Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis.

BACKGROUND: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. AIM: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. METHODS: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. RESULTS: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. CONCLUSIONS: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs.

Efecto citoprotector y antisecretor del aceite de Copaifera officinalis en lesiones gástricas inducidas en ratas / Copaifera officinalis oil cytoprotector and antisecretory effects in induced gastric lesions in rats

Objetivos: Demostrar el efecto gastroprotector del aceite de Copaifera officinalis usando indometacina y ligadura de píloro en ratas. Diseño: Estudio preclínico. Lugar: Facultades de Medicina, de Farmacia y Bioquímica. Universidad Nacional Mayor de SanMarcos, Lima, Perú. Material biológico: Ratas y aceite de copaiba. Intervenciones: Se colectó el aceite de copaiba en Ucayali, Pucallpa. La citoproteccción fue evaluada con indometacina, considerando un grupo control normal, indometacina, grupos deaceite de copaiba y omeprazol. Las lesiones de la mucosa gástrica fueron calificadas como las compatibles con necrosis local (tejido no viable), hiperemia, enrojecimiento presente y hemorragia, empleando la escala de puntaje observacional; y la úlcera,según la escala de Macallister modificado. El ensayo de antisecreción fue realizado por el modelo de ligadura del píloro, en el que 24 ratas albinas fueron divididas al azar en 3 grupos; un control, otro de aceite de copaiba 40mg/kg y un tercero de omeprazol10 mg/kg. Después de 4 horas de ligazón, fueron sacrificados, extrayéndose los estómagos; con mucho cuidado se midió el volumen y se determinó el pH de la secreción gástrica, por potenciometría. Se realizó evaluación histopatológica segúnDevi. Principales medidas de resultados: Lesiones ulcerosas. Resultados: Losresultados indicaron 100 por ciento de efecto citoprotector con el aceite de copaiba y de 97,8 por ciento para el omeprazol (p menor que 0,0001), ratificado con los hallazgos histopatológicos; la disminución del volumen de secreción fue 79,4 por ciento para omeprazol y 42,8 por ciento para el aceite de copaiba (p menor que 0,001), con incremento del pH. Conclusiones: En condicionesexperimentales, el aceite de copaiba fue efectivo como agente gastroprotector enratas con inducción de úlcera gástrica.

Objetives: To determine the gastroprotector effect of Copaifera officinalis oil using indomethacin and pyloric ligature in rats. Design: Preclinical study. Setting: Faculties of Medicine, Pharmacy and Biochemistry, National University of San Marcos, Lima, Peru. Biological material: Rats and copaiba oil. Interventions: Copaiba oil was collected in Ucayali, Pucallpa. Cytoprotection was tested withindomethacin considering a normal control group, and indomethacin, copaibaand omeprazole groups. Using visual analogue scale mucosa gastric injuries were referred as those compatible with local necrosis (unviable tissue), hyperemia, flushing, and hemorrhage, and ulcers according to the modified MacallisterÆs scale. The anti-secretion trial used the pyloric ligature model. Twenty-four albino rats were randomized in three groups: control, copaiba oil 40 mg/kg and omeprazole 10 mg/kg, respectively. After 4 hours of linkage, they were sacrificed. Stomachs were removed, their volume measured carefully and gastric secretion pH determined by potentiometry. DevisÆs histopathological evaluation was used. Main outcome measures: Ulcerous injuries. Results: There was 100 per centcytoprotection with copaiba oil and 97,8 per cent with omeprazole (p minor that 0,0001), ratified by histological findings. Decrease in secretion volume was 79,4 per cent for omeprazole and 42,8 per cent for copaiba oil (p minor thet 0,0001) with pH increment. Conclusions: In experimental conditions copaiba oil was effective as gastroprotective agent in gastric ulcers-induced rats.