ObjectiveTo assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies.MethodsA comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses.ResultsThe literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression.ConclusionsOur findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care.Protocol PROSPERO Registration NumberCRD42014007457

This study showed that the pharmacists' counseling in the simulated patient assessment was insufficient, indicating a need for substantial improvement in practice behavior.

*Background: Headache, or cephalalgia, is one of the 20 most disabling diseases in the world and affects a large portion of the world's population. People generally use over-the-counter medications to treat headaches and other minor symptoms. A pharmacist should help patients choose the most effective, safe, and convenient pharmacotherapeutic option. Objective: To assess the counselling skills of community pharmacists for headache management by using the simulated patient approach. Methods: A cross-sectional study was conducted from March 2010 to July 2010. Data were obtained from a convenience sample consisting of one pharmacist from each of the 24 participating community pharmacies. In order to evaluate the pharmacists' counselling skills, a simulated patient role played a standardized headache case requesting self-medication. The interactions of the simulated patient with the pharmacists were audiovisually recorded using a hidden micro camera, and these recordings were analysed using a validated questionnaire. Results: Of the 24 evaluated pharmacists, 19 (79.1%) were women. Information was spontaneously provided by 15 (62.5%) pharmacists. At least one question was asked by the pharmacist to assess the signs and symptoms. Most pharmacists (n=17, 70.8%) recommended sodium dipyrone, either alone or in combination with other drugs. The most discussed items in the simulation visits were contraindications (n=17, 70.8%), indications (n=10, 41.6%), and drug administration times (n=8, 33.3%). None of the pharmacists recommended any non-pharmacological therapeutic *

Twenty-nine articles (17 cross-sectional and 12 cohort) were included. The majority of the studies were conducted in Europe. Regarding the study durations, 3 to 18 months was necessary to perform the research. As for the sample characteristics, all the studies analyzed involved the older adults and included anywhere from 96 patients to 33,830,599 outpatient consultations. Of the variables analyzed, only polypharmacy presented a positive association with the use of PIDT. All meta-analysis studies showed high heterogeneity, indicating the lack of a methodological standardization of the studies included, among other factors.

A review based on personal experience and evidence of literature. Eur J Endocrinol 2005;153:723-735. 4. Randeva HS, Schoebel J, Byrne J et al. Classical pituitary apoplexy: Clinical features, management and outcome. Clin Endocrinol (Oxf) 1999;51:181-188. 5. Shimon I, Benbassat C, Hadani M. Effectiveness of long-term cabergoline treatment for giant prolactinoma: Study of 12 men. Eur J Endocrinol 2007;156:225-231. 6. Webster J, Piscitelli G, Polli A et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 1994;331:904-909. 7. Orrego JJ, Chandler WF, Barkan AL. Rapid re-expansion of a macroprolactinoma after early discontinuation of bromocriptine.To the Editor: Population aging is a worldwide phenomenon that has contributed to the growing number of residents in long-term care facilities (LTCFs). This elderly population has more symptoms and chronic diseases and uses more medications than younger people. Recently, the literature has shown the importance of multidisciplinary staff in the care of older adults. The active participation of the pharmacist is essential to the management of complex drug therapy regimens and the reduction of drug-related morbidity and mortality in this population. 1 Therefore, this review aimed at analyzing the research quality of pharmaceutical interventions in elderly residents of LTCFs. METHODSA search was conducted to identify intervention studies involving pharmacists in LTCFs. The Medline, Scopus, Scielo, and LILACS databases were reviewed from January 1988 to December 2008, using pharmacists, elderly, pharmaceutical services, multidisciplinary approach, nursing homes, and long-term care facilities as keywords.The subsequent screening process was performed in three stages. Titles and abstracts were compared with the following predefined inclusion criteria to determine the relevance of the theme: if the study was performed in a LTCF, if the study involved intervention, and if the intervention process involved the participation of a pharmacist. Studies that focused on intervention with a single medication (or medication group) or a specific disease and that were not conducted entirely in a LTCF were excluded, as were those that were not written in English or did not provide the full text.The studies that satisfied the inclusion criteria for data extraction were carefully examined regarding the following variables: scenario of the study, type of study, professionals participating in the intervention process, type of intervention used, and its results. RESULTSAt the end of the review, only seven articles met the specific inclusion criteria (Table 1). Five articles were controlled clinical trials, 2-6 only one of which was not randomized. 5 One of the articles was classified as longitudinal, with evaluation of the study group before and after interventions, 7 whereas another study did not describe its methodology. 8 In three of the seven studies, the pharmacist was the only provider in the int...