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1.
Int J Clin Pract ; 69(11): 1268-74, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26202091

RESUMO

INTRODUCTION: Medication errors are frequent at care transition points and can have serious repercussions. Study objectives were to examine the frequency/type of reconciliation errors at hospital admission and discharge and to report on the drugs involved, associated risk factors and potential to cause harm in a healthcare setting with comprehensive digital health records. MATERIAL AND METHODS: A prospective observational 2-year study was conducted in the Internal Medicine Department of a regional hospital. The best possible medication history was obtained from different sources by clinical pharmacists and compared with prescriptions at admission and discharge. The frequency and type of reconciliation errors were studied at admission and discharge, evaluating risk factors for their occurrence and their potential to cause harm. RESULTS: The study included 814 patients (mean age: 80.2 years). At least one reconciliation error was detected in 525 (64.5%) patients at admission, with a mean of 2.2 ± 1.3 errors per patient and in 235 (32.4%) patients at discharge. Drug omission was the most frequent reconciliation error (73.6% at admission and 71.4% at discharge); 39% of errors at admission and 51% at discharge had potential to cause moderate or severe harm. The risk of error at admission was higher with more pre-admission drugs (p < 0.001) and, among patients with reconciliation errors, the number of errors was significantly higher in those receiving more drugs pre-admission or with more comorbidities. The risk at discharge was higher in patients with more drugs prescribed at discharge (p = 0.04) and in those with a longer hospital stay (p = 0.03). CONCLUSIONS: Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors.


Assuntos
Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/normas , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Reconciliação de Medicamentos/estatística & dados numéricos , Segurança do Paciente , Estudos Prospectivos , Fatores de Risco , Espanha
2.
Farm Hosp ; 35(1): 32-5, 2011.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-20663704

RESUMO

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.


Assuntos
Laringoscopia , Laringoestenose/terapia , Mitomicina/administração & dosagem , Estenose Traqueal/terapia , Administração Tópica , Adulto , Terapia Combinada , Feminino , Humanos , Laringoestenose/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , Estenose Traqueal/complicações , Adulto Jovem
3.
Actas Urol Esp (Engl Ed) ; 43(7): 355-363, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31133348

RESUMO

OBJECTIVES: To perform an adjusted indirect comparison of the efficacy of enzalutamide and apalutamide in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) with a high risk of progression to metastatic disease. MATERIAL AND METHODS: After carrying out a literature search, we performed an adjusted indirect comparison (Bucher et al.) of the relative efficacy of enzalutamide and apalutamide in patients with nmCRPC with a high risk of progression to metastatic disease. The outcomes included were metastasis-free survival (MFS) and PSA response rate (PSARR). RESULTS: There were no statistically significant differences between enzalutamide and apalutamide regarding the analysed outcomes. For the comparison enzalutamide+ADT vs. apalutamide+ADT: MFS a HR (95% CI)=1,036 (0.781-1.373) was obtained. For PSARR, a RR (95% CI)=0.81 (0.339-1.938) was obtained. CONCLUSIONS: The adjusted indirect comparison performed in this study shows that there are no statistically significant differences in terms of efficacy regarding MFS and PSARR between enzalutamide+ADT and apalutamide+ADT in patients with nmCRPC with a high risk of progression to metastatic disease. However, in order to confirm these results, an independent trial with direct comparison between both drugs would be required.


Assuntos
Feniltioidantoína/análogos & derivados , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Tioidantoínas/uso terapêutico , Idoso , Benzamidas , Progressão da Doença , Humanos , Masculino , Metástase Neoplásica , Nitrilas , Feniltioidantoína/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/patologia , Medição de Risco , Resultado do Tratamento
11.
Aten Primaria ; 19(9): 487-92, 1997 May 31.
Artigo em Espanhol | MEDLINE | ID: mdl-9264685

RESUMO

OBJECTIVES: To analyse the profile and quality of antibacterials (ABs) prescription in a primary care (PC) district during 1994 and 1995. DESIGN: A longitudinal, descriptive and retrospective study. SETTING: PC doctors from the PC district Bahía de Cádiz (Cádiz). MEASUREMENTS AND MAIN RESULTS: The prescriptions for ABs belonging to the following groups were studied: JO1 (systemic antibiotics), JO3 (systemic chemotherapy drugs), GO4A (antiseptics and drugs for urinary infection) and RO5C1 (expectorants, with mucolytic drugs included with anti-infection ones). The unit of measurement was the daily defined dose (DDD). DDD per 1,000 inhabitants per day (DID) and the DDD percentage of each AB versus the total were used as quantitative indicators. The qualitative indicators were: origins of use of ABs in PC and %DDD of non-justified associations (NJA) (RO5C1 group). CONCLUSIONS: The prescription profile of ABs in the area is similar to, and somewhat more favorable than, that described in the literature for similar areas. In the reconverted network there was a more rational prescription than in the non-reconverted network for the two years of the study. In both types of network a light improvement in the indicators studied was observed from 1994 to 1995.


Assuntos
Antibacterianos/uso terapêutico , Prescrições de Medicamentos/normas , Atenção Primária à Saúde/normas , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Espanha
12.
Aten Primaria ; 25(1): 22-8, 2000 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-10730454

RESUMO

OBJECTIVES: To determine how new medicines are adopted by primary care doctors, identifying innovators or first adopters. Also, to define the variables determining the characteristics of innovative doctors. DESIGN: Retrospective, longitudinal, observational and descriptive study. SETTING: Primary care doctors from the Bahía-Vejer Area in Cádiz (78 general practitioners and 22 paediatricians). MEASUREMENTS AND MAIN RESULTS: All the prescriptions dispensed in pharmacy offices between 1/1/94 and 31/12/96 and prescribed by doctors with over three years experience (74 doctors) were analysed. The active principles sold for the first time between 1/10/93 and 31/12/96 and mainly used in primary care were chosen. Medicines coming on prescription were grouped by three-month periods (28 medicines) and studied for a year. The number of containers of each group prescribed by each doctor was calculated. The doctors were classified in decreasing order according to the number of containers used and given scores through weighting more the initial periods of the prescription of each medicine. The characteristics of the innovative doctor were found with the following variables: age, gender, training, type of care network, type of contract, drugs expenditure and prescription quality through logistic regression. The OR of prevalence for each variable analysed was calculated, and 90% confidence intervals were also determined. 33% of the total (25 doctors) were identified as innovative doctors or first adopters. The statistically significant variables correlating with this group of doctors were: doctors aged > 45, male, non-MIR training, temporary contract, not their sole job, with drug expenditure over the area's 50 percentile, from non-reformed centres. CONCLUSIONS: The identification of this group of doctors will enable specific programmes to be set up in an attempt to alter their attitude to the marketing of new medicines (objective information, evaluation comparing new medicines with existing ones, and increasing doctors' awareness of perceived risk of the use of medicines).


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Medicina de Família e Comunidade , Padrões de Prática Médica , Humanos , Espanha
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