[Implementation of the Lean Six Sigma in the improvement of the medication dispensing circuit]. / Implementación Lean Six Sigma en la mejora del circuito de dispensación de medicación.

OBJECTIVE: Lean Six Sigma (LSS) methodology is used to increase productivity and to improve performance, by eliminating processes that do not add value to the customer, as well as reducing variability. In recent years, its application in healthcare sector is increasing in order to improve the efficiency of processes. The aim of this study was to evaluate the results obtained in terms of efficiency in the medication dispensing circuit, after application of LSS methodology. MATERIAL AND METHODS: A multidisciplinary team was created in order to analyse and improve the medication dispensing circuit. The main tools used in LSS methodology were the DMAIC cycle (Define, Measure, Analyse, Improve and Control), SIPOC diagram (Suppliers, Inputs, Process, Outputs, and Customers), a root-cause analysis; a survey to determine the "Customer's voice" about the circuit; and the cost of each task in terms of staff time. Two Pilot Nursing Units (Thoracic Surgery and Cardiology) were selected to introduce the improvement actions. The main analysed variables were: urgent medication orders per day, and percentage of medication orders made online. RESULTS: After the application of LSS methodology, a significant reduction was found in urgent medicament orders per day in both nursing units, and a significant improvement in the electronic processing of urgent orders. The performance of medication dispensing circuit was increased from 60% (1.76 sigma) during initial data analysis, to 93% (3 sigma) in Thoracic Surgery, and from 71% (2.11 sigma) to 81% (2.4 sigma) in Cardiology. Six months after the implementation of improvements, the performance values were increased to 94% (3.1 sigma) and 93% (3 sigma), respectively. Estimated cost savings related to staff were 798.2 € (266 € per month) after implementation, ascending to 2, 228.5 € (371.4 € per month) after 6months. CONCLUSION: The use of LSS methodology has improved the performance of medication dispensing circuits, reducing costs in terms of staff time, and obtaining satisfactory results.

Uso, efectividad y seguridad de abiraterona en cáncer de próstata / Usage, effectiveness and safety of abiraterone in prostate cáncer

Fundamento y objetivo: Tras la comercializació de abiraterona, inhibidor de la síntesis de andrógenos, el objetivo del estudio fue analizar el uso, la respuesta y la seguridad de abiraterona en la población de un hospital de tercer nivel. Material y métodos: Se realizó un estudio observacional retrospectivo en el que se incluyeron todos los pacientes que iniciaron tratamiento con abiraterona en un periodo de 21 meses. Se recogieron variables demográficas, diagnósticas, terapéuticas y clínicas. La respuesta se evaluó de acuerdo con la reducción del PSA con respecto al basal. Para evaluar la seguridad se registraron todas las reacciones adversas secundarias al tratamiento. Resultados: Se incluyó un total de 45 pacientes de los que, fueron evaluables con respecto a la efectividad del fármaco el 88,89%. La mediana de PSA basal era de 457,31 (rango 9032-2,81). La reducción de PSA fue ≥ 50%, ≥ 90% y < 30% en 16 (40%), 3 (7,5%) y 20 (50%) respectivamente. Los efectos adversos más comunes de grado 1-2 fueron astenia (35,6%), elevación de las enzimas hepáticas (28,9%), hipopotasemia(13,3%) y retención de fluidos (11,1%),Conclusiones: Abiraterona fue un fármaco bien tolerado que ha presentado actividad en pacientes con cáncer de próstata tratados previamente con taxanos, por lo que se ha postulado como una alternativa en dicha patología

Background and objective: After the marketing of Abiraterone, an androgen synthesis inhibitor, the aim of the study was to analyze its use, response, and safety in the population of a tertiary care level hospital. Materials and methods: A retrospective observational study was carried out including all patients that were started on Abiraterone within a 21-month period. Demographical, diagnostic, therapeutic, and clinical variables were gathered. The response was assessed through the decreased of PSA as compared to baseline values. To assess the safety, all treatment-related adverse events were recorded. Results: A total of 45 patients were included of which 88.89% could be assessed for the drug effectiveness. The median baseline PSA value was 457.31 (range 9032-2.81). PSA decrease was ≥ 50%, ≥ 90% and < 30% in 16 (40%), 3 (7.5%) y 20(50%), respectively. The most common grade 1-2 adverse events were fatigue (35.6%), increased liver enzymes (28.9%), hipokalemia (13.3%) and fluid retention (11.1%). Conclusions: Abiraterone was a well tolerated drug that has shown to be active in prostate cancer patients previously treated with taxans, so it has been postulated as an alternative in this pathology

[Usage, effectiveness and safety of abiraterone in prostate cancer]. / Uso, efectividad y seguridad de abiraterona en cáncer de próstata.

BACKGROUND AND OBJECTIVE: After the marketing of Abiraterone, an androgen synthesis inhibitor, the aim of the study was to analyze its use, response, and safety in the population of a tertiary care level hospital. MATERIALS AND METHODS: A retrospective observational study was carried out including all patients that were started on Abiraterone within a 21-month period. Demographical, diagnostic, therapeutic, and clinical variables were gathered. The response was assessed through the decreased of PSA as compared to baseline values. To assess the safety, all treatment-related adverse events were recorded. RESULTS: A total of 45 patients were included of which 88.89% could be assessed for the drug effectiveness. The median baseline PSA value was 457.31 (range 9032-2.81). PSA decrease was ≥ 50%, ≥ 90% and < 30% in 16 (40%), 3 (7.5%) y 20 (50%), respectively. The most common grade 1-2 adverse events were fatigue (35.6%), increased liver enzymes (28.9%), hipokalemia (13.3%) and fluid retention (11.1%). CONCLUSIONS: Abiraterone was a well tolerated drug that has shown to be active in prostate cancer patients previously treated with taxans, so it has been postulated as an alternative in this pathology.

Fundamento y objetivo: Tras la comercialización de abiraterona, inhibidor de la síntesis de andrógenos, el objetivo del estudio fue analizar el uso, la respuesta y la seguridad de abiraterona en la población de un hospital de tercer nivel. Material y métodos: Se realizó un estudio observacional retrospectivo en el que se incluyeron todos los pacientes que iniciaron tratamiento con abiraterona en un periodo de 21 meses. Se recogieron variables demográficas, diagnósticas, terapéuticas y clínicas. La respuesta se evaluó de acuerdo con la reducción del PSA con respecto al basal. Para evaluar la seguridad se registraron todas las reacciones adversas secundarias al tratamiento. Resultados: Se incluyó un total de 45 pacientes de los que, fueron evaluables con respecto a la efectividad del fármaco el 88,89%. La mediana de PSA basal era de 457,31 (rango 9032- 2,81). La reducción de PSA fue ≥50%, ≥90% y.

[Role of new biological therapy in psoriasis treatment]. / Papel de los nuevos tratamientos biológicos en la psoriasis.

Psoriasis is an inflammatory disease mediated by immune system T cells. The use of current systemic immunosuppressive therapies is limited by an inability to maintain disease remission safely knowledge on. Advances in recombinant DNA technology and the increase in knowledge on psoriasis immunopathology knowledge have led to the development of numerous biologic agents for the treatment of the disease. In this review the mechanisms of action for these new agents, as well as their safety profiles and efficacy data have been analyzed.

[Use of maintenance fluid therapy in surgery]. / Utilizacíon de fluidterapia de maintenimiento en cirurgía.

OBJECTIVE: To analyze the use of various maintenance fluid therapy regimens, as well as their adequacy to hospital recommendations, in adult in-patients admitted to a general surgery ward during 1 year. MATERIAL AND METHODS: Data on solution type and volume, fluid therapy regimen, and duration in days were retrospectively collected for each administered solution from computerized medical orders within the Unit-Dose Drug Distribution Area. A database was developed including the composition of available solutions within our hospital, so that electrolytes, glucose and volumes administered may be calculated. RESULTS: Out of 354 patients undergoing fluid therapy 125 were selected to receive maintenance regimens. Fluid therapy was administered for more than 5 days in 31% of patients. The most commonly supplied fluids were 5% glucose (43%) and 0.9% saline + 1500 mL of 5% glucose + 60 mEq potassium chloride (CIK). Amongst patients receiving the recommended volume/day (84%) 50% received sodium and potassium more than twice as much the recommended amount, and 70% received glucose amounts not covering minimal daily requirements. Potassium was administered according to recommendations in 85% of patients. CONCLUSIONS: There is an excessive use of 0.9% saline and 5% glucose to the detriment of 1/3 glucosaline and 10% glucose, which translates as an excessive daily sodium and defective daily glucose provision. In our hospital we have recommended maintenance fluid therapy regimens, as well as fluids more appropriate for postoperative electrolyte replacement; however, their use is still deficient.

Compatibilidad de fármacos con nutrición parenteral / Compatibility of parenteral nutrition with drugs

La bibliografía sobre compatibilidad de fármacos con nutrición parenteral (NP) es extensa. Para facilitar el acceso a esta información hemos realizado una revisión de todos los artículos relacionados y hemos confeccionado una tabla donde se especifican la concentración del fármaco, la concentración de aminoácidos, glucosa y lípidos que tiene la nutrición parenteral en estudio, si el fármaco se introdujo dentro de la bolsa de NP o se administró en Y con la NP, la temperatura de estudio, el tiempo durante el cual se consideró estable la mezcla, comentarios y referencias bibliográficas. (AU)

[Liver complications associated with short-term parenteral nutrition in children]. / Complicaciones hepáticas asociadas a nutrición parenteral de corta duración en niños.

OBJECTIVE: Liver dysfunction (LD) with abnormalities in biochemical liver function tests is the most common metabolic complication of parenteral nutrition (PN). The aim of this study was to estimate the prevalence of LD in children receiving short-term PN and to identify risk factors. PATIENTS AND METHODS: Data were gathered retrospectively during a 2-year period. Ninety-four children older than 28 days received PN (mean age 5.4 +/- 5.1 years). PN related LD was defined as when serum levels of one or more of the following liver function tests were increased: ALT > or = 80 IU/L, GGT > or = 120 IU/L and total bilirubin > or = 1.8 mumol/L. Children with previous liver disease were excluded (n = 17), as well as those with incomplete data (n = 16). RESULTS: LD was present in 33 children (54%). The incidence rate was 5.8 cases/100 patient days of PN. It started 9.8 +/- 6.9 days after beginning PN. The nadir appeared during the second week of PN. The following variables did not appear to significantly influence the presence of PN: age, gender, nutritional status, PN caloric load or composition and underlying disease. Length of PN (9.6 +/- 4.4 vs 19.5 +/- 10.5 days; p < 0.001) and presence of sepsis (21% vs 55%, p = 0.014) were the only variables associated with LD. It was not necessary to discontinue PN because of LD in any case. CONCLUSIONS: Early LD is present in more than 50% of our children on PN. In preventing LD we should try to avoid infection and to reduce the time on PN.