Effect of care transfer model led by the hospital clinical pharmacist on reduction of hospital readmissions in the elderly.

Transfer of care is a critical point for patient safety and requires an optimal care transfer model in order to ensure safe pharmacotherapy transfer. Polypharmacy among elderly is associated with adverse health consequences such as hospital readmissions. Hospital readmissions represent priorities in health care research and are one of the measures for assessing patient safety. Medication-related problems among elderly are associated with polypharmacy. The aim of the study was to show the impact of a developed model of care transfer led by a hospital clinical pharmacist on the number of hospital readmissions in the 12-months period in the elderly. A randomized controlled study of patients aged 65 or more was conducted at Dubrava University Hospital, Community Health Centre Zagreb - East and community pharmacies in the City of Zagreb and Zagreb County, Croatia. An intervention group received specially designed care transfer led by the hospital clinical pharmacist. Model included high-intensity pharmacotherapy interventions delivered at admission, during hospital stay and discharge, transition to primary care and post-discharge and cooperation between all healthcare professionals. In all, 182 patients in the intervention and 171 in the control group were analysed. The total number of hospital readmissions and emergency readmissions, within one year from the hospital discharge, was lower in the intervention group than in the control group (41.7% vs. 58.3%, p=0.005; 40.8% vs. 59.2%, p=0.008). The model of the health care transfer applied in this research thus significantly reduced hospital readmissions in the 1-year period in elderly patients. Therefore, the hospital clinical pharmacists should design and coordinate the transfer between hospital and primary care.

Potential clinically significant drug-drug interactions in prescribed pharmacotherapy in an outpatient setting.

The aim of this study was to determine the most common potential clinically significant drug-drug unteractions (DDIs) in prescribed pharmacotherapy in an outpatient setting in Croatia. Twelve community pharmacies were randomly selected in this research. Retrospective pharmacotherapy record data analysis was conducted on consecutive eligible patients. Potential DDIs were detected using Lexicomp software that categorizes DDIs according to clinical significance. Categories C (monitor drug therapy), D (consider therapy modification) and X (avoid combination) are of clinical concern. In total, 1211 patients were enrolled in this study. The results showed that 84% of patients had at least one clinically significant interaction. The average number of interactions per patient was 4. Overall, 4798 potentially clinically significant DDIs were identified; 3945 (82.2%) required therapy monitoring, while other interactions (D and X category) required specific therapy modification. According to the level of clinical significance the most common clinical consequences of identified potential drug interactions were increased risk of hypotension, impaired renal function, central nervous system depression, gastrointestinal toxicity and QTc prolongation. Research indicates the high exposure to potential clinically significant DDIs in the prescribed pharmacotherapy in an outpatient setting and imposes the need for standardised models of pharmacist interventions.

Incidence of potential drug interactions in co-prescription of statins and macrolide antibiotics in Croatia during the 14 year period.

The objective of this study was to determine the number of patients on the national level that took macrolide antibiotics along with chronic statin therapy in Croatia in the period from 2002 to 2015, and to analyse prescription patterns. In 2002, statins were used in the treatment of 2.6% of the total number of insured persons in Croatia. By 2015, this number increased to 8.4%. In the period studied, on average 15.3% of the patients on statin therapy were co-prescribed macrolide antibiotics. Erythromycin was combined with different statins on average in 1.4% of cases, clarithromycin in 25.5% and azithromycin in 73.2% of the cases. Relative frequency of combining statins with macrolides was similar for all statins. On average, 11.5% of patients on concomitant statin-macrolide therapy were taking high-dose statins. On average, 90% of these co-prescriptions can lead to potentially clinically significant DDIs (X, D, C). The co-prescription of statins and macrolide antibiotics in the Republic of Croatia is increasing. The greatest number of co-prescriptions with macrolides were with atorvastatin and simvastatin.

[Cholecystectomy in young women from the south-oriental area of Santiago: comparison between 2 periods]. / Colecistectomía en mujeres jovenes del area suroriente de Santiago: comparación entre dos períodos.

The aim of this study was to know if cholecystectomy rates have decreased in young women, considering that these rates have decreased in the last years in the general chilean population. The frequency of previous cholecystectomy was compared in 1582 women aged 23.9 +/- 5.8 years admitted to a maternity for delivery between 1985 and 1986 and 4943 women aged 24.6 +/- 5.9 years admitted between 1989 and 1990 for the same reason. There was a reduction in cholecystectomy frequency from 4.7 to 2.5% specially among women 21 to 35 years old. Cholecystectomy was performed at a mean age of 23 years in both groups and 42.6% of the procedures were done before the first pregnancy. An unexpected finding was a lower body weight among women studied in the second period (62.5 +/- 9.1 vs 67.7 +/- 8.4 k).

[Blood pool in the study of hepatic hemangioma]. / Pool sanguineo en el estudio del hemangioma hepatico.

Blood pool scintigraphy is a useful tool in the diagnosis of hepatic hemangioma. We reviewed retrospectively the clinical histories of 24 patients with abnormal blood pool scintigraphies and a presumptive diagnosis of hepatic hemangioma, based on clinical or ultrasonographic findings. In 20 of these patients, blood pool scintigraphy was diagnostic for hepatic hemangioma. The diagnosis was confirmed by an asymptomatic clinical evolution of 12 to 78 months in all the patients, CT scan in 8, angiography in 5 and liver biopsy in one. In the remaining 4 patients scintigraphy ruled out the presence of a hepatic hemangioma. Our results are similar to previous reports in the literature and blood pool scintigraphy has a high specificity for the diagnosis of hepatic hemangioma.

[Treatment of gigantocellular tumors of the bone in our department]. / Lijecenje gigantocelularnog tumora kosti na nasem odjelu.

Thirty-four patients with giant cell tumor of bone were followed up at the Department of Orthopedics, University Hospital Firule, Split from 1960 to 1989. The age and sex distribution of patients and the location of tumors reported in this study are similar to those presented in the majority of large series. Thirty patients were treated with surgery and four with irradiation only. A significant correlation was observed between therapeutic procedures and recurrence of tumors. The incidence of local recurrence was 14.7%. The metastatic lesions in the lung were present in 26.5% of the patients. The most successful therapies for giant cell tumors are excision or resection "en bloc" and cancellous bone grafting. The authors recommend radical resection of tumors.

[Symptomatic lithiasic biliary disease. Comparison between men and women undergoing cholecystectomy]. / Enfermedad biliar litiasica sintomatica. Comparacion entre hombres y mujeres sometidos a colecistectomia.

A prospective survey was carried out in 205 males and 667 females who had their gallbladder removed for gallstone disease during 1989 at a general hospital in Chile. Females had a greater prevalence of disease with an earlier appearance of symptoms leading to surgery at a younger age. In contrast, males developed a more aggressive form of the disease, with a shorter interval from appearance of symptoms and surgery.

Regulation of biliary cholesterol secretion. Functional relationship between the canalicular and sinusoidal cholesterol secretory pathways in the rat.

The functional interrelationship between biliary cholesterol secretion, sinusoidal lipoprotein cholesterol secretion and bile salt synthesis was studied in the rat. Diosgenin, fructose, and colestipol in the diet were used to, respectively, influence biliary cholesterol output, VLDL production and bile salt synthesis. In the acute bile fistula rat, biliary cholesterol output was 700% increased by diosgenin and 50% decreased by fructose. In the rats fed both diosgenin and fructose, biliary cholesterol secretion was increased only by approximately 200%, whereas biliary bile salts and phospholipid outputs were unchanged. In the isolated perfused liver, VLDL-cholesterol output was 50% reduced by diosgenin alone, but was unchanged following feeding of diosgenin plus fructose. However, the livers of rats fed diosgenin plus fructose exhibited a 700% increase in VLDL-triglyceride production and a 200% increase in VLDL-cholesterol output. A significant reciprocal relationship between VLDL-cholesterol secretion and the coupling ratio of cholesterol to bile salts in bile was observed. Colestipol added to the diet maintained both sinusoidal and biliary cholesterol outputs within the normal range. In the chronic bile fistula rat, colestipol increased bile salt synthesis by 100% while diosgenin and fructose diets had no effect. Similarly, the addition of fructose to the colestipol diet did not decrease bile salt synthesis. These data suggest a reciprocal relationship between biliary cholesterol secretion and hepatic secretion of cholesterol as VLDL particles. The free cholesterol pool used for bile salt synthesis seems functionally unrelated to the pool from which VLDL-cholesterol and biliary cholesterol originate. These findings support the idea that metabolic compartmentalization of hepatic cholesterol is a major determinant of the quantity of cholesterol available for recruitment by the bile salt-dependent biliary cholesterol secretory mechanism.