Farmacia Hospitalaria (English Edition)最新文献

Objective

To determine whether a mixture for intravenous perfusion containing tramadol (5 mg/ml), ranitidine (1.5 mg/ml), ketorolac (1.5 mg/ml) and metoclopramide (0.5 mg/ml) in a 0.9% sodium chlorides solution is compatible and stable at room temperature during a 48-hour period.

Methods

We tested the mixture for stability using the HPLC technique (high performance liquid chromatography), with parallel visual assessments of any changes in colour, appearance of precipitate or phase separation indicating incompatibilities between the components.

Results

At the end of the trial, chromatography data showed a mean metoclopramide concentration between 100% and 105% of the initial level, while concentrations of tramadol, ketorolac and ranitidine were between 99% and 102% of initial levels. There was no evidence of incompatibility between the drugs at any time during the study period.

Conclusions

The combination is stable as a solution and its components are physically and chemically compatible in the concentrations used in the study, during at least 48 hours at room temperature.

Objectives

To evaluate antiretroviral treatment adherence in the HIV patient cohort of our hospital and observe their evolution over a 9-year period, and to determine the individual pattern of adherence over time.

Methods

Descriptive study of the evolution of average annual adherence and the annual percentage of adherent patients greater than 95% from 2000 to 2008. We analysed the individual pattern of adherence over time and patients were classified as ‘consistently adherent’, ‘consistently non-adherent’, and ‘fluctuating’.

Results

In the analysis of 577 patients, baseline adherence was significantly greater in naïve patients compared to those who were pre-treated.

Average annual adherence increased slightly and stayed at values around 95%. As with the percentage of patients with adherence greater than 95%, which increased from 64% in 2000 to 79% in 2008.

In terms of the individual pattern of adherence over time, of the 468 patients analysed, the majority (59%) were consistently adherent, 4% non-adherent, and the rest (37%) fluctuated in their adherence.

Conclusions

In our cohort, the overall adherence values remained steady over time and even show a positive trend, which is likely to be the result of systematic monitoring of adherence and implementation strategies to maintain adherence.

Objective

To analyse the effectiveness of an antiemetic protocol in patients receiving chemotherapy treatment.

Method

Prospective study in patients with solid tumours receiving chemotherapy in an oncology day hospital between January 2006 and 2007. We conducted a literature review and an evaluation of the recommendations of different clinical practice guidelines. The emetogenic potential was calculated according to the Hesketh level (HL), and the antiemetic premedication was determined for each regimen. We evaluated the effectiveness of an antiemetic protocol by using a survey as a method for measuring emetic episodes and nausea in the acute and delayed phases.

Results

172 patients completed the survey. 13.4% vomited in the acute phase and 16.9% in the delayed phase; the median number of times was 2 (1–8) and 1 (1–5) for each respective phase. With treatment regimens classed as HL 4–5, 18.5% experienced vomiting in the acute phase and 20.2% in the delayed phase, with 46% experiencing nausea in the acute phase and 38.4% in the delayed phase. Control of vomiting in patients with treatment regimens classed as HL 1–3 was 100% in acute phase and 91.7% in the delayed phase; nausea was reported by 27% in the acute phase and 31% in the delayed phase. The factors that contributed the most to the presence of vomiting and nausea were the emetogenic potential of the treatment regimen (P < .05), vomiting in the previous cycle (P < .05) and age younger than 50 years (P < .002).

Discussion

The proposed antiemetic protocol is effective for controlling vomiting in chemotherapy regimens with an HL of 1–3. For highly emetogenic regimens, the antiemetic protocol is also effective, but protection is not complete. This protocol seems less effective for controlling nausea, although this is a subjective symptom which is difficult to assess and not routinely measured in clinical trials.

Objectives

Describe and evaluate the use of atypical antipsychotics on the institutionalized elderly population of the Valencian Community and prevalence of associated metabolic disorders.

Material and methods

Multicentre transversal descriptive study on drug use and case-control of the prevalence of disorders of glycaemia, cholesterol and triglycerides. The statistical analysis of metabolic disorders is performed on the difference in prevalence and its statistical significance between control and study groups.

Results

Six hundred eighty-one patients were included (study group: 344; control group: 337) from 20 social-health-care centres. 18.5% of the institutionalized patients are being treated with atypical antipsychotics. The most frequent diagnoses are: behavioural disorders associated with dementia (63.6%) and schizophrenia (18.4%). Risperidone is the most frequently used antipsychotic (66.0%). For all the drugs in general the doses used adjusted to those recommended for the elderly patients. The prevalence of disorders in glucose, cholesterol and triglyceride metabolism in the group under study is 23.96%, 34.83%, and 26.29%, respectively, with no statistically significant differences from the control group. The analysis by type of drug did not show significant differences.

Conclusions

The results obtained show that use of atypical antipsychotics in elderly patients complies with the established general recommendations. The doses used in elderly patients with behavioural disorders associated with dementia, mostly treated with risperidone, do not have a significant impact on the prevalence of metabolic disorders.

Objective

To develop a prediction model for identifying patients with the possibility of improving pharmacotherapy during the process of pharmaceutical validation of the prescription.

Method

Cross-sectional study over two months, performed in the Internal Medicine and Infectious Disease divisions. Detecting opportunities for improving quality of pharmacotherapy is done by means of a pharmacist's validation of the prescription. Based on the information we obtained through this process, we performed a multivariate logistic regression analysis using as prognostic factors the demographic, pharmacotherapy and clinical variables related to identifying any drug-related problems (DRPs) in the patient. The model's prediction validity was assessed using the diagnostic performance curve and calculating the area under it.

Results

The final prediction model included the variables age, cardiovascular drugs (digoxin) and drugs for which a dosage adjustment is recommended in the case of organ failures. Analysis of the ROC curve showed an estimated area under the curve AUCROC) of 84.0% (95% CI: 80.5–87.1), a sensitivity value of 28% (95% CI: 24.07–32.19), a specificity value of 99.10% (95% CI: 97.80–99.73), a positive predictive value of 77.78% and a negative predictive value of 92.41%.

Conclusion

The resulting prediction model enables population-based detection of pharmacotherapy safety risks in adult patients admitted to the selected hospital units. The predictive variables used by the model are commonly used in daily practice.

Introduction

The persistence of drug-related morbidity and mortality of patients admitted to hospital means scientific criteria need to be identified for implementing and evaluating Pharmaceutical Care (phC) in a hospital setting.

Objective

To conduct a systematic review of the literature to identify, select and analyse studies on the implementation and evaluation of phC in hospitalised patients.

Material and methods

A search for articles related to clinical pharmacy (CP) and phC published between 1990 and 2006 was performed using a restricted search strategy combining all descriptors. The databases searched were Medline, Embase, Drug & Pharmacology and Cochrane Library. Original and review articles, available in English or Spanish, describing CP and phC programmes which had a participating pharmacist and were carried out on hospitalised patients were selected.

Results

Sixty-six articles were found, of which 49 (74.2%) were included and 17 (25.8%) excluded. 15 (22.7%) regarding the integration between CP and phC in hospitals were selected, as well as 18 (27.3%) on implementing phC and 16 (24.2%) related to the evaluation of phC programmes.

Conclusions

In the studies described, pharmacists have managed to incorporate phC programmes in the care activities of pharmacy services. Efforts to unify CP and phC criteria should be a common plan for the future in this profession. Patients treated must obtain specific health benefits from phC and medical institutions must recognise they have beneficial effects at a reasonable cost.

Introduction

Adverse drug effects (ADE) are the reason for 0.86% to 38.2% of emergency hospital admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring reduce the appearance of such health problems.

Method

Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADE. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method.

Results

Eight hundred forty patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADE were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index.

Discussion

One third of emergency hospital admissions were due to ADE, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADE are predominant in patients with low values on the health practices index, and in those with underlying illnesses.

Objective

To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens.

Method

Restrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/ patient/day was calculated and, multiplying by an adherence factor (f_ADH), the (cost/patient/day)_ADH. The comparison of both allowed us to obtain the Δ_cost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs (“combos”). A study of the budgetary impact of these combos was carried out.

Results

468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day)_ADH was significantly higher than the cost/patient/day (27.3 ± 9.8 € compared to 24.3 ± 7.6 €, P<.001). Just as with the f_ADH, no differences were found in the Δ_cost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δ_cost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δ_cost/patient=13.52 ± 17.68%). No significant differences were found in the iCER calcluated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact.

Conclusions

The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/3TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence.

Objective

To study the effectiveness and safety of pemetrexed in non-small cell lung cancer.

Method

Retrospective study (March 2006-May 2008) of pemetrexed use. Information was obtained from the Access database belonging to the Pharmacy and Oncology Departments, the registry of external consultations and clinical histories. Data were analysed using SPSS software version 12.0. Quantitative variables are expressed as the median (minimum-maximum).

Results

The study included 44 patients (61.7 [39–77] years old), mostly male (86%), smokers or former smokers (80%) with predominantly epidermoid/squamous disease (46%) or adenocarcinoma, in a good functional state (86%) and in stage ≥III upon beginning pemetrexed treatment (93%). Prior treatment with taxanes and taxane treatment along with a prior history of neutropoenia were the criteria for changing to pemetrexed in 34.4% and 22.7% of the patients, respectively. None of the patients presented a complete or partial response: 18.2% showed disease stability and 81.8% showed disease progression. The main reasons for discontinuing pemetrexed were progression of the disease (54.5%) and worsening of symptoms (15.9%). Median survival after beginning chemotherapy was 22.2 months (ranging from 16–28.4) and 7.8 months (4.4–11.2) after beginning pemetrexed treatment. These last figures were significantly higher in women and those with an ECOG of 0 to 1. The most common adverse effects were weakness and neurotoxicity.

Conclusion

In each of the cases, pemetrexed was used as a second-line treatment or higher with a good safety profile. A complete or partial response was not reached in any of the cases, but survival after beginning pemetrexed was equal to or longer than that achieved in other studies.

Objective

To assess the effectiveness of palifermin for the prevention of oral mucositis in patients with haematological cancers.

Method

Retrospective observational study of cohorts of patients with haematological cancer undergoing cytotoxic therapy causing hematopoietic ablation. The main variable assessed was the duration of the oral mucositis. Secondary variables assessed were incidence of mucositis, febrile or septic neutropenia and the administration of opioids and parenteral nutrition.

Results

We included 36 patients in this study, 11 in the group that received palifermin and 25 in the control group. The duration of oral mucositis was 4.6 ± 3.1 days (median: 5 days) in the patients treated with palifermin in comparison with 7.4 ± 4.0 days (median: 6 days) in patients treated with conventional prophylactic therapy (P < .05). However, no significant differences were seen in the incidence of mucositis, febrile or septic neutropenia, opioid administration of the use of parenteral nutrition.

Conclusions

Prophylactic treatment with palifermin reduces the duration of oral mucosities in patients with haematological cancer. Further studies are necessary with larger samples to be able to assess palifermin and its influence on other variables, such as incidence of mucositis, sepsis, febrile neutropenia, etc.