2SPD-003 Errors detected in the telepharmacy procedure Sánchez Ruiz, A; Muñoz Cid, C; Garcia Gomez, N ...
European journal of hospital pharmacy. Science and practice,
03/2023, Letnik:
30, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Background and ImportanceAfter the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines ...to community pharmacies within a population area of 600,000 inhabitants.Aim and ObjectivesThe purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements.Material and MethodsWe carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected.ResultsIn the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient‘s medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge.Conclusion and RelevanceAmong the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Background and importanceTreatment with biologic drugs is indicated in patients with moderate to severe psoriasis, and the therapeutic goal is an improvement equal to or greater than Psoriasis Area ...and Severity Index (PASI) 75.Aim and objectivesTo analyse the use of profile guselkumab in a tertiary hospital and to evaluate the effectiveness, safety and adherence of the treatment in clinical practice in moderate-severe plaque psoriasisMaterial and methodsObservational, retrospective, descriptive study including all the patients who were prescribed guselkumab from 2019 to October 2021.Demographic (sex, age) and clinical data (previous biological treatment, date of initiation of treatment and subsequent doses administered, adverse effects and reason for ending treatment) were collected from the digital medical record and the electronic prescription programme.Effectiveness was derived from PASI levels and recorded over an average of 56 weeks. Safety was measured by the rate of adverse effects.Results33 patients (48.5% male and 51.5% female) with a mean age of 49 years. 6.1% received guselkumab as the first line of treatment, 48.9% as the second line and 45.4% as the third or more lines. The biological drugs which were previously used were etanercept (63.6%), adalimumab (30.3%), ustekinumab (30.3%), secukinumab (27.3%), ixekizumab (12.1%) and apremilast (3%).An average of 57.53 days of difference between medication administration dates was recorded, confirming good adherence to the treatment (100 mg subcutaneous every 56 days).In terms of effectiveness evaluation, the mean baseline PASI was 10.6 and the mean PASI over a 56-week period was 2.17. This represents an average reduction of 79.5% in PASI levels.26 patients achieved a decrease in PASI, and of these 12 reached PASI 100.Adverse effects were detected in 3 patients (9%): diarrhoea, candida spp infection and suppurative outbreak. Treatment discontinuation occurred in 5 patients (15.1%) due to the appearance of adverse effects (2) inefficiency of treatment (2) and desire for pregnancy (1).Conclusion and relevanceThe use of guselkumab is an appropriate therapeutic option in patients diagnosed with moderate-to-severe plaque psoriasis after failure of at least one biologic treatment. The achievement of a PASI 79, as well as the few adverse effects that made it necessary to discontinue treatment, demonstrate its therapeutic effectiveness and safety.References and/or acknowledgementsConflict of interestNo conflict of interest
Background and importanceIn recent years innovative therapies have been developed for the treatment of hypercholesterolaemia that allow an effective decrease in low density lipoprotein ...(LDL)-cholesterol (LDL-c). These are alirocumab and evolocumab, anti-proprotein convertase subtilisin-kexin type 9 (PCSK9) monoclonal antibodies. The Pharmacy and Therapeutics Commission of our hospital has accepted the following indications: familial hypercholesterolaemia (HF) with LDL-c >100 mg/dL with maximum tolerated dose of statins, cardiovascular disease (CVD) established with LDL-c >100 mg/dL with maximum tolerated dose of statins and statin intolerant with LDL-c >100 mg/dL.Aim and objectivesTo study the correct use of PCSK9 inhibitors in real clinical practice in a third level hospital. To evaluate efficacy and adherence to treatment.Material and methodsThis was an observational, analytical and retrospective study of patients treated with anti-PCSK9 who attended the pharmacy service for a consultation. On 30 September 2019, a cross section was performed and the data collected were: sex, prescribed anti-PCKS9, dosage, theoretical and real dispensed units, indication and analytical data at 0 and 12 weeks (total cholesterol, LDL-c, high density lipoprotein cholesterol and triglycerides).ResultsA total of 82 patients (53 men, 29 women) were studied: 57(69.5%) patients received evolocumab and 25 (30.5%) alirocumab. The distribution by diagnoses were: 17.1% HF, 46.3% CVD, 13.3% statin intolerance and 15.8% other.After 12 weeks, the mean reduction in LDL-c was 54.3%, reaching the LDL-c target <100 mg/dL in 89.0% of cases. However, 4.9% of patients experienced an increase in LDL-c levels. Adherence to treatment was calculated by an indirect method from the record of dispensations (medication possession rate (MPR)=real/theoretical dispensed units×100). A patient with MPR >80% was considered adherent. Only 8.5% of patients were below the established limit, and were non-adherent.Conclusion and relevancePCSK9 inhibitors are effective in decreasing LDL-c levels (<100 mg/dL). The reduction obtained in our study was similar to that obtained in pivotal studies. The prevalent diagnosis was uncontrolled CVD with maximum doses of statins. Only in 15.8% of cases was the PCSK9 inhibitor not indicated (initial LDL-c <100 mg/dL). Adherence to treatment was high bur it could have been overestimated because it was assumed that the patient administered the dispensed medication. More long term studies are needed to corroborate the data. In real clinical practice, it would be interesting to assess if this reduction in LDL-c is associated with a decrease in cardiovascular events.References and/or acknowledgementsNo conflict of interest.
BackgroundPsoriasis is a disease that requires long-term treatment. Apremilast is indicated in the treatment of psoriasis in patients who have not responded or have contraindicated or cannot tolerate ...other treatment systemics. This drug has a lower accumulated specific organ toxicity, so it seems that it is the first oral systemic drug with which long-term treatments can be planned.PurposeTo estimate the persistence and safety of treatment with apremilast in patients diagnosed with psoriasis.Material and methodsRetrospective observational study of all patients with psoriasis who were treated with apremilast (January 2016 to September 2018). Demographic variables (age, sex) and variables related to the drug were collected (treatment start and discontinuation date, adverse reactions, causes of suspension and previous treatment). Persistence was defined as time (months) from the start of treatment until its discontinuation due to toxicity or inefficiency. Persistence was calculated with Kaplan–Meier survival curves (log rank test).ResultsForty-two patients (54.8% women) were included. Mean age was 46.5 years (SD=13,2). Previous therapies: topical (100%), methotrexate (38.1%), acycretin (30.9%), cyclosporin (23.8%) and etanercept (7.2%). Average of previous treatments/patient: 2 (1–3). Mean persistence was 19.4 months (95% CI 14.9 to 23.9). At the end of the study period, 69% (n=29) of patients continued with apremilast and 31% (n=13) were discontinued. The causes of suspension were inefficacy in 62% (n=8) and toxicity in 38% (n=5). The severe adverse reactions that required the suspension of treatment were: diarrhoea (one), migraine (one), low back pain (one) and psychiatric disorder (two). Two patients required dose reduction (30 mg/24 hour). The estimated median time of treatment until discontinuation due to toxicity is 3 months compared to 4 months for patients who leave treatment due to inefficiency. There are no statistically significant differences between the survival curves of the causes of abandonment of treatment with apremilast (p=0.532). After 15 months of treatment the probability of discontinuing treatment for any of the causes is maintained over time.ConclusionThe role of the pharmacist is essential in detecting the symptoms and signs of toxicity and ineffectiveness in the first year of treatment. Even so it would be of interest to extend the study time to analyse the long-term persistence.References and/or acknowledgementsNo conflict of interest.
Ni2+, Fe2+ and Cu2+ were attractants and aspartate was an apparent repellent for Leptospirillum ferrooxidans, a behaviour opposite to that for Escherichia coli. Membranes from L. ferrooxidans ...contained proteins with a molecular mass in the range of 80 kDa which were methylated in vitro. Methylation was stimulated in the presence of a membrane-free extract from E. coli, showing the response pattern expected for L. ferrooxidans, increased methylation by Ni2+, and demethylation by aspartate. This suggests the existence of sensory transducers having a common methylation domain with the E. coli methyl-accepting chemotaxis proteins. Total chromosomal DNA digests from L. ferrooxidans, Thiobacillus ferrooxidans and T. thiooxidans hybridized with probes containing different domains of the tar gene from E. coli, implying the presence of tar type genes in the acidophilic bacteria studied.
ABSTRACT
Background
Surveys for intestinal parasitic infections (IPIs) often involve samples from three sampling dates analysed by various microscopy techniques. However, analysis of three samples ...per individual is a huge burden on time and resources. We compared the value from analysing three or fewer samples.
Methods
In this cross-sectional study, three faecal samples were collected every other day from 332 children from two locations in Guantanamo province, Cuba. Samples were analysed by wet mount with Lugol stain, Willis flotation method and Kato–Katz thick smear.
Results
Most parasites were detected by wet mount, although helminth eggs not found by wet smear were detected by the Willis flotation method (in particular) and Kato–Katz smear. Blastocystis spp. was the most commonly detected parasite (about 65%), then Giardia duodenalis and then Entamoeba spp. Although analysis of two stool samples significantly increased occurrence data for Blastocystis, this was not so for the other parasites. For none of the protozoan parasites were results from analysing three samples significantly higher than results from analysing just two samples.
Conclusions
Analysing two faecal samples by wet mount and the Willis flotation method provides useful data for estimating the prevalence of IPIs in relatively high prevalence settings. Analysing further samples provides limited additional information and adds an extra burden in terms of time and resources.
To determine the absolute and relative reliability of functional trunk tests, using a functional electromechanical dynamometer to evaluate the isokinetic strength of trunk flexors and to determine ...the most reliable assessment condition, in order to compare the absolute and relative reliability of mean force and peak force of trunk flexors and to determine which isokinetic condition of evaluation is best related to the maximum isometric.
Test-retest of thirty-seven physically active male student volunteers who performed the different protocols, isometric contraction and the combination of three velocities (V
= 015 m s
, V
= 0.30 m s
, V
= 0.45 m s
) and two range of movement (R
= 25% cm ; R
= 50% cm) protocols.
All protocols to evaluate trunk flexors showed an absolute reliability provided a stable repeatability for isometric and dynamic protocols with a coefficient of variation (CV) being below 10% and a high or very high relative reliability (0.69 < intraclass correlation coefficient ICC > 0.86). The more reliable strength manifestation (CV = 6.82%) to evaluate the concentric contraction of trunk flexors was mean force, with 0.15 m s
and short range of movement (V
R
) condition. The most reliable strength manifestation to evaluate the eccentric contraction of trunk flexors was peak force, with 0.15 m s
and a large range of movement (V
R
CV = 5.07%), and the most reliable way to evaluate isometric trunk flexors was by peak force (CV = 7.72%). The mean force of eccentric trunk flexor strength with 0.45 m s
and short range of movement (V
R
) condition (r = 0.73) was best related to the maximum isometric contraction.
Functional electromechanical dynamometry is a reliable evaluation system for assessment of trunk flexor strength.
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