[Spanish multicentre study for the prevention of medication errors: results over four years (2007-2011)]. / Estudio Multicéntrico español para la Prevención de Errores de Medicación. Resultados de cuatro años (2007-2011).

OBJECTIVE: The primary objective of the Spanish Multicentre Study for the Prevention of Medication Errors 2007-2011 was to increase patient safety by improving drug practices in 26 participating Spanish hospitals. The secondary objective was to ascertain the medication error rate. METHOD: We used a modified Barker and McConnell observation method. RESULTS: During 2007-2008, 21 009 observations were recorded In 23 hospitals; during 2008-2009, 11 320 observations were recorded in 10 hospitals; during 2009-2010, 6819 observations were recorded in 8 hospitals, and during 2010-2011, 5876 observations were recorded in six hospitals. Error rates, including medication time errors and failure to inform patients came to 21.7%, 33.3%, 35.6% and 25.7% in each of the years respectively. Excluding time errors, the rates were 18.2%, 32.2%, 33.4% and 23.5%; excluding failure to inform patients as well, rates dropped to 12.6%, 14.8%, 12.8% and 8.6%. STRATEGIES FOR IMPROVEMENT: a normalised drug administration timetable, normalised IV drug dilutions and rates, better drug administration coordination with mealtimes, electronic prescription, improved patient identification measures, adjusting doses for kidney function, drug reconciliation programmes and patient and drug bar code scanning. CONCLUSIONS: 1. The applied measures improved patient safety through better drug practices in participating EMOPEM hospitals. 2. Drug error rates obtained for this sample of Spanish hospitals are some of the highest published. They are significantly lower, however, when we exclude time errors and failure to inform the patient.

A new rapid desensitization protocol for chemotherapy agents.

BACKGROUND: Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. OBJECTIVE: To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs. METHODS: We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. RESULTS: We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease. CONCLUSION: Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents.

Exposure to ELF-pulse modulated X band microwaves increases in vitro human astrocytoma cell proliferation.

Common concern about the biological effects of electromagnetic fields (EMF) is increasing with the expansion of X-band microwaves (MW). The purpose of our work was to determine whether exposure to MW pulses in this range can induce toxic effects on human astrocytoma cells. Cultured astrocytoma cells (Clonetics line 1321N1) were submitted to 9.6 GHz carrier, 90% amplitude modulated by extremely low frequency (ELF)-EMF pulses inside a Gigahertz Transversal Electromagnetic Mode cell (GTEM-cell). Astrocytoma cultures were maintained inside a GTEM-incubator in standard culture conditions at 37+/-0.1 degrees C, 5% CO2, in a humidified atmosphere. Two experimental conditions were applied with field parameters respectively of: PW 100-120 ns; PRF 100-800 Hz; PRI 10-1.25 ms; power 0.34-0.60 mW; electric field strength 1.25-1.64 V/m; magnetic field peak amplitude 41.4-54.6 microOe. SAR was calculated to be 4.0 x 10-4 W/Kg. Astrocytoma samples were grown in a standard incubator. Reaching 70-80% confluence, cells were transferred to a GTEM-incubator. Experimental procedure included exposed human astrocytoma cells to MW for 15, 30, 60 min and 24 h and unexposed sham-control samples. Double blind method was applied. Our results showed that cytoskeleton proteins, cell morphology and viability were not modified. Statistically significant results showed increased cell proliferation rate under 24h MW exposure. Hsp-70 and Bcl-2 antiapoptotic proteins were observed in control and treated samples, while an increased expression of connexin 43 proteins was found in exposed samples. The implication of these results on increased proliferation is the subject of our current research.

[Primary mesenchymal chondrosarcoma of the mediastinum]. / Condrosarcoma mesenquimal primario en el mediastino.

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more exceptional. Radiologic findings are unspecific. However, certain characteristics can orient the diagnosis. They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance.

[Multicenter study on the prevalence of hyperglycemia among hospitalized patients with parenteral nutrition]. / Estudio multicéntrico de prevalencia de hiperglucemia en pacientes hospitalizados con nutrición parenteral.

OBJECTIVE: The aim of this cross-sectional national multicentric study was to determine the prevalence of hyperglycemia in patients with parenteral nutrition and to assess other clinical factors associated with this complication. METHOD: All Spanish hospital pharmacy services were invited to participate in the study. RESULTS: Twenty eight (28) pharmacy services agreed to participate. The study included 442 patients. The prevalence of hyperglycemia (plasma levels > 200 mg/dL) was 26.7%. Eighty four point two per cent of the patients received less than 3.5 mg/kg/minute of glucose, this infusion rate being considered as the safe threshold. In most patients, follow-up of glycemia was based on capillary blood determination with reactive strips and in 27.6% of the cases in which insulin was prescribed, it was added to the parenteral nutrition bag, in full or in part. No significant correlations were found between glycemia and the clinical factors studied (disorders, fever, medication), except for insulin. CONCLUSIONS: This national multicentric study of the prevalence of hyperglycemia among patients with parenteral nutrition, leaded by hospital pharmacists, was a joint effort aimed to better understand this metabolic complication. Findings are consistent with those reported by other authors and have allowed us to describe the current situation.

Economic evaluation of Viaflex with vial adapter in a unit-dose drug distribution system.

The cost of parenteral admixtures has an important impact on the hospital budget. Recently, a Viaflex with vial adapter (named 'minibag plus' in some countries) has been commercialized in order to facilitate parenteral admixture preparation. In the present study a preparation using Viaflex with a vial adapter has been economically compared with a preparation with a traditional Viaflex (without adapter) in a centralized unit or in nursing wards in a unit-dose drug distribution system. A cost-analysis was conducted from the hospital point of view. Direct costs were considered: these included supplies and human resources. Differences in the whole process between the two types of Viaflex were analysed. The process included: purchasing, reception, storage, medical order record, preparation in the Pharmacy Service (PS), delivery from the PS to the nursing unit, preparation by the nurse, return of unused material to the PS. Human resource costs were estimated by time counting and multiplying by the average salary. To estimate wasted material, drug and supplies delivered from the PS and returned to the PS were counted during 26 days. With the new Viaflex costs are reduced by 30% in comparison with drug dilution using the traditional Viaflex in a centralized unit of the PS, and by 13.4% in comparison with preparation with the traditional Viaflex in the nursing ward. In addition it can be estimated that contamination risk with the new Viaflex is lower than preparation in the nursing ward with the traditional Viaflex. Therefore, owing to its lower cost we recommend the use of Viaflex with vial adapter for drug dilution for those vials that are compatible with the system.

[Reorganising specialist care in the Ciutat Vella Health Sector: analysis of an experience]. / La reordenación de la atención especializada en el Sector Sanitario Ciutat Vella: análisis de una experiencia.

OBJECTIVE: Analysis of the results obtained in terms of improvement in the continuity of care, its resolutive capacity and accessibility, in the framework of the organisational change brought about by the reorganisation of specialist care (RSC) in the Ciutat Vella Health Sector. DESIGN: A descriptive study of the reorganised model of specialist care introduced in 1995 and comparison between this and the previous model (1993) in terms of activity, further tests made, referral to hospital, filling in the clinical history and waiting-list. T SETTING: The experience involved 4 PCTs in the Ciutat Vella Health sector of Barcelona (covering 74,449 people). MEASUREMENTS AND MAIN RESULTS: The volume of visits was in general less in 1995, while other types of activity had been incorporated: minor surgery, cryotherapy, consultations and sessions. CONCLUSIONS: The model of RSC satisfies the basic objectives for which it was designed. It increased the specialist's ability to resolve the case within Primary Care. It improved user accessibility to specialist care in terms of waiting time. Finally, the model favours ongoing care, thanks to a single clinical history for both levels.

Synergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting.

OBJECTIVES: To evaluate and compare the clinical efficacy, impact on hemodynamics, safety profiles, and cost of combined administration of propofol and midazolam (synergistic sedation) vs. midazolam and propofol administered as sole agents, for sedation of mechanically ventilated patients after coronary artery bypass grafting. DESIGN: Prospective, controlled, randomized, double-blind clinical trial. SETTING: Intensive care unit of SCIAS-Hospital de Barcelona. PATIENTS: Seventy-five mechanically ventilated patients who underwent coronary artery bypass graft surgery under low-dose opioid anesthesia. INTERVENTIONS: According to the double-blind method, patients were randomly assigned to receive propofol (n = 25), midazolam (n = 25), or propofol combined with midazolam (n = 25). Infusion rates were adjusted to stay between 8 and 11 points on Glasgow Coma Score modified by Cook and Palma. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD duration of sedation was 14.4 +/- 1.5 hrs, 14.1 +/- 1.1 hrs, and 14.7 +/- 1.9 hrs for the propofol, midazolam, and synergistic groups, respectively. The induction dose was 0.55 +/- 0.05 mg/kg for propofol as sole agent, 0.05 +/- 0.01 mg/kg for midazolam as sole agent, and 0.22 +/- 0.03 mg/kg for propofol administered in combination with 0.02 +/- 0.00 mg/kg of midazolam (p = .001). The maintenance dose was 1.20 +/- 0.03 mg/kg/hr for propofol as sole agent, 0.08 +/- 0.01 mg/kg/hr for midazolam as sole agent, and 0.50 +/- 0.09 mg/kg/hr for propofol administered in combination with 0.03 +/- 0.01 mg/kg/hr of midazolam (p < .001). All sedative regimens achieved similar efficacy in percentage of hours of adequate sedation (93% for propofol, 88% for midazolam, and 90% for the synergistic group, respectively). After induction, both propofol and midazolam groups had significant decreases in systolic blood pressure, diastolic blood pressure, left atrial pressure, and heart rate. Patients in the synergistic group had significant bradycardia throughout the study, without impairment in other hemodynamic parameters. Patients sedated with propofol or synergistic regimen awoke sooner and could be extubated before those patients sedated with midazolam (0.9 +/- 0.3 hrs and 1.2 +/- 0.6 hrs vs. 2.3 +/- 0.8 hrs, respectively, p = .01). Synergistic sedation produced cost savings of 28% with respect to midazolam and 68% with respect to propofol. CONCLUSIONS: In the study conditions, the new synergistic treatment with propofol and midazolam administered together is an effective and safe alternative for sedation, with some advantages over the conventional regimen with propofol or midazolam administered as sole agents, such as absence of hemodynamic impairment, >68% reduction in maintenance dose, and lower pharmaceutical cost.

[Local staging with CT of tumors of the upper urothelium]. / Estadiaje local mediante TC de los tumores del urotelio superior.

OBJECTIVE: To evaluate the ability of computerized tomography (CT) to stage transitional cell carcinoma of the upper urinary tract. METHODS: 29 transitional cell carcinoma of the upper urinary tract submitted to nephroureterectomy were retrospectively evaluated. All 29 tumors had preoperative CT scans performed to stage the lesion. The pathological staging was compared to that of CT. RESULTS: 10 of the 29 tumors had CT evidence of tumor extension and 19 had localized noninvasive tumor on CT. Of the 10 patients with CT findings of tumor extension, 2 (20%) had superficial tumors and 8 (80%) had tumors that invaded into the adventitial fat, renal parenchyma or perirenal fat (pT3, pT4). Of the 19 patients with localized noninvasive tumor on CT, 13 (68%) had superficial tumors and 6 (32%) had pT3 or pT4 tumors. CT sensitivity for tumor invasion was 57% with a specificity of 87.5%. CONCLUSIONS: Our analysis shows that CT is of limited value in staging these tumors. When CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage tumor. However, the results obtained in low stage tumors must be viewed with caution.

[Retroperitoneal tumor arising from neural crest: ganglioneuroma+]. / Tumor retroperitoneal derivado de la cresta neural: ganglioneroma.

OBJECTIVES: This study shows the contribution of the different imaging methods in the diagnosis of retroperitoneal ganglineuroma. METHODS: A retroperitoneal mass was incidentally detected in a young male patient. Patient evaluation included plain abdominal radiography, intravenous urography, ultrasound and computed tomography. RESULTS: Ultrasound and computed tomography provide information on tumor characteristics and extent, although it has no diagnostic specifity and does not permit distinguishing ganglioneuroma from other neural crest tumors.

Seroprevalence and risk factors for HIV transmission among female prostitutes: a community survey.

To estimate the prevalence of HIV-1, HIV-2 and HTLV-I among female prostitutes, and to identify possible risk factors for HIV transmission in this collective, sera and epidemiological information from 71 prostitutes were obtained. Using the local network of a well-defined area in southern Catalonia, all prostitution bars were identified and their working women interviewed using a previously validated questionnaire. Eight sera were found positive for HIV-1 antibodies. Of those, 7 sera were also positive in the HIV-2 assay, probably as a result of cross-reactivity between the two viruses. All sera were negative for HTLV-I antibodies. In our area, where intravenous drug users (IVDUs) account for the majority of AIDS cases, the use of drugs by the prostitutes or by their steady sexual partners seems to be the most important risk factor for HIV infection in that group.

Pyrogens in small-volume parenterals prepared in hospital pharmacy.

Three pyrogen assay methods [the rabbit method, Limulus Amebocyte Lysate (LAL) gelation and chromogenic substrate, and bioburden prior to sterilization] were evaluated in three standard batches of small-volume parenteral preparations; i.e., water for injection, sodium chloride 0.9% injection, and sodium bicarbonate 8.4% injection. The same preparations were also assayed after contamination with Escherichia coli followed by sterilization. All methods gave the same results with the water for injection and the sodium chloride 0.9%. With sodium bicarbonate 8.4%, only the rabbit method was valid. For sodium chloride 0.9%, the chromogenic substrate method was valid; the gelation method was not valid. Endotoxins from the manufacturing plant were less pyrogenic in rabbits than were standard endotoxins or those from hospital E. coli.