Análisis e implementación de un modelo asistencial basado en la integración de un farmacéutico de hospital en un Servicio de Hematología y Hemoterapia / Analysis and implementation of a healthcare model based on the integration of a hospital pharmacist in a Hematology and Hemotherapy Service

Objetivo: Analizar el impacto sanitario y económico, así como evaluar la actividad clínica y asistencial, que supone la integración de un farmacéutico de hospital en un Servicio de Hematología y Hemoterapia. Material y métodos: Se trata de un estudio observacional prospectivo, unicéntrico, realizado en un hospital de tercer nivel desde enero de 2014 hasta febrero de 2019, diseñado para definir las funciones y las actividades clínicas a realizar por un farmacéutico de hospital integrado en un Servicio de Hematología de un hospital de tercer nivel y medir los resultados que se obtienen mediante la adopción de este nuevo modelo asistencial integrado Hematología-Farmacia, basado en la multidisciplinariedad. Resultados: El farmacéutico se integró totalmente en la actividad clínica diaria del equipo multidisciplinar perteneciente al Servicio de Hematología y Hemoterapia, siendo un facilitador del trabajo diario de los profesionales del Servicio de Hematología y un mediador de las necesidades de ambos servicios implicados (Hematología y Farmacia). Esta integración permitió garantizar la seguridad en la administración de tratamientos hematológicos en 9.125 pacientes hematológicos, reducir los errores de medicación en un 95%, detectar y notificar 45 reacciones adversas a medicamentos, diseñar medidas de eficiencia y seguimiento de las mismas en patologías de elevado impacto económico como mieloma múltiple, leucemia linfática crónica, leucemia mieloide crónica y hemofilia, consiguiendo un ahorro de 1.500.000 euros, entre otros resultados. Conclusiones: La integración de un farmacéutico de hospital en un Servicio de Hematología constituye una medida de innovación y eficiencia, mejora la calidad asistencial, garantiza la seguridad, favorece la sostenibilidad del sistema sanitario y facilita la incorporación de innovación. (AU)

Objective: To analyze the health and economic impact and to evaluate the clinical and care activity of the integration of a hospital pharmacist in a Hematology and Hemotherapy Service. Material and methods: This is a prospective, single-centre, observational study conducted in a tertiary hospital from January 2014 to February 2019, designed to define the functions and clinical activities to be performed by a hospital pharmacist integrated into a Hematology and Hemotherapy Service of a tertiary hospital and to measure the results obtained by adopting this new integrated Hematology-Pharmacy care model, based on multidisciplinarity. Results: The pharmacist was fully integrated into the daily clinical activity of the multidisciplinary team belonging to the Hematology and Hemotherapy Service, being a facilitator of the daily work of the professionals of the Hematology Service and a mediator of the needs of both services involved (Hematology and Pharmacy). This integration made it possible to guarantee safety in the administration of hematological treatments in 9,125 hematological patients, to reduce medication errors by 95%, to detect and notify 45 adverse drug reactions, to design efficiency measures and follow-up of these in pathologies with a high economic impact such as multiple myeloma, chronic lymphatic leukemia, chronic myeloid leukemia and hemophilia, achieving savings of 1,500,000 euros, among other results. Conclusions: The integration of a hospital pharmacist in a Hematology and Hemotherapy Service constitutes a measure of innovation and efficiency, improves the quality of care, guarantees safety, favours the sustainability of the health system and facilitates the incorporation of innovation. (AU)

Manejo de altas dosis de metotrexato en un caso de leucemia aguda linfoblástica / Management of high doses of methotrexate in a case of acute lymphoblastic leukemia

Se presenta un caso de un paciente diagnosticado de leucemia aguda linfoblástica Pro-T, que se trata con altas dosis de metotrexato. Se describe el manejo de niveles tóxicos de metotrexato que resulta de la colaboración entre el farmacéutico de hospital y el hematólogo. (AU)

We present a case of a patient diagnosed with acute Pro-T lymphoblastic leukemia, who is treated with high doses of methotrexate. The management of toxic levels of methotrexate resulting from the collaboration between the hospital pharmacist and the hematologist is described. (AU)

Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar / Multidisciplinary Management of the Adverse Effects of Apremilast

En el presente artículo, en base a una revisión de la literatura y su experiencia personal, un equipo multidisciplinar de 14 profesionales sanitarios (incluyendo dermatólogos, reumatólogos, neurólogos, gastroenterólogos, farmacéuticos y enfermeras) ha elaborado una serie de recomendaciones generales y específicas (basadas en la fisiopatología) para el manejo de los efectos adversos secundarios a apremilast que con mayor frecuencia conducen a la suspensión del tratamiento (diarrea, náuseas y cefalea). Se aportan algoritmos sencillos de manejo que incluyen aspectos clínicos de evaluación y sugerencias de tratamiento farmacológico. Los efectos adversos de apremilast pueden ser abordados desde un punto de vista multidisciplinar y la optimización en su manejo pretende proporcionar un beneficio clínico a los pacientes que los sufren

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients

Multidisciplinary Management of the Adverse Effects of Apremilast. / Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar.

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients.

Functionalization of sol-gel coatings with organophosphorus compounds for prosthetic devices.

Sol-gel coatings are proposed as surface treatments for titanium-based materials to promote the osseointegration of prosthetic devices with the host. As precursors of sol-gel synthesis, two silanes were selected: 3-methacryloxypropyltrimethoxy silane and 2 tetramethyl orthosilane. Sol-gel synthesis was functionalized with the addition of two different organophosphorus compounds, namely, tris(trimethylsilyl) phosphite and tris(trimethylsilyl) phosphate. Depending on the organophosphorus compound, phosphorus was incorporated into the sol-gel network by different mechanisms: organophosphate was incorporated following a hydrolysis/polycondensation reaction with the precursors of synthesis (two organopolysiloxanes), whereas organophosphite was introduced into the network through transformation of trivalent phosphorus to pentavalent phosphorus following a Michaelis-Arbuzov reaction and subsequent reaction of hydrolysis/polycondensation. When compared to the control coating, which has good adhesion coating-substrate, only the addition of the organophosphite ensured good adhesion without altering synthesis. The resulting coating modified with organophosphite was subjected to cellular study and the concentration of this compound was varied to reach the highest enhancement of proliferation. It was demonstrated that by increasing the amount of organophosphite cell proliferation increased. Inspection of the surfaces of the coatings revealed that by increasing the quantity of organophosphite, adhesion to the substrate was compromised. Thus, an intermediate quantity of organophosphite was considered the most suitable for application on metallic prosthetic devices.

Dry sliding wear behaviour of ß-type Ti-Nb and Ti-Mo surfaces designed by diffusion treatments for biomedical applications.

The dry sliding wear behaviour of different Ti-Nb and Ti-Mo surfaces was investigated in order to evaluate the role of Nb and Mo ß-stabilizing elements in titanium wear resistance to consider them for biomedical applications. Dry sliding wear tests were performed under unlubricated conditions using a ball-on-plate tribometer (UMT) with reciprocating lineal movement of 1 Hz frequency at different loads (2 and 5 N) and against two counterface materials (alumina and stainless steel) to assess the effect of these parameters on wear. The results indicated an improvement in wear resistance for all the modified Ti surfaces. Metal-on-metal surfaces exhibited higher wear rate than ceramic-on-metal, and higher wear was observed for the more severe conditions. Wear rate values on modified surfaces were between 53% and 96% lower compared to pure Ti tested at 2 N, and up to 79% lower than Ti at 5 N. In both cases the highest wear reduction was observed for Ti-MoNH4Cl surface.

[Boceprevir and telaprevir safety in routine clinical practice]. / Seguridad de boceprevir y telaprevir en la práctica clínica habitual.

PURPOSE: To compare the safety profile of telaprevir (TLV) and boceprevir (BOC) with each other and with those described in clinical trials (CT). MATERIAL AND METHODS: Retrospective multicenter observational study. Variables collected: age, sex, type of patient (naive, nonresponder or recurrent), fibroscan, Hb nadir, neutrophil and platelet count, presence of rash, anorectal discomfort, number of patients treated with erythropoiesis stimulating factors (EPO) and colony stimulating factors granulocyte (G-CSF). RESULTS: BOC vs CT: anemia (56.5% vs. 49%.), Thrombocytopenia (56.5% vs 32%, p = 0.023). neutropenia (17.4% vs. 29.5%). Use of EPO (13% vs 43%;. p = 0.008), pruritus (13% vs. 21.1%), rash (16.1% vs. 8.7%), anorectal discomfort (4.3% vs. 0%, p = 0.0001), dysgeusia (47.8% vs. 37%). TLV vs. CT: anemia (51.2% vs. 32%, p = 0.014), neutropenia (2.3 vs 3.6%), thrombocytopenia (41.9% vs. 27.4%, p = 0.05), pruritus (39.5% vs 47), rash (16.3% vs 55%, P <0.001), anorectal discomfort (39.5% vs 26%), dysgeusia (14% vs. 9.5%). BOC vs TLV: anemia (56.5% vs 51.2%), neutropenia (17.4% vs 2.3%), thrombocytopenia (56.5% vs 41.9%), rash (8.7% vs 16.3%), pruritus (39.5% vs 13%) and anorectal discomfort (4.3% vs 39.5%, P = 0.006), dysgeusia (14% vs 47.8%, P = 0.007), EPO (13% vs. 25.6%). GCSF was used for a patient treated with TLV. CONCLUSIONS: 1. BOC and TLV have shown a worse safety profile for anemia, thrombocytopenia and anorectal discomfort than those described in CT. 2. As in CT, anemia, neutropenia and thrombocytopenia were more common with BOC. Patients treated with TLV experienced more pruritus, rash and anorectal discomfort.

Seguridad de boceprevir y telaprevir en la práctica clínica habitual / Boceprevir and telaprevir safety in routine clinical practice

Objetivo: Comparar el perfil de seguridad telaprevir (TLV) y boceprevir (BOC) entre sí y con lo descrito en ensayos clínicos (EECC).Material y método: Estudio multicéntrico observacional retrospectivo. Variables recogidas: edad, sexo, tipo de paciente (naïve, no respondedor o recidivantes), fibroscan, Hb nadir, recuento de neutrófilos y plaquetas, presencia de exantema, malestar anorrectal, número de pacientes tratados con estimuladores de la eritropoyesis (EPO) y factores estimuladores de colonias de granulocitos (G-CSF).Resultados: BOC vs EECC: anemia (56,5% vs. 49%), trombocitopenia (56,5% vs. 32%; p = 0,023). Neutropenia (17,4% vs. 29,5%).Utilización de EPO (13% vs. 43%; p = 0,008), prurito (13% vs.21,1%), exantema (8,7% vs. 16,1%); molestias anorrectales (4,3%vs. 0%; p = 0,0001), disgeusia (47,8% vs. 37%). TLV vs. EECC: anemia (51,2% vs. 32%; p = 0,014), neutropenia (2,3 vs. 3,6%), trombocitopenia (41,9% vs. 27,4%; p = 0,05), prurito (39,5 vs. 47%),exantema (16,3% vs. 55%; p < 0,001), molestias anorrectales(39,5% vs. 26%). Disgeusia (14% vs. 9,5%). BOC vs. TLV: anemia (56,5% vs. 51,2%), neutropenia (17,4% vs. 2,3%), trombocitopenia (56,5% vs. 41,9%), exantema (8,7% vs. 16,3%), prurito (39,5% vs. 13%) y molestias anorrectales (4,3% vs. 39,5%; p = 0,006), disgeusia (47,8% vs. 14%; p = 0,007) EPO (13% vs.25,6%). G-CSF se utilizó para un paciente tratado con TLV.Conclusiones:1. BOC y TLV han mostrado un perfil de seguridad peor que en los EECC en cuanto a anemia, trombocitopenia y malestar ano-rrectal.2. Al igual que en EECC, anemia, neutropenia y trombocitopenia fueron más frecuentes con BOC. Por otro lado los pacientes tratados con TLV presentaron más prurito, exantema y malestar anorrectal

Purpose: To compare the safety profile of telaprevir (TLV) and boceprevir (BOC) with each other and with those described in clinical trials (CT).Material and methods: Retrospective multicenter observational study. Variables collected: age, sex, type of patient (naive, non responder or recurrent), fibroscan, Hb nadir, neutrophil and platelet count, presence of rash, anorectal discomfort, number of patients treated with erythropoiesis stimulating factors (EPO) and colony stimulating factors granulocyte (G-CSF).Results: BOC vs CT: anemia (56.5% vs. 49%.), Thrombocytopenia(56.5% vs 32%, p = 0.023). neutropenia (17.4% vs. 29.5%). Use of EPO (13% vs 43%;. p = 0.008), pruritus (13% vs. 21.1%), rash(16.1% vs. 8.7%), anorectal discomfort (4.3% vs. 0%, p =0.0001), dysgeusia (47.8% vs. 37%). TLV vs. CT: anemia (51.2%vs. 32%, p = 0.014), neutropenia (2.3 vs 3.6%), thrombocytopenia (41.9% vs. 27.4%, p = 0.05), pruritus (39.5% vs 47), rash(16.3% vs 55%, P <0.001), anorectal discomfort (39.5% vs26%), dysgeusia (14% vs. 9.5%). BOC vs TLV: anemia (56.5% vs51.2%), neutropenia (17.4% vs 2.3%), thrombocytopenia(56.5% vs 41.9%), rash (8.7% vs 16.3%), pruritus (39.5% vs 13%) and anorectal discomfort (4.3% vs 39.5%, P = 0.006), dysgeusia (14% vs 47.8%, P = 0.007), EPO (13% vs. 25.6%). G-CSF was used for a patient treated with TLV.Conclusions:1. BOC and TLV have shown a worse safety profile for anemia, thrombocytopenia and anorectal discomfort than those described in CT.2. As in CT, anemia, neutropenia and thrombocytopenia were more common with BOC. Patients treated with TLV experienced more pruritus, rash and anorectal discomfort

Enhancing in vitro biocompatibility and corrosion protection of organic-inorganic hybrid sol-gel films with nanocrystalline hydroxyapatite.

Application of novel organic-inorganic hybrid sol-gel coatings containing dispersed hydroxyapatite (HAp) particles improves the biocompatibility, normal human osteoblast (NHOst) response in terms of osteoblast viability and adhesion of a Ti6Al4V alloy routinely used in medical implants. The incorporation of HAp particles additionally results in more effective barrier proprieties and improved corrosion protection of the Ti6Al4V alloy through higher degree of cross-linking in the organopolysiloxane matrix and enhanced film thickness.

Triethylphosphite as a network forming agent enhances in vitro biocompatibility and corrosion protection of hybrid organic-inorganic sol-gel coatings for Ti6Al4V alloys.

The biocompatibility and life of metallic implants can be enhanced through improving the biocompatibility and corrosion protection characteristics of the coatings used with these materials. In this study, triethylphosphite (TEP) was used to introduce phosphorus into organic-inorganic hybrid silica based sol-gel coatings prepared using γ-methacryloxypropyltrimethoxysilane and tetramethylorthosilicate. Addition of TEP dramatically increased the rate of intermolecular condensation and resulted in materials showing greater cross-linking. Protein (fibrinogen) uptake, osteoblast in vitro biocompatibility and corrosion resistance was enhanced in coatings containing TEP. Although higher concentrations of phosphorus supported the greatest improvement in biocompatibility, a compromise in the phosphorus concentration used would be required if corrosion resistance was most desirable parameter for optimisation. Films prepared by dip coating on Ti6Al4V alloys from these sols offer a promising alternative to wholly metallic prostheses.

Mejoras en las consultas de pacientes externos tras la implantación de un robot automático de dispensación / Improvement of the outpatient clinics after the implementation of an automated robot for delivery

Objetivos: Describir mejoras en logística, gestión y satisfacción de los pacientes tras la implantación de un robot de dispensación (RAD) en las consultas externas de Farmacia. Material y métodos: Diseño pre-post intervención: implantación de un RAD. El estudio se llevó a cabo en un hospital de tercer nivel. Debido a un cambio de ubicación de las consultas externas, se planificó un nuevo circuito de medicamentos. Se implementaron modificaciones en los programas de farmacia para la integración con el RAD. Se midió el stock inmovilizado, diferencia ente las existencias reales-virtuales para medicamentos antirretrovirales; medidos en porcentaje respecto al total y el índice de rotación de stock. Se compararon encuestas de satisfacción de 2007-2011 tras la realización de distintos cambios en las consultas. Resultados: El circuito de medicamentos así como los cambios informáticos realizados resultaron eficaces para el mantenimiento de existencias de medicamentos. El stock inmovilizado descendió en el periodo de estudio 2.209.935,77€. El índice de rotación descendió de 1,87 a 0,79. El robot ha reducido la espera a menos de 10 minutos en un 90% respecto a las encuestas anteriores. Discusión: La incorporación del RAD a las consultas ha significado mejoras en la logística, en la gestión y en la satisfacción de los pacientes (AU)

Objectives: To discover the improvements in logistics, management and satisfaction of the patients after the implantation of a robot of dispensation (RAD) in the external consultations of Pharmacy. Material and Methods: Pre-post design: implantation of RAD. The study was conducted on a third level hospital. A new circuit of drugs was designed due to a change of location of the external consultations. Modifications on the pharmacy pro grams were implemented for the integration with RAD. The immobilized stock was measured, difference among the real-virtual existences for anti-retroviral drugs; measured as a percentage of the total and the index of rotation of the stock. Satisfaction surveys of 2007-2011 were compared after the realization of the different changes in the consultations. Results: The circuit of drugs as well as the computer changes made were efficient for the maintenance of the stock of drugs. The immobilized stock decreased 2.209.935,77€ during the pe riod of the study. The index of rotation decreased from 1.87 to 0.79. The robot has reduced the waiting to less than 10 minutes in 90% with regard to the previous surveys. Discussion: The incorporation of RAD in the consultations has meant improvements in the logistic, in the management and in (AU)

[Improvement of the outpatient clinics after the implementation of an automated robot for delivery]. / Mejoras en las consultas de pacientes externos tras la implantación de un robot automático de dispensación.

OBJECTIVES: To discover the improvements in logistics, management and satisfaction of the patients after the implantation of a robot of dispensation (RAD) in the external consultations of Pharmacy. MATERIAL AND METHODS: Pre-post design: implantation of RAD. The study was conducted on a third level hospital. A new circuit of drugs was designed due to a change of location of the external consultations. Modifications on the pharmacy pro grams were implemented for the integration with RAD. The immobilized stock was measured, difference among the real-virtual existences for anti-retroviral drugs; measured as a per centage of the total and the index of rotation of the stock. Satisfaction surveys of 2007-2011 were compared after the realization of the different changes in the consultations. RESULTS: The circuit of drugs as well as the computer changes made were efficient for the maintenance of the stock of drugs. The immobilized stock decreased 2.209.935,77€ during the pe riod of the study. The index of rotation decreased from 1.87 to 0.79. The robot has reduced the waiting to less than 10 minutes in 90% with regard to the previous surveys. DISCUSSION: The incorporation of RAD in the consultations has meant improvements in the logistic, in the management and in.

Hospitalización domiciliaria y hospital de día como medidas de mejora de adherencia / Home hospitalization and day hospital as interventions for improving adherency

Paciente con tuberculosis multirresistente (estreptomicina, isoniazida y rifampicina) debido a un incumplimiento reiterado del tratamiento, debido a factores como analfabetismo, pobreza, alcoholismo y razones socioculturales, por lo que se procedió a un ingreso programado de 18 meses para supervisión del tratamiento y vigilancia de la evolución del cuadro clínico. Al alta hospitalaria se realizaron 5 visitas a domicilio dirigidas por la Subdirección Médica, Farmacia y los Servicios Sociales para dispensarle la medicación semanal en un pastillero, verificar el cumplimiento del tratamiento y proporcionar educación sanitaria para evitar la transmisión de la enfermedad. Si durante la realización de estas visitas el farmacéutico consideraba que el paciente no era adherente al tratamiento, la Subdirección Médica ordenaría el ingreso de éste para finalizar el tratamiento tuberculostático indicado por la unidad de infecciosos. Hubo un ingreso dirigido por el Servicio de Farmacia en el Servicio de Respiratorio debido a expectoración hemoptoica autolimitada y tuberculosis pulmonar en proceso cicatricial. Tras una placa de tórax sin índice de cavernas y una baciloscopia y cultivo de micobacterias negativos se continuó con el seguimiento. Desde que el paciente empezó a acudir semanalmente a consultas de farmacia a modo de hospital de día, donde se le realizaba el Test de Adherencia SMAQ, el paciente tomaba la dosis correspondiente al día de la cita delante del farmacéutico y se le dispensaba su tratamiento semanal, siendo adherente con un 95% de cumplimiento terapéutico, evitando el ingreso hospitalario hasta la finalización del tratamiento(AU)

Patient with multidrug-resistant tuberculosis (streptomycin, isoniazid and rifampicin) due to reiterative nonfulfillment of the treatment, owing to factors such as analphabetism, poverty, alcoholism and socio-cultural reasons. A programmed hospital admission was carried out for 18 months to supervise the treatment and to keep under surveillance the evolution of the clinic profile. After the hospital discharge, 5 domiciliary visits were coordinated between the Sub-divisions of Medicine, Pharmacy and Social Services in order to dispense the weekly medication in a pillbox, to verify the fulfilment of the treatment and to give the sanitary education to avoid the transmission of the disease. During domiciliary visits, the pharmacist evaluated the adherence of the patient and, in the case that was not achieved; the Sub-division of Medicine would order hospital admission to conclude the tuberculostatic treatment. The Service of Pharmacy determined the need of admission in the Respiratory Service due to an auto-limited hemoptoic expectoration and pulmonary tuberculosis with cicatrisation process. The treatment was resumed after inspection of a thoracic radiography and negative Mycobacterium culture and baciloscopy. It was observed that since the patient started to visit the Service of Pharmacy as a day hospital, where the SMAQ adherence test was applied, he took his daily drug dose and followed the treatment. He also received his weekly treatment and reached adherence with a 95% of therapeutic fulfilment, avoiding hospital readmission until the end of the treatment(AU)