Eventos adversos a insulina en ancianos de UCI y prescripción inapropiada de medicamentos / Adverse insulin events in elderly ICU patients and inappropriate medication prescription

El tratamiento de la diabetes tipo 2 en el anciano representa un importante reto tanto desde el punto de vista clínico como del de la salud pública.La prescripción inapropiada es aquella donde los medicamentos prescriptos no manifiestan claros beneficios frente a los riesgos habiendo alternativas más seguras y disponibles.Objetivo: Este estudio se propone como objetivo medir la tasa de eventos adversos a insulina en ancianos diabéticos tipo II hospitalizados en una unidad de cuidados intensivos y analizar la prescripción inapropiada de medicamentos con los criterios de Beers 2015.Materiales y métodos: Estudio observacional prospectivo.Resultados: Se estudiaron 308 pacientes. El número de eventos de hipo e hiperglucemias asociadas a insulina fue de 36 (11,7%), de los cuales: 20 fueron hiperglucemias y 16 fueron hipoglucemias. Los pacientes con estos eventos han sido 30 (9,7%), de los cuales 18 han presentado criterios Beers positivos (60%). En el total de la población, 21 pacientes, es decir el 6,8% presentó criterios Beers.Conclusiones: La proporción de pacientes ancianos con eventos adversos a insulina en esta muestra de pacientes ha sido del orden del 9,7% y en un 60% han presentado criterios Beers positivos de prescripción inapropiada. (AU)

The treatment of type 2 diabetes in the elderly represents a major challenge from both a clinical and public health point of view.Inappropriate prescription is one where the prescribed drugs do not show clear benefits versus risks, with safer and more available alternatives.Objective: The objective of this study is to measure the rate of adverse events to insulin in type II diabetic elderly hospitalized in an intensive care unit and to analyze inappropriate prescription of drugs with the Beers 2015 criteria.Materials and methods: Prospective observational study.Results: 308 patients were studied. The number of events of hypo and hyperglycemia associated with insulin was 36 (11.7%), of which: 20 were hyperglycemic and 16 were hypoglycemic. There were 30 patients with these events (9.7%), of which 18 had positive Beers criteria (60%). In the total population, 21 patients, that is, 6.8% presented Beers criteria.Conclusions: The proportion of elderly patients with adverse events to insulin in this sample of patients has been of the order of 9.7% and 60% have presented positive Beers criteria of inappropriate prescription. (AU)

Incidencia de eventos adversos a quimioterapia mediante dos métodos de detección: caracterización y costos sanitarios asociados / Incidence of adverse events to chemotherapy using two detection methods: characterization and associated health costs

A pesar del avance que ha supuesto en la supervivencia de los pacientes oncológicos, la aparición de nuevos agentes quimioterápicos y nuevas combinaciones, estos han traído consigo numerosos efectos adversos que pueden llegar a comprometer el tratamiento y, por consiguiente, el pronóstico de la enfermedad.Objetivos: Conocer la incidencia de los eventos adversos asociados a quimioterapia (EA), caracterizarlos y analizar sus implicancias económicas utilizando dos herramientas de detección.Materiales y métodos: Estudio de incidencia de corte longitudinal.Resultados: Se estudiaron 350 pacientes. La media de edad: 56,9, mediana: 43,4, rango: 19-85. El número de pacientes con EA fue: 323 en los cinco años. La incidencia acumulada (IA) fue: 0,923 es decir 92,3% pacientes en 5 años y la densidad de incidencia (DI) fue 0,186 en cinco años es decir 18,6%. El número de ADES en la muestra fue 1.601 con la revisión manual, una media de 4,57 EA/paciente en el total de la muestra. Los indicadores de EA fueron: 457,42 EA/100 altas, y 118,57 EA/1.000 días paciente hospitalizados. Se detectaron 152,47 EA/1.000 dosis de oncológicos administrados. Con la revisión de GTT se hallaron 1.578 EA, una media de 4,50 EA/paciente. Los indicadores de EA fueron: 450,8 EA/100 altas, y 126,64 EA/1.000 días paciente y 141,45 EA/1.000 dosis de medicamentos oncológicos administrados. Los costos facturados con y sin eventos son USD 5.343,75 vs. 15.287,5. Las dos herramientas de detección tienen similar capacidad de detección en cuanto número de EA pero la revisión completa de historia clínica sin gatillos lleva seis veces el tiempo que lleva la herramienta de gatillos. (AU)

Despite the progress it has made in the survival of cancer patients, the appearance of new chemotherapeutic agents and new combinations, these have brought with them numerous adverse effects that can compromise treatment and, consequently, the prognosis of the disease.Objectives: To know the incidence of adverse events associated with chemotherapy (AE), characterize them and analyze their economic implications using two detection tools.Materials and methods: Longitudinal cut incidence study.Results: 350 patients were studied. Mean age: 56.9, median: 43.4, range: 19-85. The number of patients with AD was: 323 in the five years. The cumulative incidence (AI) was: 0.923 that is 92.3% patients in 5 years and the incidence density (DI) was 0.186 in five years that is 18.6%. The number of ADES in the sample was 1,601 with manual review, a mean of 4.57 EA/patient in the total sample. The AE indicators were: 457.42 AE/100 discharges, and 118.57 AE/1,000 hospitalized patient days. 152.47 EA/1,000 doses of oncology administered were detected. With the GTT review, 1,578 AE were found, a mean of 4.50 AE/patient. The AE indicators were: 450.8 AE/100 discharges, and 126.64 AE/1,000 patient days and 141.45 AE/1,000 doses of oncological drugs administered. The costs invoiced with and without events are USD 5,343.75 vs. 15,287.5. The two detection tools have a similar detection capacity in terms of number of AE, but the complete medical history review without triggers takes six times the time that the trigger tool takes.Conclusions: The incidence of adverse cancer events is high, the GTT tool is useful compared to the complete review of medical records to find AE, the costs of hospitalization with events in relation to without events are significantly higher. The most frequent reactions are dermatological, and those that affect the blood system, among others. (AU)

Prevalencia de prescripción potencialmente inapropiada de medicamentos en adultos mayores / Prevalence of potentially inappropriate drug prescription in the elderly

Introducción. Una de las causas prevenibles de los eventos adversos a medicamentos (EAM) en los adultos mayores lo constituye la prescripción inapropiada (PIM), es decir, aquella prescripción donde los riesgos superan los beneficios clínicos. Existen varios instrumentos para medir este problema, los más utilizados son: a) los criterios de Beers; b) los Screening Tool to Older People Potentially inapproriate Prescriptions (STOPP); c) los Screening Tool to Alert Doctors to Right Appropriate treatments (START); y d) el Medication Appropriateness Index(MAI). Este estudio tiene como objetivo evaluar la prevalencia de potenciales PIM en una población de adultos mayores en 3 ámbitos clínicos de un hospital universitario. Material y métodos. Estudio de corte transversal de 300 casos de una muestra aleatoria de los ámbitos: hospitalización (100), ambulatorio (100) y urgencias (100). Todos pacientes de 65 años o más que fueron atendidos en un hospital universitario. Resultados. Se analizaron 1.355 prescripciones de fármacos, encontrándose en pacientes ingresados una PIM de 57,7%; 55%, 26% y 80% según Beers, STOPPP, START y MAI respectivamente. En ambulatorio: 36%, 36,5%, 5% y 32%, mientras que en emergencias 35%, 35%, 6% y 52% con las mismas herramientas; se halló asociación significativa de PIM con polifarmacia con los 3 criterios de PIM. Conclusiones. Los resultados obtenidos son comparables a la literatura mundial (26-80% vs. 11-73,1%), los criterios STOPP-START usados de modo integrado serían mejores estimando el problema de PIM (AU)

Introduction. One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. Material and methods. cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. Results. 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. Conclusions. results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM (AU)

[Prevalence of potentially inappropriate drug prescription in the elderly]. / Prevalencia de prescripción potencialmente inapropiada de medicamentos en adultos mayores.

INTRODUCTION: One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. MATERIAL AND METHODS: cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. RESULTS: 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. CONCLUSIONS: results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM.