Telepharmacy scorecard: Activity and quality indicators for the pharmaceutical care in a hospital pharmacy service.

OBJECTIVE: Telepharmacy, as a complementary activity to face-to-face pharmaceutical care in a Hospital pharmacy service, must have specific activity, effectiveness and quality indicators. The objectives of the  project were to design a scorecard of activity, effectiveness and quality  indicators that will make it possible to assess the situation and progress of Telepharmacy and enable continuous improvement. A tool is also provided to measure the indicators, and some recommendations are given for its  implementation. METHOD: The project, led by a panel of expert pharmacists, was developed in  2021 in four phases: a literature review, preliminary identification of quality  criteria and indicators, evaluation of indicators, adjustment of the proposal and definition of priority indicators, and drafting of descriptive files, as well as the  development and validation of a scorecard. The indicators were prioritized  based on their appropriateness, usefulness, relevance and feasibility. Finally,  the scorecard was submitted for evaluation by the members and Patient  Committee of the Spanish Hospital Pharmacy Society. RESULTS: The resulting scorecard consists of 50 indicators grouped into five  areas: General aspects (18); pharmacotherapeutic follow-up (12); home drug  delivery (15); patient information and education (2); and coordination with the  care team (3). A total of 31 were considered priority or essential  indicators, which are initially recommended for the implementation of a  Telepharmacy program. In contrast, 15 are general indicators, including  measurement of patient and professional satisfaction; 6 indicators refer to  pharmacotherapeutic follow-up; 1 is related to patient information and  education, and 2 correspond to care team coordination. CONCLUSIONS: The scorecard developed is a management tool for the implementation and evaluation of Telepharmacy in the Hospital pharmacy service. This tool enables assessing the initial situation, monitoring  implementation progress, measuring quality and performance, facilitating  decision-making and establishing an improvement plan.

OBJETIVO: La Telefarmacia, como actividad complementaria de la atención farmacéutica presencial en un servicio de farmacia de hospital, debe disponer de indicadores de calidad, actividad y efectividad específicos. Los objetivos del proyecto fueron definir los indicadores de calidad, actividad y efectividad de un cuadro de mando que permitan conocer la  situación y evolución de la Telefarmacia y ayuden a la toma de decisiones de mejora continua, además de diseñar una herramienta que permita medir los indicadores y establecer recomendaciones para su implantación.Método: El proyecto liderado por un grupo de expertos farmacéuticos se desarrolló durante el año 2021 en cuatro fases: revisión bibliográfica,  elaboración preliminar de criterios de calidad e indicadores, valoración de los indicadores y definición de indicadores prioritarios, la elaboración de fichas descriptivas, y el desarrollo y validación de una herramienta de cuadro de mando. Los indicadores se priorizaron en función de su adecuación, utilidad, pertinencia y factibilidad. Finalmente, el cuadro de mando fue sometido a la evaluación de los socios y del Comité de Pacientes de la Sociedad Española de Farmacia Hospitalaria. RESULTADOS: El cuadro de mando consta de 50 indicadores agrupados en cinco ámbitos: 18 de ellos sobre aspectos generales, 12 en el ámbito del  seguimiento farmacoterapéutico, 15 relacionados con la dispensación y entrega informada de medicamentos a distancia, 2 sobre formación e información a los  pacientes y 3 en relación con la coordinación con el equipo asistencial. Se  consideraron 31 de ellos prioritarios, siendo los recomendados inicialmente en  la implantación de un programa de Telefarmacia. De ellos, 15 son generales  (incluyendo la medida de satisfacción del paciente y el profesional), 6 son  indicadores de seguimiento, 1 de formación e información y 2 de coordinación  asistencial. CONCLUSIONES: El cuadro de mando desarrollado es una herramienta de  gestión para implantar y evaluar la Telefarmacia en los servicios de farmacia  hospitalaria, que permite conocer la situación inicial, monitorizar la  implantación, medir la calidad y el desempeño, facilitar la toma de decisiones y  establecer un plan de mejora.

Defining a Standard Set of Patient-Reported Outcomes for Patients With Advanced Ovarian Cancer.

Purpose: Advanced ovarian cancer (AOC) and its treatment cause several symptoms and impact on patients' health-related quality of life (HRQoL). We aim to reach a consensus on the most relevant patient-reported outcome (PROs), the corresponding measures (PROMs), and measurement frequency during AOC patients' follow-up from patients' and healthcare professionals' (HCP) perspective. Methods: The project comprised five steps: 1) a literature review, 2) a focus group with patients, 3) a nominal group with HCP, 4) two round-Delphi consultations with patients and HCP, and 5) a final meeting with HCP. Delphi questionnaire was elaborated based on literature review, focus group (n=5 patients), and nominal group (n=16 HCP). The relevance of each PRO and the appropriateness (A) and feasibility (F) of the proposed PROM were assessed (Likert scale 1=strongly agree; 9=strongly disagree). The consensus was reached when at least 75% of the panelists rated it as 'relevant', 'appropriate', or 'feasible' (score 7-9). Results: A total of 56 HCP [51.8% Hospital Pharmacy; 41.1% Oncology; 3.6% Nursing; and 3.6% Psycho-oncology; mean time in specialty 12.5 (8.0) years] and 10 AOC patients [mean time diagnosis 5.4 (3.0) years] participated in the 1st round. All PROs achieved consensus regarding their relevance, except dry skin (58.0%). Agreement was reached for PRO-CTCAE to be used to assess fatigue (A:84.9%; F:75.8%), neuropathy (A:92.4%; F:77.3%), diarrhea (A:87.9%; F:88.7%), constipation (A:86.4%; F:75.8%), nausea (A:89.4%; F:75.8%), insomnia (A:81.8%; F:88.7%), abdominal bloating (A:82.2%; F:82.2%) and sexuality (A:78.8%; F:88.6%); EQ-5D to determine patients' HRQoL (A:87.9%; F:80.3%), pain (A:87.9%; F:75.8%) and mood (A:77.7%; F:85.5%); to assess treatment adherence the Morisky-Green (A:90.9%; F:84.9%) and the dispensing register (A:80.3%; F:80.3%) were chosen. It was agreed to note in the medical record whether the patient's treatment preferences had been considered during decision-making (A:78.8%; F:78.8%) and to use a 5-point Likert scale to assess treatment satisfaction (A:86.4%; F:86.4%). Panelists agreed (A:92.4%; F: 77.3%) to collect these PROs (1) at the time of diagnosis/relapse; (2) one month after starting treatment/change therapeutic strategy; (3) every three months during the 1st-year of treatment; and later (4) every six months until treatment completion/change. Conclusions: The consensus reached represents the first step towards including the patient's perspective in AOC follow-up. The standardized collection of PROs in clinical practice may contribute to optimizing the follow-up of these patients and thus improving the quality of care.

Specialized training in hospital pharmacy: an overview of the concerns, needs and current situation of resident tutors.

OBJECTIVE: To provide new insight into the training needs and resources required by hospital pharmacy resident tutors in Spain, as well as  into their level of motivation and satisfaction with their teaching. Method: Google Forms® was used to design a survey addressed to hospital pharmacy resident tutors between January and March 2019. They survey consisted of generic (tutor, hospital, service) and specific  questions (available resources, teaching activities, teaching satisfaction,  training needs). A univariate exploratory analysis was conducted to study  possible factors related to teaching satisfaction and motivation. Results: Replies were received from 83 tutors (rate of response: 52.8%), from  15/17 Spanish regions. The annual resident/tutor ratio was 4 (IQR = 2- 4). A total of 96.4% of tutors conducted interviews, of whom 65.1% did so  quarterly. Other activities included the management of external training  rotations (97.6%), planning of rotations (97.6%) and annual  appraisals  (96.4%). Only 17.1% of respondents were given time off their regular duties  for their tutorship work, with 71.4% stating that the time they were allowed  was insufficient. A total of 70.7% of tutors from eight Spanish regions where  the granting of protected time was regulated said were not given any time off  for their teaching endeavors. Most tutors declared to be satisfied (66.7%) and  motivated (63%) with their teaching work. Motivation appeared to fall with  age, and both motivation and satisfaction decreased as a function of the tutors'  years of professional experience and when they were given no time off  for their tutorship work or when the remuneration was low, without any  relationship being identified between these factors. Tutors pointed out that work should be done to increase the number of hours assigned to tutorships  (78%), preparing SEFH-validated training plans (76.8%), improving teaching  techniques (65.9%), and decreasing the clinical workload (62.2%). Over the  past 3 years, 69.1% of tutors had received training. This training was arranged  by educational committees (63.3%), the Spanish regional authorities  (42.4%) and SEFH (13.6%). All the training in clinical, teaching, and communicative competencies enjoyed wide acceptance (> 90%). The  preferred delivery method was hybrid (partly on-line and partly onsite)  (64.6%). CONCLUSIONS: SEFH's tutors' group conducted its first national survey  addressed to hospital pharmacy resident tutors. The survey showed that, although tutors are highly satisfied with their teaching activities, they  ould like more training and to be able to devote more time to their tutorship work. It was also shown that a regulatory framework needs to be  implemented in various Spanish regions and that compliance with existing  regional regulations must be improved.

Objetivo: Conocer las necesidades formativas y de recursos de los tutores de  formación especializada de farmacia hospitalaria de España, así como su  motivación y satisfacción con la docencia.Método: Se realizó, mediante Google-forms®, una encuesta dirigida a tutores  de farmacia hospitalaria durante enero-marzo de 2019 con preguntas generales (tutor, hospital, servicio) y específicas (medios  disponibles, actividades docentes, satisfacción con la docencia, necesidades  formativas). Se realizó un análisis exploratorio univariante para estudiar  posibles factores relacionados con la satisfacción y la motivación docente. Resultados: Respondieron 83 tutores (tasa de respuesta: 52,8%), de 15/17  comunidades autónomas. El número de residentes/año-tutor resultó 4 (rango  intercuartílico = 2-4). El 96,4% realizan entrevistas (trimestrales [65,1%]- ninguna [3,6%]. También se ocupan principalmente de la gestión de rotaciones  externas [97,6%], planificación de rotaciones  [97,6%] y la  evaluación anual [96,4%]). El 17,1% dispone de horas para la docencia  insuficientes para el 71,4%. Un 70,7% de los tutores de ocho comunidades  autónomas con normativa sobre el tiempo de liberación carecen de dicho  tiempo. Los tutores se declararon mayoritariamente satisfechos con la docencia  (66,7%) y motivados (63,0%). Parece que la motivación desciende  con la edad, y que motivación y satisfacción disminuyen con los años como  tutor y como especialista, también son menores en ausencia de liberación o  retribución económica, sin haberse podido demostrar asociación. Los tutores  seleccionaron como acciones de mejora: aumento de dedicación horaria  (78%), planes formativos validados por la Sociedad Española de Farmacia  Hospitalaria (76,8%), mejorar técnicas pedagógicas (65,9%) y menor carga  asistencial (62,2%). En los últimos 3 años el 69,1% recibió formación. La  formación fue organizada por la Comisión de Docencia (63,3%), comunidades  autónomas (42,4%) y Sociedad Española de Farmacia Hospitalaria (13,6%). La  formación propuesta en competencias clínicas, docentes y de comunicación  fue ampliamente aceptada (> 90%). El formato docente  preferido fue semipresencial (64,6%).Conclusiones: El Grupo de Tutores de la Sociedad Española de Farmacia Hospitalaria ha realizado la primera encuesta nacional dirigida a  tutores de farmacia hospitalaria. La encuesta muestra que, aunque la satisfacción con la actividad docente es elevada, los tutores demandan más tiempo de dedicación y una mayor formación. Además, pone de  manifiesto que es preciso desarrollar el marco normativo en varias  comunidades autónomas y mejorar el cumplimiento de la normativa  autonómica vigente.

Percepción de los residentes sobre el impacto de la pandemia COVID 19 en la formación en profesionalismo / Residents ́perspective of the impact of the COVID 19 pandemic on professional competency training

Introducción: el profesionalismo es clave para construir la identidad de los profesionales sanitarios. El objetivo de este trabajo ha sido conocer en un colectivo de residentes, la influencia de la primera ola de la pandemia por SARS-CoV2 en sus competencias del profesionalismo. Materiales y métodos: estudio descriptivo transversal mediante cuestionario electrónico, remitido a 167 residentes, para medir su percepción sobre el impacto de la pandemia COVID-19 en el profesionalismo, con una escala verbal de cuatro niveles: excelente, por encima de lo esperado, lo esperado, por debajo de lo esperado. Se realizó, además, una pregunta abierta de "reflexión personal" analizada cualitativamente mediante un proceso de triangulación. La encuesta se hizo en el Hospital Universitario Fundación Alcorcón en los dos meses siguientes a la primera ola pandémica. Resultados: respondieron 59 residentes (35,3%) de 21 especialidades. Sus lugares de trabajo fueron muy variados. Los atributos del profesionalismo valorados por encima de esperado o excelente fueron: trabajo en equipo (74,6%), empatía (71,2%) y responder a las necesidades del paciente por encima de las propias (69,5%). Se encontró por debajo de lo esperado la gestión de las emociones (22%). Discusión: la pandemia COVID-19 ha contribuido a reforzar la identidad profesional de los residentes, manifestándose a través de muchas dimensiones del profesionalismo. La gestión de las emociones fue la que obtuvo menor valoración.

Introduction: Professionalism is essential to build the identity of health professionals. The aim in this study was to determine, in a group of residents, the influence of the first wave of SARS-CoV2 pandemic on their professionalism competencies. Methods: Cross-sectional descriptive study with an electronic survey sent to 167 residents of Hospital Universitario Fundación Alcorcón to assess their perception of the impact of COVID-19 pandemic on professionalism, with a four-level verbal scale: excellent, above expected, expected, below expected. In addition, an open-ended "personal reflection" question was qualitatively analyzed through a triangulation process. The survey was completed immediately after the first pandemic wave. Results: The questionnaire was answered by 59 residents (35.3%) of 21 specialties from different workplaces. The attributes of professionalism rated above expected or excellent were: teamwork (74.6%), empathy (71.2%) and responding to patient's needs above their own (69.5%). Management of emotions (21%) was found to be below expectations. Discussion: COVID-19 pandemic has contributed to reinforce the professional identity of the residents, expressing itself through many dimensions of professionalism. Emotional management was the lowest rated.

Evaluation of specialized training in hospital pharmacy.

OBJECTIVE: To analyze the degree of satisfaction of hospital pharmacy residents and identify areas of improvement in their training. METHOD: A survey (5-point Likert scale) was administered among  fourthyear hospital pharmacy residents due to complete their residency  in 2018. Bivariate and multivariate logistic regression analyses was  performed to identify the association of each independent variable with  overall satisfaction. RESULTS: 67.4% (91/135) of residents filled out the questionnaire. The  mean overall satisfaction rate was acceptable-good (3.52 ± 0.92);  86.8% of residents had received an individualized training program, with  50% of them considering their individualized training program to be very  well attuned to their day-to-day professional practice. The work of the  tutor and other staff members involved in resident education was rated  as positive by 63.7% and 72.5% of residents, respectively. A total of  15.4% of residents said that their units had a supervision and  progressive empowerment protocol in place. With respect to the level of  on-call responsibility bestowed on them, 81% of residents considered it  to be adequate; 69.2% considered the supervision they received to be  adequate. As many as 96.7% of residents dedicated less than 10 hours  per week to teaching or research activities; 35.2% of residents had  produced five or less articles or congress presentations as first authors.  Residents that had defended or were in the process of writing their PhD  dissertation were 30.8%; 45.1% were involved in an Research project.  Finally, 89% of residents rated the training received as positive, with  75.8% of them stating that they would select the same hospital again. In the statistical analysis, an association was found between overall  satisfaction and several variables, with the work done by the main tutor  being independently related to overall satisfaction. CONCLUSIONS: Overall satisfaction with the training received by  fourthyear residents was acceptable. The work of the tutor and other  staff members involved in resident education were the variables with the  greatest influence on overall satisfaction, albeit only the tutor´s work  achieved statistical significance. The supervision of residents' progress,  the coaching provided by other staff members during clinical rotations,  and research were identified as areas for improvement.

Objetivo: Analizar el grado de satisfacción de los residentes de la especialidad de farmacia hospitalaria e identificar áreas de mejora en su formación.Método: Cuestionario on line con 51 preguntas dirigido a residentes de  cuarto año en Farmacia Hospitalaria que finalizaban su formación en  2018. Se realizó un análisis bivariante y multivariante para identificar la  asociación de cada una de las variables independientes con respecto a la  satisfacción global y delimitar en qué medida las asociaciones pudieran  explicarse por el efecto del resto de variables recogidas en el estudio.Resultados: Un total de 91 (67,4%) residentes cumplimentaron el cuestionario. La media de satisfacción global fue aceptable-buena (3,52 ± 0,92). El 86,8% disponía de un Plan Individualizado de  Formación y el 50% valoraron su adaptación al programa de la  especialidad como buena o muy buena. El 63,7% valoró positivamente la labor del tutor principal y un 72,5% la del resto de adjuntos. El 15,4%  contestó que su servicio disponía de un protocolo de supervisión y  responsabilidad progresiva. El 81% consideró adecuado el nivel de  responsabilidad en las guardias y el 69,2% su supervisión. El 96,7%  disponía de menos de 10 horas semanales para actividades docentes o  de investigación. Un 35,2% tenía cinco o menos publicaciones o  comunicaciones a congresos como primer autor y un 45,1% participaba  en algún proyecto de investigación. Un 89% valoró positivamente la  formación recibida en su centro y un 75,8% de los residentes volvería a  elegir el mismo hospital. El análisis estadístico mostró una asociación  respecto a la satisfacción global con significación estadística de varias  variables, siendo la labor del tutor principal la que se relacionó de forma  independiente con la satisfacción global.Conclusiones: La satisfacción global con la formación recibida es aceptable, siendo la tutorización del tutor principal y la del resto de farmacéuticos de los servicios de farmacia los factores que afectan a  la satisfacción global, si bien sólo la del tutor de un modo  estadísticamente significativo. Como áreas de mejora se han detectado la supervisión de la formación, la labor del colaborador docente  farmacéutico en las rotaciones clínicas y la investigación.

Assessing Pharmacists' Preferences towards Efficacy Attributes of Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis.

Introduction: Hospital pharmacists are increasingly playing a critical role in the care of patients with multiple sclerosis (MS). However, little is known about their preferences and perspectives towards different attributes of disease-modifying therapies (DMTs). The objective of this research was to assess pharmacists´ preferences for DMT efficacy attributes. Methods: A multicenter, non-interventional, cross-sectional, web-based study was conducted. Preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition were the attributes selected based on a literature review and a focus group with six hospital pharmacists. Conjoint analysis was used to determine preferences in eight hypothetical treatment scenarios, combining different levels of each attribute and ranking them from most to least preferred. Results: Sixty-five hospital pharmacists completed the study (mean age: 43.5 ± 7.8 years, 63.1% female, mean years of professional experience: 16.1 ± 7.4 years). Participants placed the greatest preference on delaying disease progression (35.7%) and preserving HRQoL (21.6%) and cognition (21.6%). Importance was consistent in all groups of pharmacists stratified according to demographic characteristics, experience, research background, and volume of patients seen per year. Conclusions: Understanding which treatment characteristics are meaningful to hospital pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.

Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis.

OBJECTIVES: To analyse persistence and adherence in patients with multiple sclerosis receiving first-line treatment with subcutaneous glatiramer acetate 20 mg (GA), subcutaneous interferon ß1a (IFNß1a-sc), intramuscular interferon ß1a (IFNß1a-im) and subcutaneous interferon ß1b (IFNß1b-sc) and to identify associated factors and reasons for discontinuation. METHODS: An observational retrospective study was performed between January 1999 and November 2014. Persistence was defined as the time from treatment initiation until discontinuation, and adherence as the number of units dispensed since treatment initiation until its interruption divided by the theoretical number of units needed to cover said period as a percentage. A patient was considered adherent if ≥95%. Persistence was measured using the Kaplan-Meier method and univariate Cox regression; adherence was measured using a univariate binary logistical regression model. RESULTS: The study included 224 patients. The median persistence was 1349 days (95% CI 1017.4 to 1680.6). Patients receiving IFNß1a-im continued treatment for a longer time (1720 days; 95% CI 1196.8 to 2243.2), while patients treated with IFNß1a-sc had the lowest persistence (771 days; 95% CI 377.4 to 1164.6) (HR=1.7; 95% CI 1.02 to 2.72). Patients with Expanded Disability Status Scale (EDSS) 1.5-6 discontinued treatment earlier than those with EDSS 0-1 (HR 1.5; 95% CI 1.01 to 2.25); 94.4% of patients discontinued treatment due to medical decision, primarily due to lack of efficacy (24.6%) and adverse effects (17.4%), while 80.8% of patients had good adherence. GA had the highest adherence, with no major difference from IFNß1a-im, while IFNß1b-sc showed the highest non-adherence (OR 3.5; 95% CI 1.29 to 9.28). CONCLUSIONS: The persistence levels obtained were lower than in similar studies. EDSS was identified as an independent predictor of treatment interruption. Acceptable adherence was achieved among the population, comparable to other studies and influenced by the drug.

Comparison of the effectiveness and renal safety of tenofovir versus entecavir in patients with chronic hepatitis B.

OBJECTIVE: To compare the effectiveness and renal safety of treatment with tenofovir versus entecavir in patients with chronic hepatitis-B. METHODS: Retrospective study in hepatitis-B patients who initiated treatment with tenofovir or entecavir since January 1998 until 2013. The primary effectiveness variable was defined as viral DNA < 20 UI/ml (HBV-DNA) and the variable for renal safety was variations in glomerular filtration rate (eGFR) after 48 weeks of treatment. RESULTS: The analysis was conducted in 64 patients (1:1), with similar characteristics except for the prevalence of naive patients (p=0.036), comorbidities (p=0.077) and nephrotoxic drugs (p=0.088) in the entecavi arm, while the tenofovir arm presented a prevalence of patients with HBV-DNA < 20 UI/ml (p=0.032) and HBeAg-positive (p=0.050). Statistical univariate analysis and adjustment for confounding variables was conducted through the Propensity Score (PS). The outcomes for the primary effectiveness variable showed tenofovir superiority after PS adjustment, with an ORadj=6.7 (95% CI:1.2-35.3; p=0.028). Three patients on tenofovir experienced seroconversion (p=0.148). The outcomes for the primary safety variable (eGFR < 60 ml/min/1.73m2) showed no difference between both arms after adjustment, achieving an ORadj=0.6 (95% CI:0.1-2.8; p=0.521). The tenofovir arm registered two cases of treatment interruption due to renal toxicity, with subsequent recovery, including one Fanconi Syndrome. CONCLUSIONS: In our study, there are significant differences between both treatments regarding effectiveness, with tenofovir demonstrating superiority. In terms of renal safety, we have not found any significant differences, but two cases of treatment interruption due to renal toxicity with tenofovir lead us to the conclusion that treatment decision in patients with renal function alteration should include an individualized assessment of each case.

Objetivo: Comparar la efectividad y seguridad renal del tratamiento con tenofovir frente al entecavir en pacientes con hepatitis B cronica. Métodos: Estudio retrospectivo en pacientes con hepatitis B que iniciaron tratamiento con tenofovir o entecavir entre enero 1998-2013. La variable principal de la efectividad fue definida como DNA viral < 20 UI/ml (HBV-DNA) y la de la seguridad renal como variaciones en el filtrado glomerular (eGFR) tras 48 semanas de tratamiento. Resultados: Se analizaron un total de 64 pacientes (1:1), con caracteristicas semejantes excepto por el predominio de pacientes sin tratamiento previo (p=0,036), comorbilidades (p=0,077) y farmacos nefrotoxicos (p=0,088) en el grupo-entecavir, y de pacientes con HBV-DNA < 20 UI/ml (p=0,032) y HBeAg-positivo (p=0,050) en el grupo-tenofovir. Se realizaron analisis estadisticos univariantes y se ajustaron las variables confusoras mediante Propensity score (PS). Los resultados para la variable principal de efectividad (HBV-DNA < 20 UI/ml) denotan una superioridad del tenofovir tras el ajuste por PS con una ORadj= 6,7 (IC95%: 1,2-35,3; p=0,028). Tres pacientes con tenofovir sufrieron seroconversion (p=0,148). Los resultados para la variable principal de seguridad (eGFR < 60ml/min/1.73m2) no mostraron diferencias entre ambas ramas tras el ajuste, obteniendo una ORadj= 0,6 (IC95%: 0,1-2,8; p=0,521). El grupo-tenofovir registro dos casos de suspension por toxicidad renal, con posterior recuperacion, entre ellos un sindrome de Fanconi. Conclusiones: En nuestro estudio existen diferencias significativas entre ambos tratamientos respecto a su efectividad, mostrandose el tenofovir superior. En cuanto a la seguridad renal, no hemos encontrado diferencias significativas, pero dos casos de suspension de tratamiento por toxicidad renal con tenofovir nos llevan a concluir que la decision de tratamiento en los pacientes con alteraciones en la funcion renal deberia incluir un analisis individualizado de cada caso.

[Hepatitis B virus reactivation in rituximab-treated patients: incidence and risk factors]. / Reactivación del virus de la hepatitis B en pacientes tratados con rituximab: incidencia y factores de riesgo.

Hepatitis B virus (HBV) reactivation after chemotherapy regimens is a well-known complication. The incidence and risk factors for HBV reactivation remain to be elucidated. We aimed to determine the incidence and risk factors for HBV reactivation in patients receiving rituximab, and the potential role of the cumulative rituximab dose in HBV reactivation. We retrospectively reviewed 320 patients receiving rituximab in our hospital. Of these, 42 (13.12%) had serological markers of hepatitis B. During follow-up, 21% (9/42) had HBV reactivation. Risk factors for reactivation were HBsAg positivity (p < 0.05), isolated anti-HBc positivity (p < 0.05), marginal zone lymphoma, and Mantle cell lymphoma (p < 0.05). The median rituximab dose tended to be higher in patients with reactivation (p = 0.06).