Does mHealth increase adherence to medication? Results of a systematic review.

AIMS: Adherence to medication is a major problem that affects 50-60% of chronically ill patients. As mobile phone use spreads rapidly, a new model of remote health delivery via mobile phone ­ mHealth ­ is increasingly used. The objective of this study is to provide a comprehensive overview of how mHealth can be used to improve adherence to medication. METHODS: A systematic literature review was conducted using four databases (CINAHL, PubMed, Scopus and PsycARTICLES). Eligible articles available on March 2014 had to be written in English or Spanish and have a comparative design. Articles were reviewed by two authors independently. A Cochrane Collaboration tool was used to assess the studies based on their internal validity. RESULTS: Of the 1504 articles found, 20 fulfilled the inclusion criteria [13 randomised clinical trials (RCT), one quasi-RCT, one non-randomised parallel group study and five studies with a pre-post design]. Nearly all the trials were conducted in high-income countries (80.0%). Articles were categorised depending on the target population into three different groups: (i) HIV-infected patients, n = 5; (ii) patients with other chronic diseases (asthma, coronary heart disease, diabetes mellitus, hypertension, infectious diseases, transplant recipients and psoriasis), n = 11; and (iii) healthy individuals, n = 4. Adherence improved in four of the studies on HIV-infected patients, in eight of the studies on patients with other chronic diseases, and in 1 study performed in healthy individuals. All studies reported sending SMS as medication reminders, healthy lifestyle reminders, or both. Only one trial (HIV-infected patients) had a low risk of bias. CONCLUSIONS: Our results showed mixed evidence regarding the benefits of interventions because of the variety of the study designs and the results found. Nevertheless, the interventions do seem to have been beneficial, as 65% of the studies had positive outcomes. Therefore, more high-quality studies should be conducted.

Dosificación de cidofovir en un paciente crítico en hemodiafiltración continua venovenosa / Cidofovir dosage in a critically ill patient undergoing continuous veno-venous hemodiafiltration

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Magnesium monitoring practice in monoclonal anti-epidermal growth factor receptor antibodies therapy.

WHAT IS KNOWN AND OBJECTIVE: It is now estimated that about 5% of cetuximab-treated patients and about 3% of panitumumab-treated patients will develop grade 3-4 hypomagnesemia. The aim of this study was to assess the extent of magnesium monitoring in patients treated with epidermal growth factor receptor (EGFR)-targeting antibodies and to estimate the incidence of hypomagnesemia in these patients at our institution. METHODS: A 2-year retrospective study was carried out. At least four doses of weekly cetuximab or two doses of bi-weekly panitumumab were required for inclusion. Serum magnesium profiles were reviewed from 1 month before treatment until 3 months after treatment discontinuation, and patients with <2 determinations were excluded. RESULTS AND DISCUSSION: Two hundred and one patients received at least one dose of EGFR-targeting antibodies, but only 68 met the inclusion criteria. Seventy patients had <2 magnesium determinations. The overall hypomagnesemia was 58·82% (40 of 68 patients), with a 4·41% grade 3 hypomagnesemia (three of 68 patients). No grade 4 hypomagnesemia was detected. WHAT IS NEW AND CONCLUSION: There is a lack of magnesium monitoring in these patients. Serum magnesium determinations should be done every 4-8 weeks in patients treated with EGFR-targeting antibodies, as it is a useful surrogate marker for both toxicity and efficacy.

Aplicación de los nuevos criterios de prescripción inadecuada STOPP-START a pacientes geriátricos institucionalizados / Application of the new STOPP-START criteria of inappropriate medication prescription in geriatrics in an institutional care setting

Objetivo. Identificar medicación inadecuada y fármacos necesarios no prescritos en pacientes de cuatro residencias geriátricas y cuantificar la modificación de tratamientos que realizan médicos a partir de las recomendaciones hechas por farmacéuticos. Material y métodos. Estudio cuasi experimental pre-post sin grupo control. La intervención consistió en la comunicación de prescripciones inapropiadas, basadas en los criterios STOPP-START, detectadas en los médicos responsables. Resultados. Se revisaron las historias clínicas de 121 pacientes mayores de 65 años. Ochenta y ocho pacientes (72,7%) presentaron como mínimo un criterio STOPP-START, con una media de 2 criterios por paciente. Se observó al menos una potencial prescripción inadecuada (STOPP) en 79 pacientes (65,3%) y una omisión de un tratamiento necesario (START) en 36 pacientes (29,7%). El médico aceptó como mínimo uno de los criterios detectados y modificó el tratamiento de 47 pacientes (53,4%). Se cambió el tratamiento de 33 pacientes (41,8%) siguiendo los criterios STOPP y de 20 pacientes (55,5%) según los criterios START. Conclusión. La prescripción inadecuada de fármacos y la no utilización de fármacos necesarios es un problema frecuente en geriatría (AU)

Objective. This study has aimed to determine the prevalence of inappropriate prescribing (IP) and of necessary drugs not prescribed in a geriatric population living in four assisted care nursing homes and to quantify the changes in medications made by physicians based on the recommendations made by the pharmacists. Methods. A pre-post quasi-experimental study without a control group was performed. The intervention consisted of the communication of inappropriate prescriptions based on the STOPPSTART criteria to the responsible physicians Results. The medical records of 121 patients over 65 year were reviewed. Of these, 88 patients (72.7%) had at least one STOPP-START criterion, with an average of 2 criteria per patient. At least one potential inappropriate drug (STOPP criterion) was detected in 79 patients (65.3%) and 36 patients (29.7%) were not receiving at least one drug indicated for their diseases (START criterion). The practitioners accepted at least one of the criteria detected and modified the medical prescription of 47 patients (53.4%). Treatment was modified in 33 patients (41.8%) following the STOPP criteria and 20 patients (55.5%) following the START criteria. Conclusion. Inappropriate drug prescription and the lack of using of the necessary medications is a frequent problem in older patients (AU)