, reference lists were checked, and experts were consulted. RCTs that evaluated the impact of pharmacist interventions on improving adherence to antidepressants in depressed patients in an outpatient setting (community pharmacy or pharmacy service) were included. Methodologic quality was assessed and methodologic details and outcomes were extracted in duplicate. RESULTS: Six RCTs were identified. A total of 887 patients with an established diagnosis of depression who were initiating or maintaining pharmacologic treatment with antidepressant drugs and who received pharmacist care (459 patients) or usual care (428 patients) were included in the review. The most commonly reported interventions were patient education and monitoring, monitoring and management of toxicity and adverse effects, adherence promotion, provision of written or visual information, and recommendation or implementation of changes or adjustments in medication. Overall, no statistical heterogeneity or publication bias was detected. The pooled odds ratio, using a random effects model, was 1.64 (95% CI 1.24 to 2.17). Subgroup analysis showed no statistically significant differences in results by type of pharmacist involved, adherence measure, diagnostic tool, or analysis strategy. CONCLUSIONS: These results suggest that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. However, data are still limited and we would recommend more research in this area, specifically outside of the US.

El trono preparado: reflexiones sobre estética, cultura visual e imagen simbólica en el arte tardoantiguo y su proyección en la Hispania visigoda y al-Andalus

Ensayo sobre las placas-nicho visigodas y el mihrab y macsura de la mezquita de Córdoba centrado en sus aspectos formales e iconológicos y sus referentes en la arquitectura de poder y la representación simbólica de la divinidad.

Arte publico 2010

El concepto de arte público es un término polisémico cuyos significados se reflejan en la diversidad de recursos que podemos hallar en internet. Por lo tanto, la aproximación a dichos recursos requerirá una acotación del propio concepto, que transita entre los ámbitos de la escultura, el monumento, las artes visuales y el espacio urbano entendido desde su vertiente cívica. La aproximación a los contenidos de internet vinculados con el arte público se aborda desde tres áreas temáticas cuyo análisis nos ayudará a organizar un volumen heterogéneo de información. La primera área incide en el papel de los centros de investigación y ayuntamientos en la promoción, inventariado y catalogación de las colecciones de arte en el espacio público. La segunda se centra en aquellos sitios web que son entendidos como fuentes de información y herramientas; los denominados think tanks. La tercera y última destaca la presencia en la red de páginas oficiales dedicadas a autores y obras específicas. The concept of public art is a polysemic term, and the dispersion of its meaning is reflected in the diversity of resources we can find on the web. Therefore, the approach to these resources needs a delimitation of the concept, crossing the fields of Sculpture, Monument, Visual arts and Urban space, defined from a civic perspective. The management of these resources is addressed from three strands, whose analysis will help us to organize a heterogeneous volume of information. The first affects the role of research centers and municipalities in the promotion, inventory and cataloging of collections of art in public spaces. The second focuses on those websites understood as sources of information and resources, the so-called think tanks. The third highlights the presence in the web of official sites devoted to specific authors and works. Keywords: public art, monument, public space, internet

Pd-catalysed amidation of 2,6-dihalopurine nucleosides. Replacement of iodine at 0 ºC

Pd-catalysed reactions of 2-Cl, 2-Br and 2-I derivatives of a 6-chloropurine nucleoside with benzamide have been compared, using Pd2dba3, Xantphos and Cs2CO3 in toluene, between 20 and 80 °C. The reactivity order was 2-I > 2-Br > 6-Cl ≫ 2-Cl. The 2-I substituent could be replaced even at 0 °C, under conditions disclosed here for the first time. On the other hand, the replacement of the chlorine atom at position 2 (2-Cl) required 110 °C.

Seasonal dynamics and net production of disolved organic carbon in an oligotrophic coastal environment

To understand dissolved organic carbon (DOC) seasonal dynamics in a coastal oligotrophic site in the north-western Mediterranean Sea, we monitored DOC concentrations monthly over 3 yr, together with the meteorological data and the food-web-related biological processes involved in DOC dynamics. Additional DOC samples were taken in several inshore−offshore transects along the Catalan coast. We found DOC concentrations of ~60 µmol C l−1 in winter, with increasing values through the summer and autumn and reaching 100 to 120 µmol C l−1 in November. There was high inter-annual variability in this summer DOC accumulation, with values of 36, 69 and 13 µmol C l−1 for 2006, 2007 and 2008, respectively. The analysis of the microbial food-web processes involved in the DOC balance did not reveal the causes of this accumulation, since the only occasion on which we observed net DOC production (0.3 ± 1 µmol C l−1 d−1 on average) was in 2007, and the negative DOC balance of 2006 and 2008 did not prevent DOC accumulating. The DOC accumulation episodes coincided with low rates of water renewal (average 0.037 ± 0.021 d−1 from May to October) compared with those of winter to early spring (average 0.11 ± 0.048 d−1 from November to April). Indeed, the amount of DOC accumulated each year was inversely correlated with the average summer rainfall. We hypothesize that decreased DOC turn-over due to photochemical or biological processes mostly active during the summer and low water renewal rate combine to determine seasonal DOC accumulation and influence its inter-annual variability.

The relationship between virtual body ownership and temperature sensitivity.

In the rubber hand illusion tactile stimulation seen on a rubber hand, that is synchronous with tactile stimulation felt on the hidden real hand, can lead to an illusion of ownership over the rubber hand. This illusion has been shown to produce a temperature decrease in the hidden hand, suggesting that such illusory ownership produces disownership of the real hand. Here we apply immersive virtual reality (VR) to experimentally investigate this with respect to sensitivity to temperature change. Forty participants experienced immersion in a VR with a virtual body (VB) seen from a first person perspective. For half the participants the VB was consistent in posture and movement with their own body, and in the other half there was inconsistency. Temperature sensitivity on the palm of the hand was measured before and during the virtual experience. The results show that temperature sensitivity decreased in the consistent compared to the inconsistent condition. Moreover, the change in sensitivity was significantly correlated with the subjective illusion of virtual arm ownership but modulated by the illusion of ownership over the full virtual body. This suggests that a full body ownership illusion results in a unification of the virtual and real bodies into one overall entity - with proprioception and tactile sensations on the real body integrated with the visual presence of the virtual body. The results are interpreted in the framework of a"body matrix" recently introduced into the literature.

Drift and ownership toward a distant virtual body.

In body ownership illusions participants feel that a mannequin or virtual body (VB) is their own. Earlier results suggest that body ownership over a body seen from behind in extra personal space is possible when the surrogate body is visually stroked and tapped on its back, while spatially and temporal synchronous tactile stimulation is applied to the participant's back. This result has been disputed with the claim that the results can be explained by self-recognition rather than somatic body ownership. We carried out an experiment with 30 participants in a between-groups design. They all saw the back of a VB 1.2 m in front, that moved in real-time determined by upper body motion capture. All felt tactile stimulation on their back, and for 15 of them this was spatially and temporally synchronous with stimulation that they saw on the back of the VB, but asynchronous for the other 15. After 3 min a revolving fan above the VB descended and stopped at the position of the VB neck. A questionnaire assessed referral of touch to the VB, body ownership, the illusion of drifting forwards toward the VB, and the VB drifting backwards. Heart rate deceleration (HRD) and the amount of head movement during the threat period were used to assess the response to the threat from the fan. Results showed that although referral of touch was significantly greater in the synchronous condition than the asynchronous, there were no other differences between the conditions. However, a further multivariate analysis revealed that in the visuotactile synchronous condition HRD and head movement increased with the illusion of forward drift and decreased with backwards drift. Body ownership contributed positively to these drift sensations. Our conclusion is that the setup results in a contradiction-somatic feelings associated with a distant body-that the brain attempts to resolve by generating drift illusions that would make the two bodies coincide.

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study.

BACKGROUND: Previous cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome. Method A total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test. RESULTS: Repeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05). CONCLUSIONS: Executive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

Elaboració de sessions audiovisuals breus per a treballar competències transversals comunicatives i de treball en equip

Desde la creación de la asignatura de "Bases de Inmunología" del Master Oficial Interuniversitario URV-UB en Nutrición y Metabolismo (curso 2007-2008), se están utilizando diversas metodologías docentes innovadoras que permiten trabajar competencias transversales y acerca el estudiante a tecnologías de la información y la comunicación (TIC) con las que se encontrará durante el desarrollo de su actividad profesional. El objetivo de la presente innovación consistió en la realización de se-siones formativas audiovisuales con tal de trabajar las habilidades comunicativas necesarias en el desarrollo del ejercicio profesional.

Elaboració de sessions audiovisuals breus per a treballar competències transversals comunicatives i de treball en equip

Desde la creación de la asignatura de "Bases de Inmunología" del Master Oficial Interuniversitario URV-UB en Nutrición y Metabolismo (curso 2007-2008), se están utilizando diversas metodologías docentes innovadoras que permiten trabajar competencias transversales y acerca el estudiante a tecnologías de la información y la comunicación (TIC) con las que se encontrará durante el desarrollo de su actividad profesional. El objetivo de la presente innovación consistió en la realización de se-siones formativas audiovisuales con tal de trabajar las habilidades comunicativas necesarias en el desarrollo del ejercicio profesional.

Elaboració de sessions audiovisuals breus per a treballar competències transversals comunicatives i de treball en equip

Desde la creación de la asignatura de "Bases de Inmunología" del Master Oficial Interuniversitario URV-UB en Nutrición y Metabolismo (curso 2007-2008), se están utilizando diversas metodologías docentes innovadoras que permiten trabajar competencias transversales y acerca el estudiante a tecnologías de la información y la comunicación (TIC) con las que se encontrará durante el desarrollo de su actividad profesional. El objetivo de la presente innovación consistió en la realización de se-siones formativas audiovisuales con tal de trabajar las habilidades comunicativas necesarias en el desarrollo del ejercicio profesional.

Proxemics with multiple dynamic characters in an immersive virtual environment

An experiment was carried out to examine the impact on electrodermal activity of people when approached by groups of one or four virtual characters at varying distances. It was premised on the basis of proxemics theory that the closer the approach of the virtual characters to the participant, the greater the level of physiological arousal. Physiological arousal was measured by the number of skin conductance responses within a short time period after the approach, and the maximum change in skin conductance level 5 s after the approach. The virtual characters were each either female or a cylinder of human size, and one or four characters approached each subject a total of 12 times. Twelve male subjects were recruited for the experiment. The results suggest that the number of skin conductance responses after the approach and the change in skin conductance level increased the closer the virtual characters approached toward the participants. Moreover, these response variables were inversely correlated with the number of visits, showing a typical adaptation effect. There was some evidence to suggest that the number of characters who simultaneously approached (one or four) was positively associated with the responses. Surprisingly there was no evidence of a difference in response between the humanoid characters and cylinders on the basis of this physiological data. It is suggested that the similarity in this quantitative arousal response to virtual characters and virtual objects might mask a profound difference in qualitative response, an interpretation supported by questionnaire and interview results. Overall the experiment supported the premise that people exhibit heightened physiological arousal the closer they are approached by virtual characters.

Proxemics with multiple dynamic characters in an immersive virtual environment

An experiment was carried out to examine the impact on electrodermal activity of people when approached by groups of one or four virtual characters at varying distances. It was premised on the basis of proxemics theory that the closer the approach of the virtual characters to the participant, the greater the level of physiological arousal. Physiological arousal was measured by the number of skin conductance responses within a short time period after the approach, and the maximum change in skin conductance level 5 s after the approach. The virtual characters were each either female or a cylinder of human size, and one or four characters approached each subject a total of 12 times. Twelve male subjects were recruited for the experiment. The results suggest that the number of skin conductance responses after the approach and the change in skin conductance level increased the closer the virtual characters approached toward the participants. Moreover, these response variables were inversely correlated with the number of visits, showing a typical adaptation effect. There was some evidence to suggest that the number of characters who simultaneously approached (one or four) was positively associated with the responses. Surprisingly there was no evidence of a difference in response between the humanoid characters and cylinders on the basis of this physiological data. It is suggested that the similarity in this quantitative arousal response to virtual characters and virtual objects might mask a profound difference in qualitative response, an interpretation supported by questionnaire and interview results. Overall the experiment supported the premise that people exhibit heightened physiological arousal the closer they are approached by virtual characters.