ABSTRACT
A pharmaceutical care programme was implemented at our hospital in early 2013. The main objectives were to analyse and describe the pharmaceutical interventions made, to calculate adherence, interventions and to evaluate patient satisfaction with the care programme. We performed a single-centre descriptive and prospective intervention in cancer patients who received oral chemotherapy as part of a clinical trial in 2013. Eighty-three patients were included. Median age was 58 years (range, 31-80) and 42 patients (50.6%) were men. We recorded 23 interventions, 13 of which were associated with drug interactions. The mean percentage of adherence was 98.9%. The interview with the pharmacist was considered to be very important by 84.6% of the respondents. A total of 92.3% said that they would like to speak to the pharmacist at subsequent visits. The doubts detected during the visits enable us to conclude that the information patients receive with respect to their study medication is usually incomplete. An integrated pharmaceutical care programme for cancer patients participating in clinical trials with oral cytostatic drugs was successful in terms of adherence and patient satisfaction and makes it possible to guarantee the safety and effectiveness of treatment on an individual basis.
Subject(s)
Antineoplastic Agents/administration & dosage , Molecular Targeted Therapy/methods , Neoplasms/drug therapy , Administration, Oral , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Drug Interactions , Female , House Calls , Humans , Male , Medication Adherence , Middle Aged , Molecular Targeted Therapy/adverse effects , Patient Satisfaction , Prednisone/administration & dosage , Prednisone/adverse effects , Prospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization. PATIENTS AND METHODS: From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as "avoided hospitalization in outpatients" (AHO) vs. "reduced hospitalization in inpatients" (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death). RESULTS: Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1-16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period. CONCLUSIONS: The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.
Subject(s)
Home Care Services , Neoplasms/complications , Neoplasms/therapy , Acute Disease , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Male , Middle Aged , Neoplasms/nursing , Patient Readmission , Patient-Centered Care , Pilot Projects , Prospective Studies , Treatment OutcomeSubject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Neoplasm Recurrence, Local/drug therapy , Patient Selection , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Kaplan-Meier Estimate , Leukemia, Lymphocytic, Chronic, B-Cell/mortality , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Retrospective StudiesABSTRACT
The different advances in the Micro Ecological Life Support System Alternative project (MELISSA), fostered and coordinated by the European Space Agency, as well as in other associated technologies, are integrated and demonstrated in the MELISSA Pilot Plant laboratory. During the first period of operation, the definition of the different compartments at an individual basis has been achieved, and the complete facility is being re-designed to face a new period of integration of all these compartments. The final objective is to demonstrate the potentiality of biological systems such as MELISSA as life support systems. The facility will also serve as a test bed to study the robustness and stability of the continuous operation of a complex biological system. This includes testing of the associated instrumentation and control for a safe operation, characterization of the chemical and microbial safety of the system, as well as tracking the genetic stability of the microbial strains used. The new period is envisaged as a contribution to the further development of more complete biological life support systems for long-term manned missions, that should be better defined from the knowledge to be gained from this integration phase. This contribution summarizes the current status of the Pilot Plant and the planned steps for the new period.
Subject(s)
Ecological Systems, Closed , Life Support Systems/instrumentation , Space Flight/instrumentation , Waste Management/methods , Biodegradation, Environmental , Bioreactors , Conservation of Natural Resources , Ecosystem , Environmental Microbiology , Equipment Design , Humans , Pilot Projects , Reproducibility of Results , Space Simulation , Systems Integration , Waste Management/instrumentationABSTRACT
DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.
Subject(s)
Antidotes/adverse effects , Dimethyl Sulfoxide/adverse effects , Extravasation of Diagnostic and Therapeutic Materials/drug therapy , Administration, Topical , Adult , Fatal Outcome , Humans , MaleABSTRACT
The development of a loop of interconnected continuous bioreactors, aimed to provide life support in space, is reported. The complete loop concept consists of four bioreactors and one higher plant compartment. For its realization the continuous and controlled operation of the bioreactors is characterized, up to the pilot scale level, first for each individual reactor, second for the interconnected reactor operation. The results obtained with the two more advanced bioreactors in the Micro Ecological Life Support System Alternative (MELISSA) loop are described more specifically. These reactors consist of a packed-bed reactor working with an immobilized co-culture of Nitrosomonas and Nitrobacter cells, and an external loop gas-lift photobioreactor for the culture of the cyanobacteria Spirulina platensis. Their individual operation for long duration runs has been achieved and characterized, and their interconnected operation at pilot scale is reported.
Subject(s)
Bioreactors/microbiology , Coculture Techniques/instrumentation , Conservation of Natural Resources/methods , Ecological Systems, Closed , Ecosystem , Life Support Systems/instrumentation , Space Flight/instrumentation , Coculture Techniques/methods , Environmental Microbiology , Equipment Design , Equipment Failure Analysis , Feedback , Humans , Pilot Projects , Reproducibility of Results , Sensitivity and Specificity , Space Flight/methods , Space Simulation/methods , Waste Management/instrumentation , Waste Management/methodsABSTRACT
La idea de utilizar anticuerpos monoclonales como fármacos para el tratamiento del cáncer nace con el desarrollo por Köhler y Milstein de la técnica de los hibridomas en 1975. Si bien los resultados de los primeros ensayos clínicos fueron desalentadores, el desarrollo de nuevas técnicas de ingeniería genética para la obtención de anticuerpos monoclonales y el gran avance en el conocimiento de los mecanismos moleculares y fisiopatológicos del cáncer, los han convertido en una eficaz y atractiva alternativa terapéutica. En este trabajo se hace una revisión de los principales anticuerpos monoclonales que son utilizados en oncoh e m a t o l o g í a . (AU)
Subject(s)
Humans , Antibodies, Monoclonal/therapeutic use , Drug Screening Assays, Antitumor , Antineoplastic Agents/therapeutic use , Hematologic Neoplasms/drug therapy , Genetic Engineering , Multicenter Studies as TopicABSTRACT
La administración de fármacos por sonda nasogástrica o enterostomía es una práctica habitual en el hospital, pero a pesar de su comodidad puede plantear una serie de problemas por incompatibilidad con la nutrición enteral. Estas incompatibilidades se clasifican en: físicas, farmacéuticas, fisiológicas, farmacológicas y farmacocinéticas. Siguiendo una serie de recomendaciones y teniendo en cuenta cuáles son las características del fármaco o de la forma farmacéutica que pueden ser origen de los problemas, estas incompatibilidades pueden eliminarse o al menos reducir el riesgo de que se produzcan, evitando así la suspensión del soporte nutricional, la reducción de la eficacia del tratamiento farmacológico o la aparición de reacciones adversas. (AU)
