Drug assessment by a Pharmacy and Therapeutics committee: from drug selection criteria to use in clinical practice.

BACKGROUND In Spain, hospital medicines are assessed and selected by local Pharmacy and Therapeutics committees (PTCs). Of all the drugs assessed, cancer drugs are particularly important because of their budgetary impact and the sometimes arguable added value with respect to existing alternatives. This study analyzed the PTC drug selection process and the main objective was to evaluate the degree of compliance of prescriptions for oncology drugs with their criteria for use. METHODS This was a retrospective observational study (May 2007 to April 2010) of PTC-assessed drugs. The variables measured to describe the committee's activity were number of drugs assessed per year and number of drugs included in any of these settings: without restrictions, with criteria for use, and not included in formulary. These drugs were also analyzed by therapeutic group. To assess the degree of compliance of prescriptions, a score was calculated to determine whether prescriptions for bevacizumab, cetuximab, trastuzumab, and bortezomib were issued in accordance with PTC drug use criteria. RESULTS The PTC received requests for inclusion of 40 drugs, of which 32 were included in the hospital formulary (80.0%). Criteria for use were established for 28 (87.5%) of the drugs included. In total, 293 patients were treated with the four cancer drugs in eight different therapeutic indications. The average prescription compliance scores were as follows: bevacizumab, 83% for metastatic colorectal cancer, 100% for metastatic breast cancer, and 82.3% for non-small-cell lung cancer; cetuximab, 62.0% for colorectal cancer and 50% for head and neck cancer; trastuzumab, 95.1% for early breast cancer and 82.4% for metastatic breast cancer; and bortezomib, 63.7% for multiple myeloma. CONCLUSION The degree of compliance with criteria for use of cancer drugs was reasonably high. PTC functions need to be changed so that they can carry out more innovative tasks, such as monitoring conditions for drug use.

Lipid changes in HIV-patients switching to the coformulated single tablet FTC/RPV/TDF (Eviplera®). Efficacy and safety analysis. GeSida Study 8114.

INTRODUCTION Rilpivirine (RPV) has a better lipid profile than efavirenz (EFV) in naïve patients (1). Switching to RPV may be convenient for many patients, while maintaining a good immunovirological control (2). The aim of this study was to analyze lipid changes in HIV-patients at 24 weeks after switching to Eviplera® (emtricitabine/RPV/tenofovir disoproxil fumarate [FTC/RPV/TDF]). MATERIALS AND METHODS Retrospective, multicentre study of a cohort of asymptomatic HIV-patients who switched from a regimen based on 2 nucleoside reverse transcriptase inhibitors (NRTI)+protease inhibitor (PI)/non nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir boosted PI monotherapy to Eviplera® during February-December, 2013; all had undetectable HIV viral load for ≥3 months prior to switching. Patients with previous failures on antiretroviral therapy (ART) including TDF and/or FTC/3TC, with genotype tests showing resistance to components of Eviplera®, or who had changed the third drug of the ART during the study period were excluded. Changes in lipid profile and cardiovascular risk (CVR), and efficacy and safety at 24 weeks were analyzed. RESULTS Among 305 patients included in the study, 298 were analyzed (7 cases were excluded due to lack of data). Men 81.2%, mean age 44.5 years, 75.8% of HIV sexually transmitted. 233 (78.2%) patients switched from a regimen based on 2 NRTI+NNRTI (90.5% EFV/FTC/TDF). The most frequent reasons for switching were central nervous system (CNS) adverse events (31.0%), convenience (27.6%) and metabolic disorders (23.2%). At this time, 293 patients have reached 24 weeks: 281 (95.9%) have continued Eviplera®, 6 stopped it (3 adverse events, 2 virologic failures, 1 discontinuation) and 6 have been lost to follow up. Lipid profiles of 283 cases were available at 24 weeks and mean (mg/dL) baseline vs 24 weeks are: total cholesterol (193 vs 169; p=0.0001), HDL-c (49 vs 45; p=0.0001), LDL-c (114 vs 103; p=0.001), tryglycerides (158 vs 115; p=0.0001), total cholesterol to HDL-c ratio (4.2 vs 4.1; p=0.3). CVR decreased (8.7 vs 7.5%; p= 0.0001). CD4 counts were similar to baseline (653 vs 674 cells/µL; p=0.08), and 274 (96.8%) patients maintained viral suppression. CONCLUSIONS At 24 weeks after switching to Eviplera®, lipid profile and CVR improved while maintaining a good immunovirological control. Most subjects switched to Eviplera® from a regimen based on NNRTI, mainly EFV/FTC/TDF. CNS adverse events, convenience and metabolic disorders were the most frequent reasons for switching.

Itinerari d’EA des de Tamariu fins al far de Sant Sebastià

Creació d’un itinerari d’educació ambiental des de Tamariu fins al far de Sant Sebastià, al municipi de Palafrugell, per tal de sensibilitzar i conscienciar la societat sobre la necessitat de conservar el medi.S’ha fet una diagnosi per tal d’estudiar les mancances i necessitats que sorgeixen al llarg del camí. A partir d’aquesta anàlisi s’ha elaborat una sèrie de propostes divulgatives i didàctiques per tal d’adequar l’itinerari com a eina d’educació ambiental

La Cooperació transnacional europea dels governs locals: motivacions de les ciutats mitjanes de la província de Barcelona

La recerca1 es va plantejar l’estudi de les motivacions de la cooperació transnacional dels governs locals, des d’una perspectiva que analitzés quines han estat aquestes motivacions, la contribució dels projectes europeus a la creació de nous eixos de cooperació entre la Unió Europea i els governs locals i els canvis organitzatius derivats de la participació en aquest tipus de projectes. En particular, va centrar l’estudi en la realitat de vint-i-tres ciutats mitjanes de la província de Barcelona. El debat acadèmic al que la recerca present pretenia contribuir es centrava en dos conceptes particularment rellevants: d’una banda, l’europeïtzació dels governs locals, entesa com la capacitat d’aquests nivells de governs d’orientar les seves polítiques en un context europeu així com d’incorporar elements que dimanen de les directrius comunitàries. De l’altra, la governança multinivell a la Unió Europea, segons la qual s’analitza l’emergència d’un tercer actor, el local, conjuntament amb l’europeu i el nacional. Els resultats posen de manifest que les principals motivacions són, en primer lloc, l’econòmica, però existeix també una motivació secundària, però important, de projecció exterior de les ciutats i d’intercanvi d’experiències i participació en fòrums de discussió sobre temàtiques que els són d’interès. En les ciutats estudiades, la motivació per a la participació en el procés de construcció europea o la defensa dels seus interessos davant les institucions comunitàries no és tan important i apareix de forma puntual. Aquest resultats estan en línia amb altres estudis que han identificat la importància del l’incentiu econòmic per a la implicació en iniciatives transnacionals. La motivació econòmica no dóna, de totes formes, una explicació complerta a l’europeïtzació dels governs locals, ja que són poques les ciutats que desenvolupen estratègies actives més enllà de la recepció de fons que impliquin la incorporació d’idees europees en les seves polítiques. Per a aquestes l’explicació més plausible és la que fa referència a l’impuls o empreneduria política, mitjançant la qual volen millorar la posició relativa en el context normatiu i organitzatiu europeu i aprofitar les oportunitats que els ofereix. Pel que fa a la governança multinivell, els resultats mostren que els programes europeus, atesos els requisits de partenariat local/regional que imposen i atès el reconeixement de la incapacitat dels governs locals per influir en els processos de presa de decisions d’unes polítiques que els afecten, tenen més impacte en noves formes de governança regional/local que en la governança en sí.

Guía de indicadores par medir las desigualdades de género en salud y sus determinantes

Este proyecto ha recibido financiación de la Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía y del Fondo Europeo de Desarrollo Regional (Expediente P08-CTS-4321)

Semiactive backstepping control for vibration attenuation in structures equipped with magnetorheological actuatorscat

This paper deals with the problem of semiactive vibration control of civil engineering structures subject to unknown external disturbances (for example, earthquakes, winds, etc.). Two kinds of semiactive controllers are proposed based on the backstepping control technique. The experimental setup used is a 6-story test structure equipped with shear-mode semiactive magnetorheological dampers being installed in the Washington University Structural Control and Earthquake Engineering Laboratory (WUSCEEL). The experimental results obtained have verified the effectiveness of the proposed control algorithms

CAC controlled services sharing a link with connectionless data services in an ATM network: a performance evaluation study

In the B-ISDN there is a provision for four classes of services, all of them supported by a single transport network (the ATM network). Three of these services, the connected oriented (CO) ones, permit connection access control (CAC) but the fourth, the connectionless oriented (CLO) one, does not. Therefore, when CLO service and CO services have to share the same ATM link, a conflict may arise. This is because a bandwidth allocation to obtain maximum statistical gain can damage the contracted ATM quality of service (QOS); and vice versa, in order to guarantee the contracted QOS, the statistical gain have to be sacrificed. The paper presents a performance evaluation study of the influence of the CLO service on a CO service (a circuit emulation service or a variable bit-rate service) when sharing the same link

Bandwidth allocation based on real time calculations using the convolution approach

This paper focuses on one of the methods for bandwidth allocation in an ATM network: the convolution approach. The convolution approach permits an accurate study of the system load in statistical terms by accumulated calculations, since probabilistic results of the bandwidth allocation can be obtained. Nevertheless, the convolution approach has a high cost in terms of calculation and storage requirements. This aspect makes real-time calculations difficult, so many authors do not consider this approach. With the aim of reducing the cost we propose to use the multinomial distribution function: the enhanced convolution approach (ECA). This permits direct computation of the associated probabilities of the instantaneous bandwidth requirements and makes a simple deconvolution process possible. The ECA is used in connection acceptance control, and some results are presented

Multicast algorithms evaluation using an adaptative routing in ATM networks

This paper proposes a multicast implementation based on adaptive routing with anticipated calculation. Three different cost measures for a point-to-multipoint connection: bandwidth cost, connection establishment cost and switching cost can be considered. The application of the method based on pre-evaluated routing tables makes possible the reduction of bandwidth cost and connection establishment cost individually

Fast calculation of the CAC convolution algorithm using the multinomial distribution function

The authors focus on one of the methods for connection acceptance control (CAC) in an ATM network: the convolution approach. With the aim of reducing the cost in terms of calculation and storage requirements, they propose the use of the multinomial distribution function. This permits direct computation of the associated probabilities of the instantaneous bandwidth requirements. This in turn makes possible a simple deconvolution process. Moreover, under certain conditions additional improvements may be achieved

Let's talk: public evaluation of large projects: variational inequialities, bilevel programming and complementarity. a survey

Large projects evaluation rises well known difficulties because -by definition- they modify the current price system; their public evaluation presents additional difficulties because they modify too existing shadow prices without the project. This paper analyzes -first- the basic methodologies applied until late 80s., based on the integration of projects in optimization models or, alternatively, based on iterative procedures with information exchange between two organizational levels. New methodologies applied afterwards are based on variational inequalities, bilevel programming and linear or nonlinear complementarity. Their foundations and different applications related with project evaluation are explored. As a matter of fact, these new tools are closely related among them and can treat more complex cases involving -for example- the reaction of agents to policies or the existence of multiple agents in an environment characterized by common functions representing demands or constraints on polluting emissions.

Autosuficiència energètica a la casa rural "Les Vinyes Grosses"

L’objectiu del present projecte és aconseguir l’autosuficiència energètica per a la casa rural “Les Vinyes Grosses”. Aquesta casa rural està situada a Sant Agustí de Lluçanès, comarca d’Osona. Es vol aconseguir fer una canvi de les instal·lacions que utilitzen energies no renovables a unes instal·lacions que funcionin amb energies renovables. Es pretén canviar la instal·lació de calefacció i aigua calenta que funciona amb gas-oil per una instal·lació que funcioni amb estella de pi roig que provingui de la mateixa finca. També es vol fer un canvi de la instal·lació elèctrica que funciona amb electricitat de la xarxa per una instal·lació elèctrica que utilitzi energia solar fotovoltàica. Per últim, es pretén que tota l’aigua consumida en la casa rural sigui aigua de la pluja en comptes d’utilitzar l’aigua de la xarxa. El cost total calculat per a realitzar aquests canvis d’instal·lacions és de 58.825 €, amb un temps d’amortització de 15,32 anys.

Multi-isotopic and compositional exploration of factors controlling nitrate pollution

In Catalonia, according to the nitrate directive (91/676/EU), nine areas have been declared as vulnerable to nitrate pollution from agricultural sources (Decret 283/1998 and Decret 479/2004). Five of these areas have been studied coupling hydro chemical data with a multi-isotopic approach (Vitòria et al. 2005, Otero et al. 2007, Puig et al. 2007), in an ongoing research project looking for an integrated application of classical hydrochemistry data, with a comprehensive isotopic characterisation (δ15N and δ18O of dissolved nitrate, δ34S and δ18O of dissolved sulphate, δ13C of dissolved inorganic carbon, and δD and δ18O of water). Within this general frame, the contribution presented explores compositional ways of: (i) distinguish agrochemicals and manure N pollution, (ii) quantify natural attenuation of nitrate (denitrification), and identify possible controlling factors.To achieve this two-fold goal, the following techniques have been used. Separate biplots of each suite of data show that each studied region has a distinct δ34S and pH signatures, but they are homogeneous with regard to NO3- related variables. Also, the geochemical variables were projected onto the compositional directions associated with the possible denitrification reactions in each region. The resulting balances can be plot together with some isotopes, to assess their likelihood of occurrence

España en Europa - Europa en España (1986-2006)

Aquesta publicació té per objectiu oferir un balanç dels primers vint anys des de l'adhesió d'Espanya a l'Europa comunitària en termes de «europeïtzació», una formulació que és objecte de creixent atenció per part dels estudiosos del procés d'integració europea. Per això s'analitzen tant la incidència d'Espanya a la Unió Europea com la d'aquesta en el sistema institucional, els processos polítics i les polítiques públiques espanyoles. El resultat reflecteix el grau creixent de simbiosi que, amb alguns matisos, s'ha anat generant entre ambdós nivells al llarg d'aquests anys.

Studies in stoichiometry with compositional data

Geochemical data that is derived from the whole or partial analysis of various geologic materialsrepresent a composition of mineralogies or solute species. Minerals are composed of structuredrelationships between cations and anions which, through atomic and molecular forces, keep the elementsbound in specific configurations. The chemical compositions of minerals have specific relationships thatare governed by these molecular controls. In the case of olivine, there is a well-defined relationshipbetween Mn-Fe-Mg with Si. Balances between the principal elements defining olivine composition andother significant constituents in the composition (Al, Ti) have been defined, resulting in a near-linearrelationship between the logarithmic relative proportion of Si versus (MgMnFe) and Mg versus (MnFe),which is typically described but poorly illustrated in the simplex.The present contribution corresponds to ongoing research, which attempts to relate stoichiometry andgeochemical data using compositional geometry. We describe here the approach by which stoichiometricrelationships based on mineralogical constraints can be accounted for in the space of simplicialcoordinates using olivines as an example. Further examples for other mineral types (plagioclases andmore complex minerals such as clays) are needed. Issues that remain to be dealt with include thereduction of a bulk chemical composition of a rock comprised of several minerals from which appropriatebalances can be used to describe the composition in a realistic mineralogical framework. The overallobjective of our research is to answer the question: In the cases where the mineralogy is unknown, arethere suitable proxies that can be substituted?Kew words: Aitchison geometry, balances, mineral composition, oxides