Drug-related visits to the emergency department in a Spanish university hospital.

BACKGROUND: Negative outcomes of medications (NOMs) are a major public health problem that impact on patients' quality of life. As many NOMs are avoidable, it is necessary to determine their causes in each health setting in order to plan preventive strategies. OBJECTIVE: The aims of this study were to assess the frequency, type, severity, and preventability of NOMs that result in emergency department visits, to identify the main medications involved, and to determine factors associated with their development in a general hospital in Spain. SETTING: Emergency department of a 650-bed university tertiary hospital. METHODS: Descriptive, cross-sectional study. On each study day, a pharmacist administered a questionnaire to one in every three patients awaiting consultation. Information was also obtained from the emergency medical records. Emergency department visits were identified as NOMs on the basis of assessment by a pharmacist and a physician. A second pharmacist and physician reassessed the same cases. Discrepancies were adjudicated by an external team of two pharmacists and a physician. MAIN OUTCOME MEASURES: Number of NOMs detected, severity and preventability of the NOMs detected, medications involved in these NOMs, and factors associated with NOMs. RESULTS: A NOM was detected in 221 of 588 patients analyzed (37.6 %). In relation to NOM severity, 59.3 % were mild, 34.4 % were moderate and 6.3 % were severe. One hundred and fifty-seven of the 221 NOMs (71 %) were considered preventable. Drugs most frequently involved in NOMs were nervous system agents (22.1 %), musculo-skeletal system agents (19.1 %), and anti-infective agents for systemic use (17.6 %). Mean number of drugs taken was the only factor associated with NOMs. CONCLUSION: The high number of NOMs detected indicates that closer pharmacotherapy follow up is needed to avoid such events in our setting.

Cambios en la viscosidad del agua con espesantes por la adición de fármacos altamente prescritos en geriatría / Viscosity changes in thickened water due to the addition of highly prescribed drugs in geriatrics

Introducción: La disfagia es una alteración de la deglución con una elevada incidencia en el paciente geriátrico relacionada con un aumento del riesgo de desnutrición y neumonía por broncoaspiración. La adición de espesantes comerciales en líquidos es frecuente en esta situación, así como la adición de fármacos en esta mezcla para facilitar su administración. Sin embargo, no existen estudios referentes al posible cambio de viscosidad producido por la adición de los mismos. Objetivos: Evaluar la variación ejercida sobre la viscosidad del agua espesada con preparados comerciales al añadir fármacos frecuentemente utilizados en pacientes de edad avanzada. Métodos: Se prepararon muestras de agua con espesante comercial Resource® (almidón de maíz modificado) o Nutilis® (almidón modificado de maíz, maltodextrina y gomas: tara, xantana y guar) para conseguir consistencia intermedia tipo "miel". Se midió la viscosidad de estas muestras y para muestras similares a las que se había añadido alguno de los siguientes fármacos: galantamina, rivastigmina, ciprofloxacino, colecalciferol, memantina, fosfomicina, calcio y amoxilina/clavulánico. Resultados: En las muestras con espesante Resource® se observó una disminución de la viscosidad al añadir galantamina, memantina, fosfomicina o calcio, y un aumento de la viscosidad con amoxicilina/clavulánico. La viscosidad de la muestras con Nutilis® disminuyó con galantamina, rivastigmina, amoxicilina/clavulánico, fosfomicina y calcio. Conclusión: La viscosidad del agua con espesantes comerciales puede verse afectada por algunos fármacos o sus excipientes, lo que puede incidir en la capacidad de deglución de los mismos. Es aconsejable realizar más estudios in vitro e in vivo para valorar ajustar dichas pautas en caso necesario (AU)

Introduction: Dysphagia is a swallowing disorder with a high incidence in the geriatric patient related with an increased risk for undernutrition and pneumonia due to bronchial aspiration. In this condition, it is usual to add commercial thickeners in liquids, as well as the addition of drugs in this mixture to improve their administration. However, there are no studies regarding the possible change in viscosity produced by their addition. Objectives: To assess the change in viscosity of water thickened with commercial products by adding the drugs frequently used in elderly patients. Methods: Samples of water mixed with the commercial thickener Resource® (modified corn starch) or Nutilis® (modified corn starch, maltodextrin, and gums: tara, xhantan, and guar) to achieve an intermediate consistence as "honey". The viscosity of these samples was measured as well as for similar samples to which one of the following drugs was added: galantamine, rivastigmin, ciprofloxacin, cholecalciferol, memantine, fosfomycin, calcium, and amoxicillin/clavulanic acid. Results: In the samples with Resource® thickener we observed decreased viscosity by adding galantamine, memantine, fosfomycin or calcium, and increased viscosity with amoxicillin/clavulanic acid. The viscosity of the samples with Nutilis® decreased with galantamine, rivastigmine, amoxicillin/clavulanic acid, fosfomycin and calcium. Conclusion: The viscosity of water with commercial thickeners may be affected by some drugs or their preservatives, which may influence the swallowing capability. It is recommended to perform further in vitro and in vivo studies in order to adjust these formulations if necessary (AU)

Perception of healthcare providers versus patient reported incidence of chemotherapy-induced nausea and vomiting after the addition of NK-1 receptor antagonists.

PURPOSE: Physicians and nurses often underestimate the incidence of chemotherapy-induced nausea and vomiting (CINV) after both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). This study assesses physicians' and nurses' perceptions of CINV in their own practices after the introduction of aprepitant. METHODS: A prospective observational study of patients receiving the first cycle of HEC regimens with CDDP and without CDDP or MEC was performed. Eligible patients completed a 6-day diary recording emetic episodes, nausea assessment, and antiemetic medication use. Physicians and nurses estimated the incidence of acute and delayed CINV after the first administration of HEC and MEC. The observed incidence rates of CINV were compared with the rates predicted by healthcare providers. Aprepitant was given to patients receiving HEC regimes with CDDP. RESULTS: Twenty-nine physicians and nurses and 95 patients (87% receiving HEC and 14% MEC) were recruited. The global control of CINV was 66.67% for all patients and 73.33%, 47.06%, and 55.56% for patients receiving HEC regimens with CDDP, HEC regimens without CDDP and MEC, respectively. Physicians and nurses underestimated the control of acute CINV in patients receiving HEC regimens with CDDP, but they accurately predicted the control of delayed CINV. All physicians and nurses predicted the control of acute CINV after HEC regiments without CDDP and after MEC quite accurately, whereas they overestimated the control of delayed CINV after both regimens. CONCLUSIONS: Aprepitant allows for better control of CINV in HEC regimens with CDDP, and this control is accurately perceived by physicians and nurses. However, physicians and nurses overestimate the control of delayed CINV after HEC regimens without CDDP and after MEC. CINV is still an important target for improved therapeutic intervention and the healthcare providers must be aware of its actual incidence.

Effects of multilayered bags vs ethylvinyl-acetate bags on oxidation of parenteral nutrition.

BACKGROUND: We evaluate the effects of multilayered bags vs ethylvinyl-acetate bags on peroxidate formation of various emulsions for all-in-one total parenteral nutrition solutions (TPN) during storage. METHODS: Twenty-four parenteral nutritions were prepared with 4 commercial i.v. lipid emulsions (Soyacal 20%, Grifols; Intralipid 20%, Fresenius-Kabi; Lipofundina 20%, Braun; and Clinoleic 20%, Clintex) and 2 different bags (multilayered [ML] bag, Miramed; and 1 ethylvinyl-acetate [EVA] bag, Miramed). Each kind of TPN was prepared in triplicate. Samples were taken at 3 different times: immediately after preparation (time 0), after 6 days at 4 degrees C and 48 hours at 37 degrees C (time 1), and finally after a total of 14 days at 37 degrees C (time 2). Oxidation of TPN was evaluated by analysis of hydroperoxides by ferrous oxidation-xylenol orange (FOX) reactive, lipoperoxides by thiobarbituric acid reactive species (TBARS), alpha-tocopherol by high-performance liquid chromatography (HPLC), and ascorbic acid and dehydroascorbic acid by HPLC. RESULTS: TPN admixtures in ML bag showed less oxidation evaluated by peroxide determination using FOX than EVA bag. Lipoperoxides by TBARS did not show significant differences between 2 bags. Ascorbic acid and dehydroascorbic acid disappeared in EVA bags at time 1. No important differences were found in alpha-tocopherol content. CONCLUSIONS: Multilayered bags minimize oxidation.