Incidence of adverse drug reactions in COVID-19 hospitalised patients through the minimum basic data set / Incidencia de reacciones adversas a medicamentos en pacientes hospitalizados por COVID-19 a través del conjunto mínimo básico de datos

Background: At the beginning of the COVID-19 pandemic many drugs were used with an uncertain benefit/risk profile that needed to be evaluated. The goal of this study was to analyse the incidence of adverse drug reactions (ADRs) and describe the drugs used in COVID-19 hospitalised patients at the beginning of the COVID-19 pandemic through the minimum basic data set (MBDS). Methods: Retrospective observational study that included hospitalised patients with COVID-19 at our centre between March and May 2020 who had ADRs coded in discharge/death medical reports according to the International Classification of Diseases (ICD-10). Those patients with ADRs ascribed to COVID therapy were selected and the causal relationship was evaluated using the Naranjo algorithm. Descriptive statistical analysis was used. Results: We identified 141 ADRs in 110 cases of hospitalisation due to COVID-19 that entailed an incidence of 9.66% (141/1459), CI95% 8.25-11.29. From the ADRs analysed, 60.3% (85/141) were ascribed to COVID therapy. Lopinavir/ritonavir represented 38.8% (33/85) of ADRs, glucocorticoids 23.5% (20/85) and hydroxychloroquine 9.4% (8/85). Out of the ADRs, 31.8% (27/85) were gastrointestinal disorders (probable lopinavir/ritonavir), 27.0% (23/85) blood glucose disorders (probable glucocorticoid) and 17.6% (15/85) hypertransaminasaemia (probable azithromycin, possible lopinavir/ritonavir, possible hydroxychloroquine, possible interferon). Regarding intensity, 64.7% (55/85) were mild cases, 29.4% (25/85) moderate and 5.9% (5/85) severe. The percentage of ADRs that did not require intervention were 24.7% (21/85), 32.9% (28/85) required pharmacological treatment, 40.0% (34/85) suspension of the drug, 1.2% (1/85) close monitoring and 1.2% (1/85) dose reduction. Conclusions: The incidence of ADR in COVID population that required admission at the beginning of the pandemic seems to be higher than in the general population. The MBDS proves to be a useful tool to trace ADRs. (AU)

Introducción: La llegada de la pandemia de COVID-19 supuso la utilización de muchos fármacos con un perfil de riesgo/beneficio incierto que debe ser evaluado. El objetivo de este estudio fue analizar la incidencia de reacciones adversas a medicamentos (RAM) y describir los medicamentos utilizados en pacientes hospitalizados por COVID-19 al comienzo de la pandemia a través del conjunto mínimo básico de datos (CMBD). Materiales y métodos: Estudio observacional retrospectivo que incluyó pacientes hospitalizados por COVID-19 en nuestro centro entre marzo y mayo de 2020 que presentaban RAM codificadas en los informes médicos de alta/exitus según la Clasificación Internacional de Enfermedades (CIE-10). Se seleccionaron los pacientes con RAM atribuidas a la terapia COVID-19 y se evaluó la relación causal mediante el algoritmo de Naranjo. Se realizó un análisis estadístico descriptivo. Resultados: Identificamos 141 RAM en 110 casos de hospitalización por COVID-19 lo que supone una incidencia del 9,66% (141/1459), IC95% 8,25-11,29. De las RAM analizadas el 60,3% (85/141) se atribuyeron a la terapia COVID. Lopinavir/ritonavir representó el 38,8% (33/85) de las RAM, los glucocorticoides el 23,5% (20/85) y la hidroxicloroquina el 9,4% (8/85). De todas las RAM, el 31,8% (27/85) fueron trastornos gastrointestinales (probable lopinavir /ritonavir), el 27,0% (23/85) trastornos de la glucemia (probable glucocorticoide) y el 17,6% (15/85) hipertransaminasemia (probable azitromicina, posible lopinavir /ritonavir, posible hidroxicloroquina, posible interferón). En cuanto a la intensidad, el 64,7% (55/85) de las RAM fueron casos leves, el 29,4% (25/85) moderados y el 5,9% (5/85) graves. El porcentaje de RAM que no requirió intervención fue 24,7% (21/85), 32,9% (28/85) requirió tratamiento farmacológico, 40,0% (34/85) suspensión del fármaco, 1,2% (1/85) seguimiento estrecho y 1,2% (1/85) reducción de dosis... (AU)

Real-life analysis on safety and efficacy of asciminib for ponatinib pretreated patients with chronic myeloid leukemia.

Failure of second-generation tyrosine kinase inhibitors (2GTKI) is a challenging situation in patients with chronic myeloid leukemia (CML). Asciminib, recently approved by the US Federal Drug Administration, has demonstrated in clinical trials a good efficacy and safety profile after failure of 2GTKI. However, no study has specifically addressed response rates to asciminib in ponatinib pretreated patients (PPT). Here, we present data on responses to asciminib from 52 patients in clinical practice, 20 of them (38%) with prior ponatinib exposure. We analyzed retrospectively responses and toxicities under asciminib and compared results between PPT and non-PPT patients.After a median follow-up of 30 months, 34 patients (65%) switched to asciminib due to intolerance and 18 (35%) due to resistance to prior TKIs. Forty-six patients (88%) had received at least 3 prior TKIs. Regarding responses, complete cytogenetic response was achieved or maintained in 74% and 53% for non-PPT and PPT patients, respectively. Deeper responses such as major molecular response and molecular response 4.5 were achieved in 65% and 19% in non-PPT versus 32% and 11% in PPT, respectively. Two patients (4%) harbored the T315I mutation, both PPT.In terms of toxicities, non-PPT displayed 22% grade 3-4 TEAE versus 20% in PPT. Four patients (20% of PPT) suffered from cross-intolerance with asciminib as they did under ponatinib.Our data supports asciminib as a promising alternative in resistant and intolerant non-PPT patients, as well as in intolerant PPT patients; the resistant PPT subset remains as a challenging group in need of further therapeutic options.

Manejo del angiodema inducido por inhibidores de la enzima convertidora de angiotensina con icatibant / Management of angiotensin-converting enzyme inhibitors-related angioedema with icatibant

Objetivo: Evaluar la efectividad de icatibant en el tratamiento del angioedema inducido por IECA (AII), en un centro sin protocolización previa del manejo.Método: Estudio observacional retrospectivo y descriptivo. Se incluyeron pacientes diagnosticados de AII y tratados con icatibant 30 mg entre mayo 2015-diciembre 2017. Las variables de resultado principal y secundaria fueron: tiempo hasta resolución completa y tiempo hasta primera mejoría; respectivamente.Resultados: Cinco pacientes, mediana de edad 76 años (46-81); cuatro mujeres y un varón. Todos caucásicos. Medianas de tiempo hasta resolución completa y hasta primera mejoría: 23 horas (IQR 20,0-25,0) y 3 horas (IQR 3,0-6,0); respectivamente.Conclusiones. El inicio temprano del tratamiento anti-bradicinérgico puede resultar clave para la evolución del cuadro. Para alcanzar la máxima efectividad, se reduzcan las morbilidades asociadas, los ingresos en UCI y el tiempo de estancia hospitalaria, resulta primordial la elaboración de protocolos locales que tengan en cuenta las particularidades de cada centro. (AU)

Objetive: To assess the effectiveness of icatibant in the management of angiotensin-converting enzyme inhibitor-induced angioedema (AII) in a hospital without a treatment guidance.Methods: Observational, retrospective and descriptive study. All patients diagnossed with AII and treated with icatibant 30 mg between May 2015-December 2017 were included. The primary and secondary end-points were: time to total resolution and time to first improvement; respectively.Results: Five patients, median age 76 years (46-81). Four women and a man. All of them Caucasian. Median time to total resolution and to first improvement: 23 hours (IQR 20.0-25.0) and 3 hours (IQR 3.0-6.0); respectively.Conclusion: The early start with the anti-bradicinergic therapy may be key to the AII evolution. To achieve the maximum effectiveness and to get reduced the associated morbidity, the ICU admission and the time to discharge, the development of local protocols considering the particularities of each center is highly necessary. (AU)

Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy.

Treatment outcome in older patients with acute promyelocytic leukemia (APL) is lower compared with younger patients, mainly because of a higher induction death rate and postremission non-relapse mortality (NRM). This prompted us to design a risk- and age-adapted protocol (Programa Español de Tratamientos en Hematología (PETHEMA)/HOVON LPA2005), with dose reduction of consolidation chemotherapy. Patients aged ⩾60 years reported to the PETHEMA registry and were treated with all-trans retinoic acid (ATRA) plus anthracycline-based regimens according to three consecutive PETHEMA trials that were included. We compared the long-term outcomes of the LPA2005 trial with the preceding PETHEMA trials using non-age-adapted schedules (LPA96&LPA99). From 1996 to 2012, 389 older patients were registered, of whom 268 patients (69%) were eligible. Causes of ineligibility were secondary APL (19%), and unfit for chemotherapy (11%). Median age was 67 years, without relevant differences between LPA2005 and LPA96&LPA99 cohorts. Overall, 216 patients (81%) achieved complete remission with no differences between trials. The 5-year NRM, cumulative incidence of relapse, disease-free survival and overall survival in the LPA2005 vs the LPA96&99 were 5 vs 18% (P=0.15), 7 vs 12% (P=0.23), 87 vs 69% (P=0.04) and 74 vs 60% (P=0.06). A less intensive front-line regimen with ATRA and anthracycline monochemotherapy resulted in improved outcomes in older APL patients.

Comparison of the traditional pharmaceutical validation method versus an assisted pharmaceutical validation in hospitalized patients / Comparación entre el método de validación farmacéutica tradicional versus validación farmacéutica asistida en pacientes hospitalizados

OBJECTIVE: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. METHOD: The automated program, ALTOMEDICAMENTOS(R) version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. RESULTS: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. CONCLUSIONS: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals

OBJETIVO: Analizar las intervenciones farmacéuticas realizadas con el apoyo de un sistema automático de validación de tratamientos vs. el método tradicional sin apoyo informático. MÉTODOS: El programa automatizado, ALTOMEDICAMENTOS(R) version 0, cuenta con 925.052 celdas con información de aproximadamente 20.000 medicamentos, analizando dosis, vías de administración, días de tratamiento, dosificación en insuficiencia renal y hepática, control de interacciones, de medicamentos semejantes y de medicamentos por vía enteral. Durante ocho días distribuidos en cuatro hospitales diferentes (alta complejidad con más de 1.000 camas, intermedio de 400 camas, geriátrico y monográfico), los mismos pacientes y tratamientos se analizaron mediante los dos sistemas. RESULTADOS: Se han analizado 3.490 pacientes diferentes con 42.155 tratamientos. Por el sistema tradicional se han realizado 238 intervenciones (0,56% intervenciones/posibles intervenciones) vs. 580 (1,38%) con el automatizado. Las intervenciones farmacéuticas muy significativas fueron 0,14 vs. 0,46%, las significativas 0,38 vs. 0,90%, las no significativas 0,05 vs. 0,01%. Las intervenciones fueron del 1,85% al utilizar los dos sistemas vs. 0.56% usando solo el sistema tradicional. El sistema tradicional detectó el 30,5% de las posibles intervenciones, sin embargo con el sistema automático se detectaron el 84% de dichas intervenciones. CONCLUSIONES: La automatización multiplica entre 2,43 a 3,64 veces las intervenciones farmacéuticas. En base a los resultados de este estudio el sistema tradicional de validación debería ser modificado, apoyándose en sistemas automatizados. El programa automático funciona en diferentes hospitales

Comparison of the traditional pharmaceutical validation method versus an assisted pharmaceutical validation in hospitalized patients.

OBJECTIVE: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. METHOD: The automated program, ALTOMEDICAMENTOS® version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. RESULTS: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. CONCLUSIONS: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals.

Objetivo: Analizar las intervenciones farmacéuticas realizadas con el apoyo de un sistema automático de validación de tratamientos vs. el método tradicional sin apoyo informático. Metodos: El programa automatizado, ALTOMEDICAMENTOS ® version 0, cuenta con 925.052 celdas con información de aproximadamente 20.000 medicamentos, analizando dosis, vías de administración, días de tratamiento, dosificación en insuficiencia renal y hepática, control de interacciones, de medicamentos semejantes y de medicamentos por vía enteral. Durante ocho días distribuidos en cuatro hospitales diferentes (alta complejidad con más de 1.000 camas, intermedio de 400 camas, geriátrico y monográfico), los mismos pacientes y tratamientos se analizaron mediante los dos sistemas. Resultados: Se han analizado 3.490 pacientes diferentes con 42.155 tratamientos. Por el sistema tradicional se han realizado 238 intervenciones (0,56% intervenciones/posibles intervenciones) vs. 580 (1,38%) con el automatizado. Las intervenciones farmacéuticas muy significativas fueron 0,14 vs. 0,46%, las significativas 0,38 vs. 0,90%, las no significativas 0,05 vs. 0,01%. Las intervenciones fueron del 1,85% al utilizar los dos sistemas vs. 0.56% usando solo el sistema tradicional. El sistema tradicional detectó el 30,5% de las posibles intervenciones, sin embargo con el sistema automático se detectaron el 84% de dichas intervenciones. Conclusiones: La automatización multiplica entre 2,43 a 3,64 veces las intervenciones farmacéuticas. En base a los resultados de este estudio el sistema tradicional de validación debería ser modificado, apoyándose en sistemas automatizados. El programa automático funciona en diferentes hospitales.

Oral formulation of pyridoxine for the treatment of pyridoxinedependent epilepsy in a paediatric patient / Elaboración de una fórmula magistral de Piridoxina para el tratamiento de la epilepsia dependiente de piridoxina en un paciente pediátrico

No disponible

Current opinion and consensus statement regarding the diagnosis, prognosis, and treatment of patients with essential thrombocythemia: a survey of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN) using the Delphi method.

The current consensus on the diagnosis, prognosis, and treatment of essential thrombocythemia (ET) is based on experts' recommendations. However, several aspects of the diagnosis of, prognosis of, and therapy for ET are still controversial. The Delphi method was employed with an expert panel of members of the Spanish Group of Ph-negative Myeloproliferative Neoplasms in order to identify the degree of agreement on the diagnosis, prognosis, and treatment of ET. Nine leading experts selected a total of 41 clinical hematologists with well-known expertise in ET. An electronic questionnaire was used to collect the questions rated in a four-step scale. The questions were grouped into four blocks: diagnosis, risk stratification, goals of therapy, and treatment strategy. After the first round consisting of 80 questions, a second round including 14 additional questions focused on the recommendations advocated by experts of the European LeukemiaNet in 2011 was analyzed. The median and mean values for the first and second rounds were calculated. A summary of the conclusions considered as the most representative of each block of questions is presented. The Delphi method is a powerful instrument to address the current approaches and controversies surrounding ET.

Programa de conciliación entre neumología y farmacia como herramienta en la atención al paciente / No disponible

Introducción: La conciliación de la medicación (CM) es el proceso que compara el tratamiento farmacológico previo del paciente con el prescrito tras una transición asistencial. En el ámbito hospitalario, es una estrategia que permite minimizar errores de medicación. Nuestro objetivo es analizar el impacto de la implantación de un circuito de CM entre neumología y farmacia al ingreso y al alta. Pacientes y métodos: Se incluyeron pacientes polimedicados ingresados en neumología entre mayo-2012 y diciembre-2013. Se evaluaron: número de discrepancias al ingreso y alta, tipos de discrepancias no justificadas, gravedad, grado de aceptación del neumólogo, número de fármacos. Resultados: Se conciliaron al alta 507 pacientes de 818 altas (61,8%). En 2012 se conciliaron al alta 134 pacientes, detectándose 134 discrepancias en 63 pacientes (47%), con una media de 2,12 discrepancias/paciente. Se entregaron 161 medicamentos de uso limitado. En 2013 se conciliaron al ingreso 318 pacientes. Se detectaron 226 discrepancias en 130 pacientes (40,9%). Se conciliaron al alta 373 pacientes de 554 altas (67,32%), detectándose 139 discrepancias en 96 pacientes (25,7%) con una media de 1,4 discrepancias/paciente. Se entregaron 520 medicamentos de uso limitado. El análisis comparativo al alta entre mayo-diciembre 2012/2013, mostró un aumento en el número de pacientes conciliados (50,8% vs 62,9%) y disminución significativa del número de pacientes con discrepancias del 47% al 22,4% (p=0,001). Conclusiones: El descenso en el número de discrepancias por paciente demuestra que la CM es una eficaz herramienta al ingreso y al alta, obteniéndose con la misma una racionalización del uso de fármacos. La perspectiva futura es fomentar la colaboración atención primaria-especializada. Sería necesario realizar estudios para evaluar el impacto sobre los reingresos

Introduction: Medication conciliation (MC) is the process of comparing the previous pharmaceutical treatment of the patient with the prescribed treatment after transitional medical assistance. It´s a strategy to minimize medicational errors within the hospital.Our goal is to analyze the impact of the implementation of a circuit of MC between pulmonology and pharmacy at admission and discharge. Methods: Polymedicated patients that were hospitalized in pulmonology between May 2012 and December 2013 were included. There were evaluated: number of discrepancies at admission and discharge, different types of not justified discrepancies, severity, acceptability of the pulmonologist and number of drugs. Results: There were 818 patients admited, 507 of which were conciliated at time of discharge (61.8%). In 2012, 134 patients were conciliated at the time of discharge detecting 134 discrepancies in 63 patients (47%), with an average of 2.12 discrepancies/patient. 161 drugs were distributed for limited use. In 2013, 318 patients were conciliated at the time of admission. There were 226 discrepancies detected in 130 patients (40.9%). At the time of discharge 373 patients were conciliated from 554 patients (67.32%), 139 discrepancies detected in 96 patients (25.7%) with a mean of 1.4 discrepancies/patient. 520 drugs were distributed for limited use. The comparative analysis of admissions between May 2012 and December 2013 showed an increase in the number of conciliated patients (50.8% and 62.9%) and a significant decrease in the number of patients with discrepancies of 47% to 22.4% (p=0,001). Conclusions: The decrease in the number of discrepancies per patient demonstrates that MC is an effective tool at admission and discharge, obtaining there in a rational use of drugs. The future vision is to foster the collaboration between primary and specialized care. Further studies would be necessary to evaluate the impact on readmissions

Intervención farmacéutica en la adherencia al tratamiento de pacientes con enfermedad renal crónica / Pharmaceutical intervention on the therapeutic adherence in patients with chronic renal disease

Objetivos. Evaluar el cumplimiento terapéutico global en pacientes con enfermedad renal crónica (ERC) estadio 3-5, y determinar si la intervención farmacéutica mejora el cumplimiento terapéutico. Material y métodos. Estudio prospectivo no controlado de intervención tipo antes y después (julio 2008-marzo 2009), realizado en la Unidad de Atención Farmacéutica. Pacientes mayores de 65 años con ERC 3-5, polimedicados y en tratamiento con eritropoyetina. Se utilizó el programa Infowin® para ofrecer información escrita a los pacientes, quienes firmaron consentimiento informado. Para valorar el cumplimiento terapéutico se aplicaron los cuestionarios Haynes-Sackett y Morisky-Green. Resultados. De 103 pacientes candidatos, se propuso participar a 94; aceptaron 53 (56,4%); mujeres, 60,4%; media de edad, 76,8±6,9 años. Causas de exclusión: negación a participar (19,5%); el paciente o el cuidador habitual no asistieron (70,7%); paciente institucionalizado (9,8%). Número medio de fármacos/paciente: 10,8±2,97. El 88,7% no presentó dificultades en tomar la medicación (Haynes-Sackett) y el 73,6% se consideró cumplidor (Morisky-Green). Al relacionar estos dos métodos, se objetivó diferencia entre ambos (p=0,036). Los pacientes con dificultad en tomar la medicación fueron menos cumplidores en un 45,6%. Se realizó por segunda vez el cuestionario Morisky-Green al 78,6% de los incumplidores, quienes presentaron un 45,5% más de cumplimiento, aumentándose el cumplimiento global a un 87,8% (p=0,00003). Se detectaron 52 problemas relacionados con la medicación (PRM). Conclusiones. El cumplimiento inicial de los pacientes con ERC 3-5 se considera notable. No obstante, tras la intervención farmacéutica, se observa una mejora en la adherencia a los tratamientos, con resultados estadísticamente significativos(AU)

Objectives. To assess the therapeutic adherence in patients with stage 3-5 chronic renal disease (CRD), and evaluate whether pharmaceutical intervention improves medication adherence. Material and methods. A prospective uncontrolled before-after study (July 2008-March 2009) was carried out in the Pharmaceutical Care Unit of a tertiary hospital. Polymedicated patients >65years with stage 3-5 CRD, and on treatment with erythropoietin. Infowin® program was used to provide written information during the interviews with patients, who signed the informed consent. The Haynes-Sackett and Morisky-Green questionnaires were used to assess the therapeutic adherence. Results. Of a total of 103 candidates, we asked 94 patients to participate, of whom 53 agreed; women 60.4%, mean age: 76.8±6.9years. Exclusion criteria: refusal to participate (19.5%), non-appearance of patient or usual caregiver (70.7%), andinstitutionalised patients (9.8%). Average number of drugs per patient: 10.8±2.97. A total of 88.7% had no difficulty in taking medication (Haynes-Sackett) and 73.6% were considered compliant (Morisky-Green). Differences were observed when comparing both methods (P=.036). Patients with difficulty in taking medication were less compliant (45.6%). The Morisky-Green questionnaire was used for a second time on 78.6% of unreliable patients, and obtained a 45.5% increase in compliance, increasing the overall compliance to 87.8% (P=.00003). Fifty-two drug-related problems (DRP) were detected. Conclusions. The initial compliance of patients with stage 3-5 CRD was was noteworthy. However, after pharmaceutical intervention there was a statistically significant improvement in adherence to therapy(AU)

[Pharmaceutical intervention on the therapeutic adherence in patients with chronic renal disease]. / Intervención farmacéutica en la adherencia al tratamiento de pacientes con enfermedad renal crónica.

OBJECTIVES: To assess the therapeutic adherence in patients with stage 3-5 chronic renal disease (CRD), and evaluate whether pharmaceutical intervention improves medication adherence. MATERIAL AND METHODS: A prospective uncontrolled before-after study (July 2008-March 2009) was carried out in the Pharmaceutical Care Unit of a tertiary hospital. Polymedicated patients >65 years with stage 3-5 CRD, and on treatment with erythropoietin. Infowin(®) program was used to provide written information during the interviews with patients, who signed the informed consent. The Haynes-Sackett and Morisky-Green questionnaires were used to assess the therapeutic adherence. RESULTS: Of a total of 103 candidates, we asked 94 patients to participate, of whom 53 agreed; women 60.4%, mean age: 76.8 ± 6.9 years. EXCLUSION CRITERIA: refusal to participate (19.5%), non-appearance of patient or usual caregiver (70.7%), and institutionalised patients (9.8%). Average number of drugs per patient: 10.8 ± 2.97. A total of 88.7% had no difficulty in taking medication (Haynes-Sackett) and 73.6% were considered compliant (Morisky-Green). Differences were observed when comparing both methods (P=.036). Patients with difficulty in taking medication were less compliant (45.6%). The Morisky-Green questionnaire was used for a second time on 78.6% of unreliable patients, and obtained a 45.5% increase in compliance, increasing the overall compliance to 87.8% (P=.00003). Fifty-two drug-related problems (DRP) were detected. CONCLUSIONS: The initial compliance of patients with stage 3-5 CRD was was noteworthy. However, after pharmaceutical intervention there was a statistically significant improvement in adherence to therapy.

Evaluación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles (2007) / Assessment of safety practices for medication-use systems in Spanish hospitals (2007)

Fundamento y Objetivo: Conocer la situación de las prácticas de seguridad de los sistemas de utilización de medicamentos en los hospitales españoles e identificar las áreas de mayor riesgo. Material y Método: Se incluyeron los hospitales que cumplimentaron, del 1 de junio de 2007 al 15 de julio del 2007, el «Cuestionario de autoevaluación de la seguridad del sistema de utilización de los medicamentos», que contiene 232 ítems de evaluación agrupados en 20 criterios esenciales. Resultados: Participaron 105 hospitales de las 17 comunidades autó- nomas. La puntuación media del cuestionario en el total de hospitales fue de 612,7 (39,7% del valor máximo posible) y no se encontraron diferencias según tamaño, capacidad docente o finalidad asistencial. Al analizar los criterios esenciales, los valores más bajos (< 25%) correspondieron a 3 criterios relacionados con formación y competencia de los profesionales, y establecimiento de un sistema de notificación de errores. Otros 9 criterios, con porcentajes del 25 al 50%, se referían a prácticas de: acceso a información sobre pacientes y medicamentos; comunicación de prescripciones; prevención de errores por nombres, etiquetado y envasado; restricción de medicamentos en unidades asistenciales; estandarización de dispositivos de infusión; educación al paciente, y cultura de seguridad y procedimientos de doble chequeo. Conclusiones: Se han identificado numerosas oportunidades de mejora, especialmente en áreas relacionadas con formación, gestión de riesgos, incorporación de nuevas tecnologías y participación de pacientes. La información obtenida puede ser útil para priorizar las prácticas a abordar en las estrategias en seguridad del paciente y como línea basal para efectuar un seguimiento de la implantación de las iniciativas que se acometan (AU)

Material and Method: Those hospitals that completed the «Medication use-system safety self-assessment for hospitals» between June 1 and July 15, 2007, were included in the study. The survey contained 232 items for evaluation grouped into 20 core characteristics. Results: A total of 105 hospitals from the 17 autonomous communities in Spain participated in the study. The average aggregate score for the survey of all the participating hospitals was 612.7 (39.7% of the maximum possible score) and there were no differences found with regard to number of beds, training activity or type of hospital. When core characteristics were analyzed, there were 3 criteria with the lowest values (< 25%), associated with professional training, skills, and the establishment of a system for reporting errors. Another 9 criteria, with percentages between 25% and 50%, reflected practices related to: access to information regarding patients and medications; communication of medication orders; prevention of errors due to naming, labeling, and packaging problems; standardization of medication delivery devices; restriction of medications in patient care units; and safety culture and double-checking procedures. Conclusions: Many opportunities for improvement have been identified, particularly in areas related to training, risk management, incorporating new technologies and patient participation. The information obtained may prove useful for prioritizing practices when establishing patient safety strategies, and as a baseline for successfully monitoring the effectiveness of the initiatives and programs consequently set into motion (AU)

[Updated classification for medication errors by the Ruiz-Jarabo 2000 Group]. / Actualización de la clasificación de errores de medicación del grupo Ruiz-Jarabo 2000.

OBJECTIVE: To update the classification system created by the Ruiz-Jarabo 2000 group to standardize detection, analysis, and recording of medication errors, with the aim of improving its capacity and functionality. METHOD: The classification update was carried out by the Ruiz-Jarabo 2000 working group considering: a) other classifications used by incident reporting systems initiated after the original version had been created; b) suggestions offered by healthcare professionals with respect to the original version; and c) the experiences of the working group itself based on analyses of medication errors gathered in hospitals, and on analyses of reports notified to the ISMP-Spain medication error reporting and learning program. RESULTS: This article presents the updated version of the medication error classification system and describes the main changes made on to the different sections and categories. CONCLUSIONS: The new version may prove to be a useful tool for analyzing and reporting errors with regard to those detected within the framework of activities for improving safety in hospitals and primary care, as well as for those detected as a direct result of patient safety research. Thus, this document is expected to improve medication safety information management in such a way as to allow data to be used ever more efficiently for making medication use systems safer for patients.

[Orbital lymphomas. Presentation of nine cases]. / Linfomas orbitarios. Presentación de nueve casos.

PURPOSE: To report nine cases of orbital lymphomas. METHODS: We reviewed the clinical records of nine patients diagnosed with orbital lymphoma and performed a literature search related to this condition. RESULTS: We present a series of five women and four males with orbital lymphoma involving the orbital region. In our cases, most patients presented concurrent extraorbital lymphoma when the orbital disease was first noticed (seven out of nine patients). We found three MALT lymphomas, two follicular lymphomas, two non-Hodgkin large B cell lymphomas, one low grade B cell lymphoma, and one mantle cell lymphoma. Eight patients were alive and one had died as a consequence of his lymphoma at the time this report was written. CONCLUSIONS: An increase in the incidence of non-Hodgkin orbital lymphomas has been observed over the last three decades. The most common type in the orbital region is the MALT lymphoma. The clinical features observed in our series are similar to those reported in the literature. Since lymphomas are the most frequent malignant tumours in the orbit, usually with extraorbital involvement, and can be successfully treated in many cases, it is important for the ophthalmologist to be aware of this condition.