Impacto de las alertas interactivas modales en la prescripción informatizada de ácido valproico y meropenem / Effect of modal computer-based alerts on the prescription of valproic acid and meropenem

Objetivo: Analizar el impacto de las alertas interactivas modales en la incidencia de la prescripción concomitante de ácido valproico (AVP) y meropenem. Material y método: Estudio analítico de intervención desarrollado en un hospital de tercer nivel de 11 meses de duración. Se seleccionaron aquellos pacientes ingresados con diagnóstico de epilepsia y en tratamiento con AVP y meropenem de forma concomitante. En el sistema de prescripción electrónica asistida se incluyó una alerta modal para que avisase al médico cuando se prescribiese de forma conjunta el AVP y meropenem. Para medir el impacto de esta alerta se compararon los resultados obtenidos con los de un periodo anterior en el que la alerta era no modal. Resultados: El número de pacientes en tratamiento concomitante con AVP y meropenen disminuyó de 13 a 4 pacientes (p = 0,046). Sin embargo, disminuyeron el número de peticiones de niveles de AVP y aumentó el número medio de días conjuntos de prescripción de 4,7 a 8,75. Conclusiones: La implementación de alertas modales disminuye la exposición de los pacientes al tratamiento concomitante de meropenem y AVP (AU)

Objective: To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem. Material and method: Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal. Results: Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P = 0.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended. Conclusions: The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA (AU)

[Effect of modal computer-based alerts on the prescription of valproic acid and meropenem]. / Impacto de las alertas interactivas modales en la prescripción informatizada de ácido valproico y meropenem.

OBJECTIVE: To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem. MATERIAL AND METHOD: Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal. RESULTS: Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P=.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended. CONCLUSIONS: The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA.

Interlaboratory comparison of dicentric chromosome assay using electronically transmitted images.

The bottleneck in data acquisition during biological dosimetry based on a dicentric assay is the need to score dicentrics in a large number of lymphocytes. One way to increase the capacity of a given laboratory is to use the ability of skilled operators from other laboratories. This can be done using image analysis systems and distributing images all around the world. Two exercises were conducted to test the efficiency of such an approach involving 10 laboratories. During the first exercise (E1), the participant laboratories analysed the same images derived from cells exposed to 0.5 and 3 Gy; 100 images were sent to all participants for both doses. Whatever the dose, only about half of the cells were complete with well-spread metaphases suitable for analysis. A coefficient of variation (CV) on the standard deviation of ∼15 % was obtained for both doses. The trueness was better for 3 Gy (0.6 %) than for 0.5 Gy (37.8 %). The number of estimated doses classified as satisfactory according to the z-score was 3 at 0.5 Gy and 8 at 3 Gy for 10 dose estimations. In the second exercise, an emergency situation was tested, each laboratory was required to score a different set of 50 images in 2 d extracted from 500 downloaded images derived from cells exposed to 0.5 Gy. Then the remaining 450 images had to be scored within a week. Using 50 different images, the CV on the estimated doses (79.2 %) was not as good as in E1, probably associated to a lower number of cells analysed (50 vs. 100) or from the fact that laboratories analysed a different set of images. The trueness for the dose was better after scoring 500 cells (22.5 %) than after 50 cells (26.8 %). For the 10 dose estimations, the number of doses classified as satisfactory according to the z-score was 9, for both 50 and 500 cells. Overall, the results obtained support the feasibility of networking using electronically transmitted images. However, before its implementation some issues should be elucidated, such as the number and resolution of the images to be sent, and the harmonisation of the scoring criteria. Additionally, a global website able to be used for the different regional networks, like Share Points, will be desirable to facilitate worldwide communication.

Análisis de la interacción ácido valproico-meropenem en pacientes hospitalizados / Analysis of the valproic acid-meropenem interaction in hospitalised patients

Introducción: Existen referencias en la literatura acerca de la gravedad de la interacción entre el ácido valproico y el meropenem. Sin embargo, las recomendaciones en cuanto a su manejo son contradictorias, recomendándose en algunos estudios la monitorización más estrecha del antiepiléptico si se emplean juntos y en otros contraindicando su uso concomitante. El objetivo de este trabajo es analizar la interacción entre el ácido valproico y el meropenem y evaluar el impacto de la intervención farmacéutica sobre la utilización de estos fármacos en pacientes hospitalizados. Material y métodos: Estudio de la prescripción concomitante de ácido valproico y meropenem en un hospital de tercer nivel de 1.080 camas dividido en dos periodos: uno retrospectivo y observacional, el otro prospectivo y con intervención farmacéutica. Se compararon los hábitos de prescripción entre ambos periodos. Resultados: Un total de 26 pacientes recibieron ácido valproico y meropenem simultáneamente (13 en cada periodo), no alcanzando ninguno niveles terapéuticos del antiepiléptico durante el tratamiento. La intervención farmacéutica cambió los hábitos de prescripción, disminuyendo a la mitad los días de tratamiento concomitante, cambiando la antibioterapia y/o monitorizando más estrechamente el antiepiléptico. Conclusiones: La interacción entre el ácido valproico y el meropenem es grave, especialmente por la rapidez con la que disminuyen los niveles del antiepiléptico. Se debe evitar el uso concomitante de ambos fármacos, sustituyendo la antibioterapia de manera empírica o según los patrones de resistencia del microorganismo para mantener el mismo tratamiento anticomicial (AU)

Introduction: Published data demonstrate a serious interaction between valproic acid and meropenem. However, recommendations about the management of concomitant treatment are contradictory; some experts recommend closer monitoring of valproic acid serum concentrations and others recommend avoiding concurrent therapy. The purpose of this study is to critically analyse the interaction and to evaluate the impact of pharmaceutical intervention in the use of these drugs in hospitalised patients. Material and methods: Study of the concomitant prescription of valproic acid and meropenem in a general hospital of 1,080 beds divided in to two periods; the first period was retrospective and observational and it was followed by a prospective period involving pharmaceutical intervention. The prescription habits between both periods were compared. Results: A total of 26 patients received concurrent treatment with valproic acid and meropenem (13 per period) and none of them maintained therapeutic serum levels of the antiepileptic drug. Pharmaceutical intervention modified prescription habits, reducing by half the number of days of concomitant treatment, changing the antibiotherapy and/or monitoring serum concentrations more often. Conclusions: The interaction between valproic acid and meropenem is serious, especially because of the dramatic decrease in the antiepileptic serum concentrations. The concomitant use of both drugs should be avoided, replacing the antibiotherapy empirically, or according to the resistance profiles of the microorganism and maintaining the same the anti-epileptic treatment (AU)

[Analysis of the valproic acid-meropenem interaction in hospitalised patients]. / Análisis de la interacción ácido valproico-meropenem en pacientes hospitalizados.

INTRODUCTION: Published data demonstrate a serious interaction between valproic acid and meropenem. However, recommendations about the management of concomitant treatment are contradictory; some experts recommend closer monitoring of valproic acid serum concentrations and others recommend avoiding concurrent therapy. The purpose of this study is to critically analyse the interaction and to evaluate the impact of pharmaceutical intervention in the use of these drugs in hospitalised patients. MATERIAL AND METHODS: Study of the concomitant prescription of valproic acid and meropenem in a general hospital of 1,080 beds divided in to two periods; the first period was retrospective and observational and it was followed by a prospective period involving pharmaceutical intervention. The prescription habits between both periods were compared. RESULTS: A total of 26 patients received concurrent treatment with valproic acid and meropenem (13 per period) and none of them maintained therapeutic serum levels of the antiepileptic drug. Pharmaceutical intervention modified prescription habits, reducing by half the number of days of concomitant treatment, changing the antibiotherapy and/or monitoring serum concentrations more often. CONCLUSIONS: The interaction between valproic acid and meropenem is serious, especially because of the dramatic decrease in the antiepileptic serum concentrations. The concomitant use of both drugs should be avoided, replacing the antibiotherapy empirically, or according to the resistance profiles of the microorganism and maintaining the same the anti-epileptic treatment.

[Neurophysiological clinical study of 70 patients with type 2 spinocerebellar ataxia]. / Estudio clínico-neurofisiológico de 70 enfermos con ataxia espinocerebelosa tipo 2.

INTRODUCTION: The prevalence of hereditary ataxia in Holguín, Cuba, is 43 per 100,000 inhabitants, but in some regions reaches 503 per 100,000 inhabitants, a figure never previously recorded in the international literature. OBJECTIVES: To evaluate the part played by non-cerebellar structures and vias in causing some of the clinical signs of the disorder by means of clinico-electro physiological correlation. PATIENTS AND METHODS: A neurological examination, peripheral nerve conduction studies and somato-sensorial evoked potentials of the median and posterior tibial nerves were done in 70 patients with type 2 spinocerebellar ataxia. RESULTS: The commonest clinical signs were ataxia on walking, dysarthria, dysmetria and adiadochokinesia. Correlation analysis showed that the variable most significantly correlated with the degree of ataxia and Romberg's sign was latency of the P40 component, whilst tendon reflexes were best correlated with H reflex latency. However, the duration of the disease was not found to have statistical correlation. CONCLUSIONS: These results suggest that degeneration of long peripheral nerves and sensory paths contributes to the degree of ataxia and other clinical signs. At present no correlation has been found between the duration of the illness and increasing electrophysiological changes, and therefore seems not to have a major effect on neurodegenerative mechanisms.

Estudio clínico-neurofisiológicode 70 enfermos con ataxia espinocerebelosa tipo 2 / Neurophysicological clinical study of 70 patients with type 2 spinocerebellar ataxia

The prevalence of hereditary ataxia in Holguín, Cuba, is 43 per 100,000 inhabitants, but in someregions reaches 503 per 100,000 inhabitants, a figure never previously recorded in the international literature. To evaluate the part played by non-cerebellar structures and vias in causing some of the clinical signs of the disorder by means ofclinico-electro physiological correlation. A neurological examination, peripheral nerve conductionstudies and somato-sensorial evoked potentials of the median and posterior tibial nerves were done in 70 patients with type 2spinocerebellar ataxia. The commonest clinical signs were ataxia on walking, dysarthria, dysmetria and adiadochokinesia.Correlation analysis showed that the variable most significantly correlated with the degree of ataxia and Rombergssign was latency of the P40 component, whilst tendon reflexes were best correlated with H reflex latency. However, the durationof the disease was not found to have statistical correlation. These results suggest that degeneration of longperipheral nerves and sensory paths contributes to the degree of ataxia and other clinical signs. At present no correlation hasbeen found between the duration of the illness and increasing electrophysiological changes, and therefore seems not to have amajor effect on neurodegenerative mechanisms...(AU)

Estudio clínico-neurofisiológico de 70 enfermos con ataxia espinocerebelosa tipo 2 / Neurophysiological clinical study of 70 patients with type 2 spinocerebellar ataxia

Introducción. La prevalencia de la ataxia hereditaria en Holguín, Cuba, es de 43 por 100.000 habitantes, pero existen regiones donde alcanza 503 por 100.000 habitantes, cifra nunca antes comunicada en la literatura internacional. Objetivos. Evaluar la participación de estructuras y vías no cerebelosas en la producción de algunos signos clínicos de la enfermedad a través de la correlación clínico-electrofisiológica. Pacientes y métodos. Se realizó un examen neurológico, así como estudios de conducción nerviosa periférica y potenciales evocados somatosensoriales de nervios mediano y tibial posterior a 70 enfermos con ataxia espinocerebelosa tipo 2. Resultados. Los signos clínicos más frecuentes fueron ataxia de la marcha, disartria, dismetría y adiadococinesia. El análisis de correlación demostró que con el grado de ataxia y con el signo de Romberg, la variable que correlacionó más significativamente fue la latencia del componente P40, mientras que con las alteraciones de los reflejos osteotendinosos fue la latencia del reflejo H. Sin embargo, para el tiempo de evolución no se detectó un nivel de correlación estadísticamente significativo. Conclusiones. Estos resultados sugieren que la degeneración en nervios periféricos y vías sensoriales largas contribuye a la gravedad de la ataxia y del resto de los signos clínicos. El tiempo de evolución no se relaciona con el aumento de las alteraciones electrofisiológicas, por lo que no parece tener un efecto importante sobre los mecanismos neurodegenerativos (AU)