Emulsiones lipídicas en la intoxicación por anestésicos locales y otros fármacos. Revisión sobre mecanismos de acción y recomendaciones de uso / Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use

La emulsiones lipídicas intravenosas (ELI) se han utilizado ampliamente para el tratamiento de la intoxicación por anestésicos locales (AL) y se han propuesto como tratamiento de la intoxicación por otros fármacos. Sin embargo, el grado de evidencia de este tipo de terapias no es sólido, ya que proviene en su mayoría de casos clínicos. El objetivo de esta revisión narrativa es describir los mecanismos de acción propuestos para las ELI en la intoxicación por AL y otros fármacos, y evaluar los estudios recientes realizados en animales que sustentan las recomendaciones de su uso y la experiencia en humanos que apoyan el empleo de las ELI tanto en la intoxicación por AL como por otros fármacos. Para ello, se llevó a cabo una búsqueda en las bases de datos Embase, Medline, Cochrane y Google Scholar abarcando los artículos relevantes durante los últimos 10 años. En caso de intoxicación por AL, se recomienda aplicar los protocolos dictados por las guías internacionales, sabiendo que el grado de evidencia no es muy elevado. En la intoxicación por otros fármacos, las ELI están aconsejadas en situaciones graves inducidas por xenobióticos liposolubles que no responden al tratamiento estándar.(AU)

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.(AU)

Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use.

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.

Lipid emulsions in the treatment of intoxications by local anesthesics and other drugs. Review of mechanisms of action and recommendations for use. / Emulsiones lipídicas en la intoxicación por anestésicos locales y otros fármacos. Revisión sobre mecanismos de acción y recomendaciones de uso.

Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for their use and the experience in humans that support the use of ILESs in both LA and other drug poisoning. For this purpose, a search was performed in the Embase, Medline and Google Scholar databases covering relevant articles over the last 10 years. In the case of AL poisoning, we recommend applying the protocols dictated by international guidelines, knowing that the degree of evidence is not very high. In poisoning by other drugs, ILEs are recommended in serious situations induced by liposoluble xenobiotics that do not respond to standard treatment.

Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria / Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose

Objetivo: Analizar si el cambio de tratamiento antirretroviral a efavirenz/emtricitabina/ tenofovir en dosis única diaria (EETu) incrementa la adherencia y mantiene la efectividad del mismo, y establecer el incremento de coste provocado por dicho cambio. Métodos Estudio observacional, retrospectivo e intrasujeto, realizado en la unidad de dispensación a pacientes externos. El periodo de estudio fue un año (seis meses antes y seis meses después del cambio). Se revisaron los registros informáticos de dispensación y los días de hospitalización durante el periodo de estudio y se calculó la diferencia de adherencia al tratamiento. Para determinar la eficacia del tratamiento, se revisaron los datos de carga viral y linfocitos CD4 antes y después del cambio. Se recogió el coste de los tratamientos previo y posterior para cada paciente y se determinó el incremento de coste anual y por paciente. Resultados Se incluyeron en el estudio 127 pacientes. La diferencia de adherencia fue del 0,6%. El porcentaje de malos adherentes fue del 35,43 y del 40,94% antes y después del cambio de tratamiento, respectivamente. Los niveles de linfocitos CD4 y carga viral no cambiaron significativamente con el tratamiento. En análisis económico reveló un incremento de 25.374,60€ anuales y 199,80€/paciente. Conclusiones El uso de EETu no mejora el control de la infección por el VIH en términos de efectividad ni de adherencia y supone un aumento del gasto farmacéutico, por lo que su elección como tratamiento antirretroviral deberá basarse en criterios diferentes a los anteriormente descritos (AU)

Objective: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. Methods: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change).Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. Results: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25 374.60 and €199.80 per patient. Conclusions: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above (AU)

[Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose]. / Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria.

OBJECTIVE: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. METHODS: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change). Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. RESULTS: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25,374.60 and €199.80 per patient. CONCLUSIONS: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above.

Evaluation of inappropriate prescribing according to Beers criteria in cardiology and respiratory medicine departments

Objetivo. Conocer la incidencia de prescripciones potencialmente inapropiadas (PPI) de los pacientes mayores de 65 años ingresados en las unidades de neumología y cardiología, así como los fármacos principalmente implicados y su severidad clínica. Métodos. Estudio observacional, prospectivo, de 6 meses de duración. Se revisaron los tratamientos de los pacientes mayores de 65 años ingresados en estas unidades. Se consideraron como PPI las incluidas en la lista de Beers de 2003. Se recogió la unidad clínica, edad, sexo, fármaco inapropiado, dosis y vía de administración. Se calculó la incidencia de PPI (número de PPI/número de pacientes) global y en función la unidad clínica, así como según el sexo, fármaco implicado y severidad clínica. Resultados. Se recogieron datos de 385 pacientes (190 en cardiología y 195 en neumología). Se encontraron 111 PPI (0,29 PPI/paciente). Teniendo en cuenta la unidad de origen, se encontraron 53 PPI en cardiología (0,28 PPI/paciente) y 58 PPI en neumología (0,30 PPI/paciente). El 66,6% (n=74) de las PPI ocurrieron en hombres y el 33,4% (n=37) en mujeres. Los principales fármacos implicados fueron amiodarona (24,3%), digoxina (19,8%), doxazosina (17,1%) y diazepam (16,2%). El 68,5% de las PPI encontradas fueron de severidad alta según los criterios de Beers. Conclusión. La prescripción de medicamentos inapropiados en ancianos es elevada. Esto es importante ya que son una de las causas de aparición de reacciones adversas a medicamentos, las cuales provocan a su vez una parte importante de los ingresos hospitalarios. La inclusión de alertas en el programa de prescripción asistida y la difusión de boletines informativos al respecto en el personal implicado mejoraría la calidad de la asistencia sanitaria y minimizaría los problemas relacionados con la medicación(AU)

Objective. To determine the incidence of potentially inappropriate prescriptions (PPI) for patients older than 65 years admitted to the cardiology and respiratory medicine units, as well as the main drugs involved and their clinical severity. Methods. A prospective, observational study was carried out over a 6 month period. We reviewed the treatment of patients over 65 years old admitted to these units. PPI is considered as those included in the Beers criteria 2003. We recorded clinical unit, age, sex, inappropriate drug, dosage and route of administration. We calculated the overall incidence of PPI (number of PPI/number of patients) and according to the clinical unit, sex, drug involved, and clinical severity. Results. Data were collected from 385 patients (190 in cardiology and 195 respiratory medicine unit). We found 111 PPI (0.29 PPI/patient). If we take into account the clinical unit, there were 53 PPI in cardiology (0.28 PPI/patient) and 58 PPI in respiratory medicine (0.30 PPI/patient). Two-thirds (66.6%, n=74) of the PPI occurred in men and 33.4% (n=37) in women. The main drugs involved were amiodarone (24.3%), digoxin (19.8%), doxazosin (17.1%) and diazepam (16.2%). According to the Beers criteria, 68.5% of those were high severity PPI. Conclusion. The prescription of inappropriate medications in the elderly is high. This is important because they are a cause of adverse reactions, which leads to a significant proportion of hospital admissions. The inclusion of warnings in the program of assisted prescribing and distributing of newsletters about these to the personnel involved, improves the quality of health care and minimises medication-related problems(AU)

[Evaluation of inappropriate prescribing according to Beers criteria in cardiology and respiratory medicine departments]. / Evaluación de las prescripciones inapropiadas según los criterios de Beers en los servicios de cardiología y neumología hospitalarios.

OBJECTIVE: To determine the incidence of potentially inappropriate prescriptions (PPI) for patients older than 65 years admitted to the cardiology and respiratory medicine units, as well as the main drugs involved and their clinical severity. METHODS: A prospective, observational study was carried out over a 6 month period. We reviewed the treatment of patients over 65 years old admitted to these units. PPI is considered as those included in the Beers criteria 2003. We recorded clinical unit, age, sex, inappropriate drug, dosage and route of administration. We calculated the overall incidence of PPI (number of PPI/number of patients) and according to the clinical unit, sex, drug involved, and clinical severity. RESULTS: Data were collected from 385 patients (190 in cardiology and 195 respiratory medicine unit). We found 111 PPI (0.29 PPI/patient). If we take into account the clinical unit, there were 53 PPI in cardiology (0.28 PPI/patient) and 58 PPI in respiratory medicine (0.30 PPI/patient). Two-thirds (66.6%, n=74) of the PPI occurred in men and 33.4% (n=37) in women. The main drugs involved were amiodarone (24.3%), digoxin (19.8%), doxazosin (17.1%) and diazepam (16.2%). According to the Beers criteria, 68.5% of those were high severity PPI. CONCLUSION: The prescription of inappropriate medications in the elderly is high. This is important because they are a cause of adverse reactions, which leads to a significant proportion of hospital admissions. The inclusion of warnings in the program of assisted prescribing and distributing of newsletters about these to the personnel involved, improves the quality of health care and minimises medication-related problems.

Utilización terapéutica de los anticuerpos monoclonales / Therapeutic use of monoclonal antibodies

La utilización de terapias basadas en anticuerpos monoclonales ha supuesto un gran avance en la práctica clínica. Tienen un ámbito de utilización muy diverso, incluyendo aplicaciones diagnósticas y terapéuticas principalmente. En cuanto a su uso como tratamiento, las áreas más beneficiadas con su descubrimiento han sido la oncología y las enfermedades del sistema inmune.Se trata de un área en continuo crecimiento, tanto por la aparición de nuevos fármacos, como por la ampliación de indicaciones de los ya existentes. Esta revisión resume las características farmacológicas más importantes de los anticuerpos monoclonales comercializados en nuestro país. Se centra principalmente en la utilidad terapeútica, dosificación, eventos adversos de gran relevancia clínica y consideraciones importantes para su correcta administración. También se realiza un breve apunte de las indicaciones de los anticuerpos monoclonales autorizados por la agencia europea del medicamento (EMEA) y que se encuentran en distintas fases del proceso de comercialización(AU)

The utilization of therapies based on monoclonal antibodies has supposed a great advance in the clinical practice. They have a diverse field of use, including diagnostic and therapeutic applications. As treatment, the most benefited has been the oncology and immune system diseases.This is an area in continuous growth, so much for the appearance of new medicaments, since for the extension of indications of the already existing ones. This review summarizes the most important pharmacological characteristics of the monoclonal antibodies commercialized in our country. It centres principally on the authorized indications, dosing, adverse events of great clinical relevancy and important considerations for his correct administration. Also there is realized a brief note of the indications of the monoclonal antibodies authorized by the European agency of the medicine (EMEA) and that are in different phases of the process of commercialization(AU)

Impacto de la prescripción electrónica asistida en la reducción de los errores de transcripción a la hoja de administración / Electronically assisted prescription will minimise drug transcription errors

Objetivo Evaluar la incidencia de errores de administración por transcripción errónea a la hoja de administración de enfermería y estimar el impacto de la prescripción electrónica asistida (PEA) en reducir estos errores. Métodos Estudio observacional, prospectivo, en el área de hospitalización. En una muestra representativa, se revisaron los cambios de tratamiento de las prescripciones médicas en las 24 horas previas a la observación. Se detectaron los errores de transcripción identificando la no concordancia entre la prescripción médica y la hoja de administración de enfermería. Se calculó la incidencia de los errores de transcripción total y por unidad clínica, tipo de error, vía de administración y gravedad potencial asociada. Se estimó el impacto de la disminución del número de errores nuevos/día si se implantara la PEA en todas las unidades. Resultados De las 416 prescripciones revisadas el porcentaje global de errores de transcripción fue del 12,4%, siendo del 9,8% en las unidades médicas y del 15,2% en las quirúrgicas. Los tipos de error más prevalentes fueron por añadir un medicamento nuevo (29,4%) y en la frecuencia de administración (27,4%). El 98% no produjeron daño al paciente y el 57,7% correspondió a la Categoría C. Con la PEA se evitarán 69 errores nuevos diarios en las unidades de hospitalización. Conclusiones Los errores de transcripción tienen una magnitud suficientemente importante como para tenerlos en cuenta a la hora de diseñar estrategias para mejorar la calidad asistencial; la PEA es una herramienta eficiente que elimina los errores asociados a la transcripción de órdenes médicas (AU)

Objective To assess the impact of administration errors when transcribing treatments to nurses’ administration forms, and to estimate the impact of electronically assisted prescription (EAP) in minimising these errors. Method A prospective, observational study in hospitalised patients. In a representative sample changes in treatment in the 24h before the examination are analysed. Transcription errors were detected when checking the discrepancies between the medical prescription and the nurses’ treatment administration forms. Error incidence was calculated as a whole and by ward, type of error, administration route and their potential danger. The possible reduction in new errors per day if the EAP were to be introduced in all units was estimated. Results Of the 416 prescriptions recorded, the overall percentage of transcription errors was 12.4%, 9.8% in medical units and 15.2% in surgical units. Most of the errors were made when a new medicine was added (29.4%) and the frequency of administration was changed (27.4%). With regard to their gravity, 98% did not harm the patients, and 57.7% were filed as “Category C”. Taking into account that 1 change of treatment is made per patient per day, the introduction of the EAP is predicted to prevent 64 new errors daily in the hospital. Conclusions There are so many transcription errors that they should be taken into account when designing strategies to improve care quality. EAP is an efficient tool to eliminate errors associated with the transcription of prescriptions (AU)

Electronically assisted prescription will minimise drug transcription errors.

OBJECTIVE: To assess the impact of administration errors when transcribing treatments to nurses' administration forms, and to estimate the impact of electronically assisted prescription (EAP) in minimising these errors. METHOD: A prospective, observational study in hospitalised patients. In a representative sample changes in treatment in the 24 h before the examination are analysed. Transcription errors were detected when checking the discrepancies between the medical prescription and the nurses' treatment administration forms. Error incidence was calculated as a whole and by ward, type of error, administration route and their potential danger. The possible reduction in new errors per day if the EAP were to be introduced in all units was estimated. RESULTS: Of the 416 prescriptions recorded, the overall percentage of transcription errors was 12.4%, 9.8% in medical units and 15.2% in surgical units. Most of the errors were made when a new medicine was added (29.4%) and the frequency of administration was changed (27.4%). With regard to their gravity, 98% did not harm the patients, and 57.7% were filed as "Category C". Taking into account that 1 change of treatment is made per patient per day, the introduction of the EAP is predicted to prevent 64 new errors daily in the hospital. CONCLUSIONS: There are so many transcription errors that they should be taken into account when designing strategies to improve care quality. EAP is an efficient tool to eliminate errors associated with the transcription of prescriptions.