Farmacia Hospitalaria (English Edition)最新文献

Objective

To evaluate the effectiveness of 100% autologous serum eye drops for the treatment of various ocular surface disorders.

Methods

A descriptive prospective observational study carried out from May 2005 to February 2009 which included patients with ocular surface disorders treated with single-dose autologous serum eye drops. Treatment effectiveness was evaluated by using a clinical questionnaire in order to assess symptoms experienced by patients at the beginning and end of treatment.

Results

A total of 15 patients (24 eyes) were evaluated. Clinical symptoms such as redness, burning, sharp pain and tired eyes improved in 100% of the patients, whereas dryness and sandy/gritty sensation improved in 92% of the patients. The overall improvement of clinical symptoms was worth the inconvenience of venipuncture according to 66.7% of the patients. Regarding tolerance for autologous serum eye drops, only one patient experienced some discomfort when using the single-dose eye drops.

Conclusion

The treatment with 100% autologous serum eye drops improved ocular symptoms for most patients.

Objective

To assess the impact of administration errors when transcribing treatments to nurses’ administration forms, and to estimate the impact of electronically assisted prescription (EAP) in minimising these errors.

Method

A prospective, observational study in hospitalised patients. In a representative sample changes in treatment in the 24 h before the examination are analysed. Transcription errors were detected when checking the discrepancies between the medical prescription and the nurses’ treatment administration forms. Error incidence was calculated as a whole and by ward, type of error, administration route and their potential danger. The possible reduction in new errors per day if the EAP were to be introduced in all units was estimated.

Results

Of the 416 prescriptions recorded, the overall percentage of transcription errors was 12.4%, 9.8% in medical units and 15.2% in surgical units. Most of the errors were made when a new medicine was added (29.4%) and the frequency of administration was changed (27.4%). With regard to their gravity, 98% did not harm the patients, and 57.7% were filed as “Category C”. Taking into account that 1 change of treatment is made per patient per day, the introduction of the EAP is predicted to prevent 64 new errors daily in the hospital.

Conclusions

There are so many transcription errors that they should be taken into account when designing strategies to improve care quality. EAP is an efficient tool to eliminate errors associated with the transcription of prescriptions.

Objective

Assessing the effectiveness and safety of natalizumab for treating relapsing-remitting multiple sclerosis in a tertiary hospital.

Method

Observational, prospective study of adult patients treated with natalizumab from May 2007 until February 2009. Treatment: 300 mg natalizumab every four weeks. Response criteria: assessment of disease progression, appearance of flare-ups and assessment of magnetic resonance images. Adverse reactions during treatment with natalizumab were recorded.

Results

Thirty patients (73% female); average age 34 ± 8.4 years; mean baseline EDSS 3.4 ± 1.3; number of flare-ups in the past year 2.1 ± 1.2. Treatment was discontinued in five patients, due to refusal in one case, ineffectiveness in two cases and anaphylaxis in the other two cases. Fourteen patients completed one year of treatment with satisfactory results. A lower EDSS score by 36%, 47%, 31%, 54% and 28% was obtained at 3, 6, 9, 12 and 15 months of treatment respectively. The prevalence of relapse-free patients was 94%, 76% and 54% at 3, 6 and 12 months. MRI imaging studies in 11 patients one year after they began treatment showed no new lesions. Two patients suffered severe anaphylactic shock and another one had an outbreak of urticaria. The presence of neutralising antibodies was the reason for suspending treatment in 6.6% of the patients.

Conclusions

The treatment's effectiveness and safety in our patient group suggest that natalizumab is a treatment for refractory patients or those with aggressive types of multiple sclerosis, although we do not yet know about its long-term effects and the evolution of the appearance of neutralising antibodies.

A systematic review was made of the drug interactions of new antiretroviral drugs. In order to do this a search was made in Pubmed to find articles published from January 2007 to September 2009 and the full-text articles which contained information about new antiretroviral drugs were selected. This search was then complemented with information from the technical specifications of the drugs and consultations made on webpages specialized in antiretroviral interactions: www.interaccioneshiv.com and www.hiv-druginteractions.org. The information about the possible interactions of new antiretroviral drugs with one another and with the therapeutic groups which are most widely used in patients infected with the human immunodeficiency virus was analyzed.

Objective

To measure and provide an economic assessment of the preparations returned to a centralised cytostatic drug preparation unit, analyse reasons for their return, propose measures for minimising returns and assess their impact on the Medical Oncology division's outpatient services.

Methods

This prospective study contained two phases. During the first, we registered all returns, motives, cases of reuse and costs. In the second phase, we analysed returns at the Oncology outpatient division after having adopted measures to minimise the returns.

Results

During the first phase, 218 preparations (worth € 51,131) were returned. The Oncology Day Hospital returned 1% of the preparations worth 1% of the total value; during the second phase, these figures were 0.56% of the preparations and 0.14% of the total value.

Conclusions

Favouring reporting on and identifying expensive treatments with little stability and using returned preparations as a quality indicator for Oncology has improved management of the central cystostatic preparation unit

Objective

To describe the preparation of topical endotracheal mitomycin C and the clinical outcomes of four patients with recurrent and severe laryngotracheal stenosis (LTS) treated with adjuvant topical mitomycin C.

Method

Literature review to determine the concentration and method of preparation of topical mitomycin C for endotracheal use. Review of clinical histories.

Results

We established a concentration of 0.4 mg/ml topical mitomycin C for the treatment of laryngotracheal stenosis. In the treated cases, we applied a 0.4 mg/ml solution to the wound site following laser surgery and dilatation with bronchoscope. Three patients remain asymptomatic from a respiratory perspective, and treatment failed in one case.

Conclusions

LTS treatment is complex due to the continuous development of granulation tissue and fibrosis following injury to the airways. Topical mitomycin C seems to be the ideal adjuvant agent thanks to its powerful antifibrotic effects.

Objective

To identify and quantify the influence of different variables on the implementation of pharmacotherapy optimisation measures in hospitalised patients.

Method

Descriptive transversal study. Period: 2000–2007. Environment: public university general hospital (25,000 patients admitted/year).

The Programme implemented to improve pharmacotherapy quality and patient safety covers 30% of all patients. Using records from the Atefarm^® Farmis application, we analysed pharmacotherapy recommendations (PRs) made by pharmacists to doctors. The selected variables were the following: Risk of the medication for ADE (1-high, 0-low), ADE category, (0-indication, 1-effectiveness, 2-safety), potential severity (scale of 1 to 5), impact of the PR (0-effectiveness, 1-safety, 2-efficiency) and implementation of the PR (yes/no).

We calculated the frequency (%) and 95% CI for the categorical variables and performed a multivariate logistical regression analysis to identify the variables’ degree of influence on implementing the PRs.

Results

We identified 7920 ADEs in 4680 patients. A PR was issued in 85% of the cases (6762), and it was implemented in 83% (95% CI 74.2–89.8). Potential severity of the ADE ≥2 (OR 1.57; 95% CI 1.27–1.94), and ADE category for effectiveness and safety (OR 1.19; 95% CI 1.02–1.39) were shown to be determining factors for implementing the PR for the patient.

Conclusions

The probability that a PR will be implemented for a patient is related to the potential severity and the category of the identified ADE. Therefore, recommendations intended to improve effectiveness of pharmacotherapy or patient safety, and those with potential clinical consequences have a greater chance of being applied to a patient.

Objective

Specific immunoglobulin against cytomegalovirus has demonstrated its effectiveness in preventing and treating infections in solid organ transplantation. Several studies indicate that non-specific immunoglobulin is just as effective.

This study aims to determine anti-cytomegalovirus immunoglobulin titres from one of the non-specific immunoglobulin presentations authorised in Spain.

Method

This was an observational study, in which we analysed the anti-cytomegalovirus antibody titres from different batches of Flebogamma^® 5% 5g used at the Hospital Universitari Vall d’Hebron during 2008 and 2009.

Results

We analysed 27 batches, which included 18,944 vials of Flebogamma^® 5%. Depending on the origin, the median concentration of anti-cytomegalovirus immunoglobulin was 28 PEI-U/ml and 22 PEI-U/ml per vial of North American and Spanish origin, respectively (CI 95% for the difference of the medians 5 to 6 PEI-U/ml; P<.001).

Conclusions

The anti-cytomegalovirus antibody concentration of the non-specific immunoglobulin batches analysed was slightly lower than in the specific immunoglobulin preparations. These differences can be compensated by adjusting the dosage.

Objective

To assess the physical, chemical and microbiological stability of two oral suspensions of carbamazepine at concentrations of 2.5% and 5%.

Methods

Both oral suspensions were compounded from powdered carbamazepine and Ora-Sweet SF^® and Ora-Plus^® commercial compounding excipients. At the 2, 4 and a 6-month marks, different quality assays were performed, comprising physical (pH, state of the suspension, organoleptic properties), chemical (HPLC) and microbiological assays.

Results

The final concentration at 6 months for both the 2.5% and 5% carbamazapine suspensions was 22.9 and 45.9 mg/ml respectively, with calculated richness values between 90 and 110% fulfilling USP23 NF18 requirements. No changes in physical properties and no culture growth were observed during the study period.

Conclusion

Both oral suspensions are physically, chemically and microbiologically stable for at least 6 months when preserved at room temperature in amber glass flasks.

Objective

To verify that implementing a policy of management by objectives, based on collaboration between hospital pharmacy, primary care and specialised medical managers, improves prescription quality indicators in specialised care and reduces unwanted “induced” prescriptions (i.e. those issued by specialists, hospital doctors or the patients themselves) in primary care.

Method

A four year quasi-experimental controlled intervention study on prescription at discharge and in outpatient hospital consultations was conducted. In hospital A, a quality cycle was applied: assessment, identifying improvement opportunities, implementing corrective actions and re-assessment. However, it was not applied in control hospital B. The indicators chosen were the percentage of generic medicines prescribed, the percentage of prescriptions for new therapies with no added value and the percentage of prescriptions for ACE inhibitors recommended.

Results

In hospital A, an increase in indicators 1 and 3 has been observed, both being statistically significant, between the last year of intervention and the year previous to intervention. Hospital A managed to reduce indicator 2 to 4.5%, while this indicator increased in hospital B to 8.8%. Furthermore, a statistically significant difference in indicators between the two hospitals has been registered.

Conclusion

Pay-for-Performance programs in prescription practices of hospital physicians are effective actions to improve quality indicators of medication use.