Conciliación e información de medicación al alta hospitalaria en un servicio de urología / Conciliation and medication information at the moment of hospital discharge in a service of urology

Analizar los resultados de un programa de conciliación e información de medicación al alta hospitalaria en un servicio de urología. Material y Método: Fueron incluidos los pacientes ingresados en el servicio de urología durante 2009 con mayor complejidad en su tratamiento domiciliario. Éste fue registrado, confirmándose previamente mediante una entrevista con el paciente la adherencia al mismo, así como problemas relacionados con la medicación habitual (PRMs). A partir de la epicrisis, se concilió la medicación prescrita con el tratamiento ambulatorio, resolviendo las discrepancias con el facultativo responsable. Por último, se entregó al paciente un cronopictograma con el listado completo de su medicación a partir del episodio asistencial y recomendaciones sobre su tratamiento con la explicación verbal del mismo. Realizamos una encuesta de satisfacción a los facultativos para conocer el conocimiento del programa y su valoración. Resultados: Se seleccionaron 260 pacientes, de los cuales en 102 (39 por ciento) se detectaron PRMs. Las discrepancias más frecuentes fueron: prescripción incompleta (28 por ciento), administración inadecuada (22 por ciento), medicamento no indicado (18 por ciento) y duplicidad (16 por ciento). Los PRM’s se clasificaron en orden a la severidad, de las 102 discrepancias: el 68 por ciento no habrían causado daño al paciente y el 32 por ciento habría requerido monitorización. La valoración global del programa fue muy positiva para los facultativos. Conclusión: La conciliación de medicación reduce los PRM’s, sobre todo en las transiciones asistenciales de los pacientes. Creemos que esta actividad asistencial debería realizarse de manera habitual en los hospitales, para aumentar la seguridad de los pacientes, en el marco de un sistema de reducción de riesgos para la salud y mejora de la calidad asistencial.

To analyze the results of a medication reconciliation and drug information program at discharge, in an urology department. Materials and Methods: Patients with more complexity in their home treatment, admitted in this facility during 2009, were included in the study. Preadmission regimens were recorded and the patients were asked about drug-related problems (DRP) and drug adherence. On the day of discharge, prescribed medication was reconciled with the outpatient treatment, resolving discrepancies with the prescribers. Finally, the patients were given a complete list of their medications and oral recommendations. We conducted a survey with physicians to enquire about their reconciliation program knowledge and their assessment. Results: 260 patients were selected, of which in 102 (42 percent) DRP were detected. The most frequent discrepancies were: incomplete prescription (28 percent), incorrect administration (22 percent), inappropriate medication (18 percent) and therapeutic duplication (16 percent ). The DRP were classified according to their severity, of the 102 discrepancies, 68 percent would not have caused harm to the patient and 32 percent would require monitoring. On the survey, about the overall evaluation of the program, it was highly regarded for the most of the physicians. Conclusion: Medication reconciliation reduces the DRP, especially at transition in healthcare of patients. We believe that activity should be carried out routinely in hospitals, to increase the patients safety, as part of a system to reduce health risks and improving the quality of care.

Diastereoselective synthesis of 2-aryl-3-vinyl-2,3-dihydrobenzo[b]furans through a Sakurai reaction: a mechanistic proposal.

The condensation of 2,3-dihydrobenzoxasilepins with aromatic aldehydes in the presence of boron trifluoride to form 2,3-dihydrobenzofurans shows a level of diastereoselection which is a function of the electronic nature of the aldehyde and the polarity of the solvent. The study of the mechanism of the reaction demonstrated that it proceeds through a ring-opened allylfluorosilane, which is stable enough to be isolated and characterized.

Silver-catalyzed asymmetric synthesis of 2,3-dihydrobenzofurans: a new chiral synthesis of pterocarpans.

2,3-Dihydrobenzofurans can be diastereoselectively prepared by condensation of aromatic aldehydes with 2,3-dihydrobenzoxasilepines under the catalysis of Ag(I) complexes, and in the presence of a source of fluoride ion. The application of this strategy by using chiral catalysts leads to a new enantioselective total synthesis of natural cis-pterocarpans and their trans isomers. Through this method, the first enantioselective total synthesis of the antifungal agent (-)-pterocarpin was achieved. In addition, a new entry into the heteroaromatic system of 2,5-dihydrobenzoxepine is also presented.