[Study of the conpsumption of innapropiate medicaments in elder hospitalized in the Internal Medicine Service]. / Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna.

BACKGROUND: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD's possibility. PATIENTS AND METHOD: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. RESULTS: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p < 0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD. CONCLUSION: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD.

Evaluation of explicit criteria for total hip joint replacement.

We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.

Disposition of cefoxitin in patients with pleural effusion.

The pharmacokinetics of cefoxitin were studied in nine patients with pleural effusion of varied etiologies. All patients received a single intravenous bolus of 30 mg/kg. Cefoxitin levels were determined simultaneously in plasma and pleural fluid by means of a microbiologic plate diffusion method. The antibiotic follows a two-compartment open kinetic model. In the pleural fluid, maximum concentrations of cefoxitin of 19.72 +/- 9.72 microgram/ml were reached two hours after administration. The fraction of the antibiotic that reaches the pleural fluid represents 0.22% to 4.03% of the dose administered. The disappearance constant of the antibiotic from the pleural fluid is significantly smaller (Kd = 0.15 +/- 0.03 hours-1) than the elimination constant determined from the plasma levels (K13 = 2.27 +/- 0.90 hours-1). Cefoxitin was always found in antibacterial concentration in the pleural fluid for a considerable period of time.

Self-assessment of all the health centres of a public health service through the European Model of total quality management.

The Basque Country Public Health Service has moved in the last years from considering quality as an attribute of patient care to thinking that all management can be subject to improvement. Consequently, its general management team has promoted and supported a self-assessment experience of all their centres by means of the European Quality Model. This strategy has been facilitated by the Basque Country Government, which has strongly encouraged total quality management in companies, and has created the Basque Foundation for Quality Promotion, a key institution in this whole process. A total of 26 centres of the Public Health Service concluded a self-assessment process. As the main result of this, different improvement areas were detected, and various necessary actions were implemented in the centres assessed. Advantages, troubles and future work lines to extend and improve the use of the EFQM model in the health sector are discussed.

[Glycogenosis type III and Crohn disease with associated ankylopoietic spondylitis and secondary amyloidosis. An unusual coincidence]. / Glucogenosis tipo III-A y enfermedad de Crohn con espondilitis anquilopoyética asociada y amiloidosis secundaria. Una singular coincidencia.

We present a member of a family with glycogen deposit disease (GDD) type III (Forbes-Cori's disease) confirmed postmortem through enzymatic analysis of the hepatic and muscular tissues, coinciding with a Crohn's disease associated to ankylopoietic spondylitis, with final development of an extended secondary amiloidosis, all of these diagnosis established in life of the patient and verified in necropsy. We comment this rare finding, the absence of similar cases in the bibliography and the fortuitous nature of this association given the impossibility to suggest another relationship.

[Preliminary study of the drug consumption in hospitalized elders]. / Estudio piloto sobre el consumo de fármacos en ancianos que ingresan en un hospital.

BACKGROUND: The absence of studies that evaluate the effect of the medical acts is an example of "mala praxis". The irrational use of medications is one of these cases. This study shows the characteristics of the drugs consumption in elders. MATERIAL AND METHODS: We include 53 elders hospitalized between 1/02/02 and the 31/05/02. RESULTS: The elders received an average of 6.45 medicaments/day. The factors of more consumption are the origin from nursing home residents and the number of previous surgeries. The adverse effects were related in 25% of the hospitalizations. CONCLUSIONS: The basis of this situation is in the loss of the global perspective of the patients and in the abuse of the sanitary resources. Each drug is the result of an isolated medical act, determining the appearance of iatrogenic disease.