Association between anticholinergic activity and xerostomia and/ or xerophthalmia in the elderly: systematic review.

PURPOSE: The aim of this work was to investigate the association between anticholinergic burden or anticholinergic drug use and xerostomia and/or xerophtalmia in elderly through a systematic review of the published literature. METHODS: A search was carried out in 3 databases (CINAHL, Embase and Pubmed). Studies conducted in people ≥65 years of age, who took anticholinergic medications, and measured the association between the anticholinergic burden or the use of these medications with the prevalence of xerostomia and / or xerophthalmia, published up to August 2022, were selected. Studies published in languages other than Spanish and/or English were excluded. RESULTS: One thousand two hundred eleven articles were identified, 10 were selected for this review: six cross-sectional studies, two cohorts, one case-control and one randomized controlled clinical trial. A total of 3535 patients included in the different studies were studied. The most used scales were the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS). Four articles studied the relationship between the use of anticholinergic medication and the prevalence of xerostomia and / or xerophthalmia, finding a positive relationship with xerostomia in all of them. Another 6 measured the relationship between anticholinergic burden and xerostomia and / or xerophthalmia. Four found a positive relationship between anticholinergic burden and xerostomia and/or xerophthalmia. CONCLUSIONS: Our findings suggest a clear relationship between the use of anticholinergic drugs or anticholinergic burden and the presence of xerostomia. This relationship was less conclusive in the case of xerophthalmia.

Dalbavancina como tratamiento prolongado de rescate en infección protésica articular / Dalbavancin as prolonged-salvage treatment in prosthetic joint infection

Dalbavancina es un agente antibacteriano perteneciente al grupo de los lipoglicopéptidos semisintéticos de larga vida media, con gran actividad sobre microorganismos grampositivos y con un perfil de efectos adversos aceptable. Hasta la fecha, ha sido autorizada para el tratamiento de infecciones de piel y tejidos blandos en adultos, sin indicación en infecciones de hueso y articulaciones.La mayoría de los casos de infección protésica articular descritos en la literatura con dalbavancina en tratamiento prolongado, han sido durante un periodo no superior a 4 semanas.Se describen una serie de casos de infección osteoarticular de material protésico tratados de forma prolongada y como rescate con dalbavancina. (AU)

Dalbavancin is an antibacterial agent that belongs to the group of semi-synthetic lipoglicopeptides of long half-life, with great activity in gram-positive microorganisms and with an acceptable adverse effects profile. To date, it has been authorized for the treatment of skin and soft tissue infections in adults, with no indication of bone and joint infections.Most cases of joint prosthetic infection described in the literature with dalbavancin in prolonged treatment have been for a period not exceeding 4 weeks.A series of cases of prosthetic joint infection treated for a long time and as salvage with dalbavancin are described. (AU)

Validación en pediatría de un método para notificación y seguimiento de errores de medicación / Validation of a method for notifying and monitoring medication errors in pediatrics

OBJETIVO: Analizar el impacto en la notificación de errores de medicación de la puesta en marcha de un comité de seguridad multidisciplinar descentralizado en la unidad de gestión pediátrica, e implantación conjunta de una aplicación informática en red para la comunicación de errores de medicación, mediante seguimiento de los errores y análisis de las mejoras. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, transversal pre-post intervención. Se analizan los errores de medicación notificados a la comisión central de seguridad, en los 12 meses previos a la implantación, y los notificados mediante la aplicación informática descentralizada a la comisión de seguridad de la unidad de gestión, en los 9 meses posteriores, y las estrategias generadas por el análisis. Variables medidas: Número de errores notificados por 10.000 días de estancia, número de errores con daño por 10.000 días de estancia, tipo, categoría en función de la gravedad, fase del proceso, colectivo que notifica y medicamentos implicados. RESULTADOS: Se multiplican por 4,6 los errores de medicación notificados -7,6 notificaciones por 10.000 días de estancia en el periodo preintervención y 36 en el postintervención-, razón de tasas de 0,21 (IC 95%: 0,11-0,39) p < 0,001. No cambian prácticamente los errores con daño o que necesitaron monitorización notificados por 10.000 días de estancia de un periodo a otro, razón de tasas: 0,77 (IC95%: 0,31-1,91) p > 0,05. Se multiplica por 17,4 la notificación de errores sin daño o potenciales por 10.000 días de estancia, razón de tasas: 0,005 (IC 95%: 0,001-0,026) p < 0,001. CONCLUSIONES: El incremento de los errores de medicación notificados en el periodo postintervención es reflejo del aumento en la motivación de los profesionales sanitarios para notificar a través de este nuevo método

OBJECTIVE: To analyze the impact of a multidisciplinary and decentralized safety committee in the pediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. MATERIAL AND METHODS: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralized safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. Measured variables: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. RESULTS: Reported medication errors increased 4.6 -fold, from7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11-0.39) (P < .001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0,77 (95% IC; 0,31-1,91) (P>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005., 95% CI; 0.001-0.026, P < .001). CONCLUSIONS: The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method

[Validation of a method for notifying and monitoring medication errors in pediatrics]. / Validación en pediatría de un método para notificación y seguimiento de errores de medicación.

OBJECTIVE: To analyze the impact of a multidisciplinary and decentralized safety committee in the pediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. MATERIAL AND METHODS: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralized safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. MEASURED VARIABLES: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. RESULTS: Reported medication errors increased 4.6 -fold, from 7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11-0.39) (P<.001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0,77 (95% IC; 0,31-1,91) (P>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005., 95% CI; 0.001-0.026, P<.001). CONCLUSIONS: The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method.

[Off-label approval of drug use in a tertiary hospital]. / Autorización de usos de medicamentos fuera de indicación en un hospital de tercer nivel.

BACKGROUND AND OBJECTIVE: The Pharmacy and Therapeutics Committee (PTC) evaluates the requests for off-label uses with an abbreviated report format. The aim of this study is to perform a descriptive analysis of this activity and to study the rate of approvals. MATERIAL AND METHODS: A descriptive study was performed on the PTC reports in a tertiary hospital between September 2009 and April 2011. The type of drug by treatment group and by type of dispensing, indication and requesting department was analysed. The final decision adopted was studied as the primary outcome, and the percentage of requests approved according to the characteristics of the drug evaluated, indication requested, alternatives used, evidence and cost, as secondary outcomes. RESULTS: A total of 51 applications were analysed, of which 60.8% were drugs for hospital use and 54.9% cytostatic. The most requested indications were the onco-haematological (43.2%) and autoimmune (35.3%). Haematology was the department that made most requests (11 requests with 72.7% approved), Oncology and Paediatrics (both with 10 requests, with 50% approved). Almost two-thirds (60.8%) of the requests were approved. Of those that were not approved, 11 had not used up the therapeutic alternatives, and 8 had no evidence. Just under half (47.1%) of the drugs requested had a cost/patient between 10,000-100,000 euros,of which 58.3% were approved (cost per course of treatment if it had a defined period, or cost of treatment per year for chronic treatment). CONCLUSION: There is an increase in the activity of the PTC that is growing over the years. Most applications focus on drugs for hospital use and cytostatic drugs by Onco-haematology. There is a high rate of approval by the PTC, and high variability in the percentage of approval depending on the department and the evidence of use. The difference between approved and unapproved requests followed a logic of cost-effectiveness.