The impact of medication reconciliation program at admission in an internal medicine department.

BACKGROUND: Medication reconciliation process has proved to be an effective tool to improve the safety of drug use. The objective of this study was to assess the impact of an intervention aimed to decrease unintended discrepancies between patient's usual treatment and medications prescribed on admission to the Department of Internal Medicine. METHODS: A quasi-experimental study was carried out from June 2009 to May 2010, analyzing discrepancies between home medication and drugs prescribed in a tertiary care hospital, before (first phase) and after (second phase) an electronic reconciliation tool was introduced at admission. This tool connected patients' usual medication with the electronic prescription program. The research team was made up of two hospital pharmacists, two nurses and three physicians from the Internal and Preventive Medicine Departments. RESULTS: During the two phases of the study, 162 patients were included with a total of 1,959 medicines reconciled. The incidence of unintended discrepancies decreased from 3.5% to 1.8% after the intervention (p value 0.03). The proportion of patients with at least one unintended discrepancy was 23.7% in the first phase and 14.6% in the second phase (p value 0.20). Omission was the most common unintended discrepancy. Asthmatic patients showed 6 times higher risk of being affected by an unintended discrepancy (OR 6.37, 95%CI 1.6-25.5; p value 0.009). CONCLUSIONS: Implementing a computerized tool integrated into the electronic prescribing program could be very helpful to develop a medication reconciliation process. It is essential to involve all hospital staff in this process.

Hemangioendotelioma epiteloide pulmonar / Pulmonary Epithelioid Hemangioendothelioma

El hemangioendotelioma epitelioide es una enfermedad de difícil diagnóstico, descrita como un tumor multicéntrico y de escasa actividad metastásica, que aparece con mayor frecuencia en mujeres jóvenes asintomáticas y como un hallazgo casual. El patrón radiológico es heterogéneo. El dato más importante para su diagnóstico es la confirmación histológica de cuerpos de Weibel-Palade, o bien la inmunohistoquímica, con marcadores tumorales específicos como el factor VIII y CD34. Presentamos el caso de una mujer de 73 años en quien de forma casual se detectaron, en una imagen radiológica, nódulos pulmonares múltiples que posteriormente se diagnosticaron como esta entidad tumoral(AU)

Epithelioid hemangioendothelioma is a multifocal tumor that rarely metastasizes. It is difficult to diagnose and is most often an incidental finding in young asymptomatic women. It has a heterogeneous radiologic pattern. The most important diagnostic information is histologic confirmation of Weibel-Palade bodies or immunohistochemistry based on specific tumor markers such as factor VIII and CD34. We report the case of a 73-year-old woman in whom multiple pulmonary nodules detected by chance in a radiograph were subsequently diagnosed as epithelioid hemangioendothelioma(AU)

[Pulmonary epithelioid hemangioendothelioma]. / Hemangioendotelioma epiteloide pulmonar.

Epithelioid hemangioendothelioma is a multifocal tumor that rarely metastasizes. It is difficult to diagnose and is most often an incidental finding in young asymptomatic women. It has a heterogeneous radiologic pattern. The most important diagnostic information is histologic confirmation of Weibel-Palade bodies or immunohistochemistry based on specific tumor markers such as factor VIII and CD34. We report the case of a 73-year-old woman in whom multiple pulmonary nodules detected by chance in a radiograph were subsequently diagnosed as epithelioid hemangioendothelioma.