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Taladriz-Sender I, Manrique-Rodríguez S, Fernández-Llamazares CM, Herranz-Alonso A, Sanjurjo-Sáez M. Standardisation of intravenous infusion therapy for paediatrics: big challenges for the little patients. Eur J Hosp Pharm 2024; 31:274-280. [PMID: 36535690 DOI: 10.1136/ejhpharm-2022-003316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Worldwide organisations advocate standardising the management of intravenous drugs as an essential strategy to increase safety in paediatric healthcare settings. Intravenous administration is a route associated with some potential complications. Many adverse events are related to the use of intravenous medications, and the great variability in their handling and preparation represents an added risk that jeopardises the safety of children. PURPOSE To standardise the dilutions of intravenous drugs most commonly administered to Spanish hospitalised paediatric and neonatal patients. METHODS The process leading to the standardisation of concentrations was undertaken following a two-round modified Delphi procedure. The consensus included the most common drugs administered by continuous or intermittent intravenous infusion to hospitalised and/or critically ill paediatric patients. RESULTS For paediatric patients, the proposal included a total of 102 drugs (45 continuous infusion and 59 intermittent infusion), with 192 concentrations to be standardised. The final consensus included 101 drugs (99%), of which 44 were continuous infusion and 59 intermittent infusion; 160 concentrations were standardised (72.7%). For neonates, the initial proposal included 80 drugs (38 continuous infusion and 43 intermittent infusion), with 189 concentrations to be standardised. The final consensus included 80 drugs (100%), of which 38 were continuous infusion and 43 were intermittent infusion; 120 concentrations were standardised (49.2%). CONCLUSIONS This proposal showed that standardisation is a feasible approach that can be reached by other healthcare institutions. It can be used in other centres and contribute in the future to unifying paediatric clinical practice.
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Affiliation(s)
| | | | | | - Ana Herranz-Alonso
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
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Salvador-Martín S, Rubbini G, Vellosillo P, Zapata-Cobo P, Velasco M, Palomino LM, Clemente S, Segarra O, Moreno-Álvarez A, Fernández-Lorenzo A, Pérez-Moneo B, Montraveta M, Sánchez C, Tolín M, Loverdos I, Fobelo MJ, Navas-López VM, Magallares L, García-Romero R, Torres-Peral R, Rodríguez A, Bossacoma F, Merino-Bohórquez V, Salcedo E, Álvarez R, Dopazo A, Sanjurjo-Sáez M, López-Fernández LA. Blood gene expression biomarkers of response to anti-TNF drugs in pediatric inflammatory bowel diseases before initiation of treatment. Biomed Pharmacother 2024; 173:116299. [PMID: 38401525 DOI: 10.1016/j.biopha.2024.116299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND/AIMS Changes in gene expression profiles among individuals with inflammatory bowel diseases (IBDs) could potentially influence the responsiveness to anti-TNF treatment. The aim of this study was to identify genes that could serve as predictors of early response to anti-TNF therapies in pediatric IBD patients prior to the initiation of treatment. METHODS We conducted a prospective, longitudinal, and multicenter study, enrolling 24 pediatric IBD patients aged less than 18 years who were initiating treatment with either infliximab or adalimumab. RNA-seq from blood samples was analyzed using the DESeq2 library by comparing responders and non-responders to anti-TNF drugs. RESULTS Bioinformatic analyses unveiled 102 differentially expressed genes, with 99 genes exhibiting higher expression in responders compared to non-responders prior to the initiation of anti-TNF therapy. Functional enrichment analyses highlighted defense response to Gram-negative bacteria (FDR = 2.3 ×10-7) as the most significant biological processes, and hemoglobin binding (FDR = 0.002), as the most significant molecular function. Gene Set Enrichment Analysis (GSEA) revealed notable enrichment in transcriptional misregulation in cancer (FDR = 0.016). Notably, 13 genes (CEACAM8, CEACAM6, CILP2, COL17A1, OLFM4, INHBA, LCN2, LTF, MMP8, DEFA4, PRTN3, AZU1, and ELANE) were selected for validation, and a consistent trend of increased expression in responders prior to drug administration was observed for most of these genes, with findings for 4 of them being statistically significant (CEACAM8, LCN2, LTF2, and PRTN3). CONCLUSIONS We identified 102 differentially expressed genes involved in the response to anti-TNF drugs in children with IBDs and validated CEACAM8, LCN2, LTF2, and PRTN3. Genes participating in defense response to Gram-negative bacterium, serine-type endopeptidase activity, and transcriptional misregulation in cancer are good candidates for anticipating the response to anti-TNF drugs in children with IBDs.
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Affiliation(s)
- Sara Salvador-Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Gianluca Rubbini
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Perceval Vellosillo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Investigación Materno Infantil Fundación Familia Alonso (UDIMIFFA), Spain.
| | - Paula Zapata-Cobo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Marta Velasco
- Hospital Universitario Infantil Niño Jesús, Madrid, Spain.
| | | | | | | | | | | | | | | | - Cesar Sánchez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Mar Tolín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | - María José Fobelo
- Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain.
| | | | | | | | | | | | - Ferrán Bossacoma
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Dèu, Barcelona, Spain.
| | | | | | - Rebeca Álvarez
- Genomics Unit, Spanish National Center for Cardiovascular Disease (CNIC), Madrid 28029, Spain.
| | - Ana Dopazo
- Genomics Unit, Spanish National Center for Cardiovascular Disease (CNIC), Madrid 28029, Spain.
| | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Luis A López-Fernández
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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de Lorenzo-Pinto A, Redondo-Galán C, García-González X, Fernández-Álvarez C, Andueza-Lillo J, Sanjurjo-Sáez M. Presence of metallic components in transdermal drug delivery systems and risk of skin burns. Farm Hosp 2023:S1130-6343(23)00926-1. [PMID: 38057241 DOI: 10.1016/j.farma.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE Skin burns are associated with the presence of metallic components in transdermal drug delivery systems during Magnetic Resonance Imaging, cardioversion, or defibrillation procedures. The aim of the study was to review the presence of metallic components in marketed products of transdermal drug delivery systems in Spain. METHOD For each pharmaceutical form, the summary of product characteristics was reviewed. If the information was not provided, manufacturers were contacted. RESULTS We identified 59 marketed products of transdermal drug delivery systems of 12 different active substances. 59.3% of patches contained metallic components or their presence could not be ruled out. Information regarding the need to remove the patch was only included in 8 summaries of product characteristics (13.6%) A table was elaborated and included the following aspects: product, active substance, manufacturer, need to remove the patch before the exposure to magnetic or electric fields, and references. CONCLUSION More than a half of the patches at the time of the study contained metals or their absence could not be confirmed by the manufacturer. However, this information was only included in 13.6% of summaries of product characteristics.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Carmen Redondo-Galán
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Juan Andueza-Lillo
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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4
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Zapata-Cobo P, Salvador-Matín S, Velasco M, Palomino LM, Clemente S, Segarra O, Moreno-Álvarez A, Fernández-Lorenzo A, Pérez-Moneo B, Montraveta M, Sánchez C, Tolín M, Loverdos I, Fobelo MJ, Navas-López VM, Magallares L, García-Romero R, Sánchez-Hernández JG, Rodríguez A, Bossacoma F, Balboa MJ, Salcedo E, Sanjurjo-Sáez M, López-Fernández LA. Comments on: Polymorphisms indicating risk of inflammatory bowel disease or antigenicity to anti-TNF drugs as biomarkers of response in children. Pharmacol Res 2023; 196:106938. [PMID: 37748560 DOI: 10.1016/j.phrs.2023.106938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Paula Zapata-Cobo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Sara Salvador-Matín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Marta Velasco
- Hospital Universitario Infantil Niño Jesús, Madrid, Spain.
| | | | | | | | | | | | | | | | - Cesar Sánchez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Mar Tolín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María José Fobelo
- Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain.
| | | | | | | | | | | | - Ferrán Bossacoma
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Dèu, Barcelona, Spain.
| | | | | | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Luis A López-Fernández
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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5
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Vicente-Valor J, Rodríguez-González C, Ferris-Villanueva M, Chamorro-de-Vega E, Romero-Jiménez R, Gómez-Costas D, Herrero-Bermejo S, Tejerina-Picado F, Osorio-Prendes S, Oarbeascoa-Royuela G, Herranz-Alonso A, Sanjurjo-Sáez M. Remdesivir and SARS-CoV-2 monoclonal antibodies to prevent COVID-19 progression in hematological patients: an observational study. Pharmacol Rep 2023; 75:1254-1264. [PMID: 37656351 DOI: 10.1007/s43440-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with hematological malignancies (HM) are at high risk of COVID-19 progression. Hence, early treatments to prevent progression are needed. The aim of our work was to evaluate the effectiveness and safety of remdesivir (RDV) and SARS-CoV-2 monoclonal antibodies (mAb) in patients with HM and mild-to-moderate disease in real clinical practice. METHODS We conducted a prospective study in a tertiary hospital in 55 HM patients with mild-to-moderate SARS-CoV-2 disease diagnosed between August 2021 and July 2022 and who received RDV or mAb to prevent COVID-19 progression (related death or hospitalization). The primary endpoint was COVID-19 progression on day 28. Other outcomes were COVID-19 progression beyond day 28 and viral load evolution. RESULTS RDV was administered to 44 (80.0%) patients and mAb to 11 (20.0%) patients. Death occurred in 1 (1.8%) patient and hospitalization in 9 (16.4%) patients by day 28, respectively; 3 patients (5.5%) required intensive care and 8 (14.5%), oxygen support. Of note, 5 additional patients [15, (27.3%) in total] died or required hospitalization after day 28. Two hazard Cox regression models yielded the absence of anti-SARS-CoV-2 antibodies, age over 65 years, and ECOG-performance status ≥ 2 as the main risk factors for COVID-19-related death or hospitalization. CONCLUSION Our results from clinical practice suggest that RDV and SARS-CoV-2 mAb therapies elicit worse outcomes in hematological patients than those reported for high-risk population in clinical trials.
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Affiliation(s)
- Juan Vicente-Valor
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Carmen Rodríguez-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Ferris-Villanueva
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Esther Chamorro-de-Vega
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Rosa Romero-Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Daniel Gómez-Costas
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Sergio Herrero-Bermejo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Francisco Tejerina-Picado
- Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Santiago Osorio-Prendes
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Gillen Oarbeascoa-Royuela
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
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6
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Lozano-Ros A, Martínez-Ginés ML, García-Domínguez JM, Salvador-Martín S, Goicochea-Briceño H, Cuello JP, Meldaña-Rivera A, Higueras-Hernández Y, Sanjurjo-Sáez M, Álvarez-Sala-Walther LA, López-Fernández LA. Changes in the Expression of TGF-Beta Regulatory Pathway Genes Induced by Vitamin D in Patients with Relapsing-Remitting Multiple Sclerosis. Int J Mol Sci 2023; 24:14447. [PMID: 37833895 PMCID: PMC10572771 DOI: 10.3390/ijms241914447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Vitamin D is an environmental factor related to multiple sclerosis that plays a significant role in immune regulation. TGF-β is a superfamily of cytokines with an important dual effect on the immune system. TGF-β inhibits the Th1 response while facilitating the preservation of regulatory T cells (FOXP3+) in an immunoregulatory capacity. However, when IL-6 is present, it stimulates the Th17 response. Our aim was to analyze the regulatory effect of vitamin D on the in vivo TGF-β signaling pathway in patients with relapsing-remitting multiple sclerosis (RRMS). A total of 21 patients with vitamin D levels < 30 ng/mL were recruited and supplemented with oral vitamin D. All patients were receiving disease-modifying therapy, with the majority being on natalizumab. Expression of SMAD7, ERK1, ZMIZ1, BMP2, BMPRII, BMP4, and BMP5 was measured in CD4+ lymphocytes isolated from peripheral blood at baseline and one and six months after supplementation. SMAD7 was overexpressed at six months with respect to baseline and month one. ERK1 was overexpressed at six months with respect to month one of treatment. No significant differences in expression were observed for the remaining genes. No direct correlation was found with serum vitamin D levels. BMPRII expression changed differentially in non-natalizumab- versus natalizumab-treated patients. Changes were observed in the expression of ERK1, BMP2, and BMP5 based on disease activity measured using the Rio-Score, BMP2 in patients who had relapses, and BMP5 in those whose EDSS worsened. Our results suggest indirect regulation of vitamin D in TGF-β pathway genes in patients with RRMS.
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Affiliation(s)
- Alberto Lozano-Ros
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - María L. Martínez-Ginés
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - José M. García-Domínguez
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Sara Salvador-Martín
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
| | - Haydee Goicochea-Briceño
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Juan P. Cuello
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Ariana Meldaña-Rivera
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - Yolanda Higueras-Hernández
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.M.-G.); (J.M.G.-D.); (H.G.-B.); (J.P.C.); (A.M.-R.); (Y.H.-H.)
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
| | - Luis A. Álvarez-Sala-Walther
- Servicio de Medicina Interna, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Luis A. López-Fernández
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (S.S.-M.); (M.S.-S.)
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7
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Zapata-Cobo P, Salvador-Martín S, Velasco M, Palomino LM, Clemente S, Segarra O, Moreno-Álvarez A, Fernández-Lorenzo A, Pérez-Moneo B, Montraveta M, Sánchez C, Tolín M, Loverdos I, Fobelo MJ, Navas-López VM, Magallares L, García-Romero R, Sánchez-Hernández JG, Rodríguez A, Bossacoma F, Balboa MJ, Salcedo E, Sanjurjo-Sáez M, López-Fernández LA. Polymorphisms indicating risk of inflammatory bowel disease or antigenicity to anti-TNF drugs as biomarkers of response in children. Pharmacol Res 2023; 194:106859. [PMID: 37473877 DOI: 10.1016/j.phrs.2023.106859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Few genetic polymorphisms predict early response to anti-TNF drugs in inflammatory bowel disease (IBD), and even fewer have been identified in the pediatric population. However, it would be of considerable clinical interest to identify and validate genetic biomarkers of long-term response. Therefore, the aim of the study was to analyze the usefulness of biomarkers of response to anti-TNFs in pediatric IBD (pIBD) as long-term biomarkers and to find differences by type of IBD and type of anti-TNF drug. The study population comprised 340 children diagnosed with IBD who were treated with infliximab or adalimumab. Genotyping of 9 selected SNPs for their association with early response and/or immunogenicity to anti-TNFs was performed using real-time PCR. Variants C rs10508884 (CXCL12), A rs2241880 (ATG16L1), and T rs6100556 (PHACTR3) (p value 0.049; p value 0.03; p value 0.031) were associated with worse long-term response to anti-TNFs in pIBD. DNA variants specific to disease type and anti-TNF type were identified in the pediatric population. Genotyping of these genetic variants before initiation of anti-TNFs would enable, if validated in a prospective cohort, the identification of pediatric patients who are long-term responders to this therapy.
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Affiliation(s)
- Paula Zapata-Cobo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Salvador-Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Velasco
- Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | | | - Cesar Sánchez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mar Tolín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María Jesús Fobelo
- Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | | | | | | | | | | | - Ferrán Bossacoma
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Dèu, Barcelona, Spain
| | | | | | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis A López-Fernández
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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8
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García-Martín E, Romero-Jiménez RM, Baniandrés-Rodríguez O, Escudero-Vilaplana V, Benedí-González J, de Los Ríos Luna PM, Herranz-Alonso A, Sanjurjo-Sáez M. Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors. Eur J Hosp Pharm 2023:ejhpharm-2022-003594. [PMID: 37094886 DOI: 10.1136/ejhpharm-2022-003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Interleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies' survival, dose adjustment, and clinical patients' factors associated with their effectiveness and safety. METHODS A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected. RESULTS 38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies. CONCLUSIONS Anti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17.
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Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - R M Romero-Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ofelia Baniandrés-Rodríguez
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juana Benedí-González
- Pharmacology, Pharmacognosy and Botany Department, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Morales de Los Ríos Luna
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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9
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de Lorenzo-Pinto A, Ortega-Navarro C, Torroba-Sanz B, Fernández-Llamazares CM, Taladriz-Sender I, Castuera-Gil A, A. Andueza Lillo J, Sanjurjo-Sáez M. Appropriateness of Empirical Antibiotic Therapy for Cervicitis and Urethritis Prescribed in the Emergency Department. Hosp Pharm 2023; 58:106-110. [PMID: 36644749 PMCID: PMC9837327 DOI: 10.1177/00185787221123219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives Sexually transmitted infections are a prevalent global health care problem. Treatment guidelines have recently been updated as a result of antimicrobial resistance and public health trends. The aim of the study was to assess the appropriateness of empirical antibiotic therapy prescribed for cervicitis and urethritis in the emergency department. Methods We designed a retrospective observational cohort study. We included adult patients with suspected cervicitis or urethritis who attended the emergency department of a tertiary hospital in 2020. We excluded patients with suspected pelvic inflammatory disease, pregnancy or prostatitis and those requiring admission to hospital. Appropriateness of empirical antibiotic therapy was evaluated taking into account 4 aspects: indication, dosing, duration of therapy, and route of administration. Data were obtained from the electronic medical record, the electronic prescription program, and the discharge summary. Results The study population comprised 176 patients; mean age was 28.9 years (SD = 7.7), and 90.9% were men. The most prescribed treatment was the combination of ceftriaxone and azithromycin (83.0%). Treatment was inappropriate in 71.6% of patients. A total of 159 drug errors were recorded. The most frequent cause was undertreatment (36.4%) related to underdosing (46.5%), particularly with regard to ceftriaxone. The percentage of errors was 11.9% for indication, 84.9% for dosing, 3.1% for duration, and 0% for route of administration. Conclusions A high percentage of patients who attended the emergency department for suspected cervicitis or urethritis received an inappropriate empirical antibiotic regimen. The main reason was undertreatment due to underdosing.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Beatriz Torroba-Sanz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Ana Castuera-Gil
- Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan A. Andueza Lillo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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10
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Salvador-Martín S, Zapata-Cobo P, Velasco M, Palomino LM, Clemente S, Segarra O, Sánchez C, Tolín M, Moreno-Álvarez A, Fernández-Lorenzo A, Pérez-Moneo B, Loverdos I, Navas López VM, Millán A, Magallares L, Torres-Peral R, García-Romero R, Pujol-Muncunill G, Merino-Bohorquez V, Rodríguez A, Salcedo E, López-Cauce B, Marín-Jiménez I, Menchén L, Laserna-Mendieta E, Lucendo AJ, Sanjurjo-Sáez M, López-Fernández LA. Association between HLA DNA Variants and Long-Term Response to Anti-TNF Drugs in a Spanish Pediatric Inflammatory Bowel Disease Cohort. Int J Mol Sci 2023; 24:ijms24021797. [PMID: 36675312 PMCID: PMC9861004 DOI: 10.3390/ijms24021797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
The genetic polymorphisms rs2395185 and rs2097432 in HLA genes have been associated with the response to anti-TNF treatment in inflammatory bowel disease (IBD). The aim was to analyze the association between these variants and the long-term response to anti-TNF drugs in pediatric IBD. We performed an observational, multicenter, ambispective study in which we selected 340 IBD patients under 18 years of age diagnosed with IBD and treated with anti-TNF drugs from a network of Spanish hospitals. Genotypes and failure of anti-TNF drugs were analyzed using Kaplan-Meier curves and Cox logistic regression. The homozygous G allele of rs2395185 and the C allele of rs2097432 were associated with impaired long-term response to anti-TNF drugs in children with IBD after 3 and 9 years of follow-up. Being a carrier of both polymorphisms increased the risk of anti-TNF failure. The SNP rs2395185 but not rs2097432 was associated with response to infliximab in adults with CD treated with infliximab but not in children after 3 or 9 years of follow-up. Conclusions: SNPs rs2395185 and rs2097432 were associated with a long-term response to anti-TNFs in IBD in Spanish children. Differences between adults and children were observed in patients diagnosed with CD and treated with infliximab.
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Affiliation(s)
- Sara Salvador-Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Paula Zapata-Cobo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Marta Velasco
- Hospital Universitario Infantil Niño Jesús, 28009 Madrid, Spain
| | | | | | | | - Cesar Sánchez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Mar Tolín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | | | | | | | - Inés Loverdos
- Hospital Universitario Parc Taulí, 08208 Sabadell, Spain
| | | | - Antonio Millán
- Hospital Universitario Virgen de Valme, Universidad de Sevilla, 41014 Sevilla, Spain
| | | | | | | | - Gemma Pujol-Muncunill
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Dèu, 08950 Barcelona, Spain
| | | | | | | | - Beatriz López-Cauce
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Ignacio Marín-Jiménez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - Luis Menchén
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - Emilio Laserna-Mendieta
- Departamento of Gastroenterología, Hospital General de Tomelloso, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
| | - Alfredo J Lucendo
- Departamento of Gastroenterología, Hospital General de Tomelloso, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 28029 Madrid, Spain
| | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Luis A López-Fernández
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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11
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Somoza-Fernández B, Ribed-Sánchez A, Martín-Lozano S, de Vega-San Vicente FM, Menéndez-Tarín R, Giménez-Manzorro Á, Sanz-Ruiz P, Garutti-Martínez I, Herranz-Alonso A, Vaquero-Martín J, Sanjurjo-Sáez M. Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results. Injury 2022; 53:3987-3992. [PMID: 36244831 DOI: 10.1016/j.injury.2022.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery. MATERIAL AND METHODS A multidisciplinary group created the programme and the patient school (preoperative consultations where the patients' surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D). RESULTS One hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively. CONCLUSIONS The ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.
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Affiliation(s)
- B Somoza-Fernández
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain.
| | - A Ribed-Sánchez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - S Martín-Lozano
- Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - F M de Vega-San Vicente
- Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - R Menéndez-Tarín
- Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - Á Giménez-Manzorro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - P Sanz-Ruiz
- Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - I Garutti-Martínez
- Anesthesiology and Resuscitation Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - A Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - J Vaquero-Martín
- Traumatology and Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
| | - M Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo Street, 46, Madrid 28007, Spain
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12
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Villanueva-Bueno C, Collado-Borrell R, Rodríguez-González CG, Escudero-Vilaplana V, Chamorro-de-Vega E, Ais-Larisgoitia A, Herranz-Alonso A, Sanjurjo-Sáez M. Implementation and evaluation of a home pharmaceutical care model through Telepharmacy. Farm Hosp 2022; 46:36-46. [PMID: 36520559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To describe the impact of a Specialized Pharmaceutical Care model that includes pharmacotherapeutic monitoring of patients through an Telepharmacy platform and home medication dispensing. METHOD A descriptive and retrospective study conducted in the Pharmacy Service of a tertiary hospital, between 23 March 2020 and 31 December 2021. A new pharmaceutical care model for chronic ambulatory patients was developed, including: (i) definition of criteria for selecting Telepharmacy candidate patients; (ii) stratification of patients by risk level; (iii) definition of individualized pharmacotherapeutic monitoring; (iv) adaptation of the Pharmacy Service app platform to ensure continuous pharmacotherapeutic monitoring and patient monitoring (e- Oncohealth, e-Midcare and farMcuida), (v) implementation of an appointment system; and (vi) development of a software module for the management of home medication delivery. The impact of this pharmaceutical care model was assessed by analyzing indicators of activity, safety, adherence and perceived quality. Moreover, an additional study on the impact of COVID‑19 was developed in order to assess the accessibility of medical care and continuity of treatment through a survey conducted on a random sample of 100 patients. RESULTS During the study period, 2,737 patients benefited from the new remote pharmaceutical care model. A total of 7,758 Telepharmacy consultations were performed. Pharmacotherapeutic monitoring prevented 1,043 adverse drug reactions, which affected 10.4% of patients (3.6 adverse drug reactions/patient). Mean adherence to treatment was 95.2%. Overall satisfaction with the new model was 9.8/10. All patients would recommend this model to other patients. CONCLUSIONS The new Pharmaceutical care model increases patient safety and improves treatment adherence, with a high perceived quality. Patient stratification and individualized follow-up via an Telepharmacy platform were crucial to the development of this model.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Roberto Collado-Borrell
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Carmen Guadalupe Rodríguez-González
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Vicente Escudero-Vilaplana
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Esther Chamorro-de-Vega
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Arantza Ais-Larisgoitia
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón. Madrid.
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Bravo-Gómez A, Salvador-Martín S, Zapata-Cobo P, Sanjurjo-Sáez M, López-Fernández LA. Genotyping of UGT1A1*80 as an Alternative to UGT1A1*28 Genotyping in Spain. Pharmaceutics 2022; 14:pharmaceutics14102082. [PMID: 36297516 PMCID: PMC9610287 DOI: 10.3390/pharmaceutics14102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The variant rs34983651 (UGT1A1*28) and its genotyping are used to prevent irinotecan-induced toxicity. Several variants are in close linkage disequilibrium. Our objective was to evaluate the potential correlation of genotyping UGT1A1*80 instead of UGT1A1*28 in different populations. Methods: We studied SNPs in linkage disequilibrium with UGT1A1*28 in several populations and selected rs887829 to develop an inexpensive and rapid genotyping method and compare it with the one we currently use for UGT1A1*28 genotyping. Samples from cancer patients (n = 701) already tested using PCR and electrophoresis prior to treatment with irinotecan for rs34983651 (UGT1A1*28) in a Spanish hospital were genotyped for rs887829 (UGT1A1*80) using real-time PCR with a TaqMan probe. Results: We observed a complete match for both genotypes, except in one sample. This method was 100% efficient in correctly genotyping *28/*28 patients, 99.68% efficient for *1/*28, and 100% efficient for *1/*1. Linkage disequilibrium between populations showed the Iberian population to be the most suitable for the clinical use of UGT1A1*80. This method is less expensive and the time to decision is shorter. Conclusion: Genotyping of rs887829 using the proposed method may be used to substitute genotyping of rs34983651 as a pharmacogenetics test in cancer patients prior to starting irinotecan-based treatments, mainly in the Iberian population. In addition, it is less expensive than other conventional methods and easy to implement, with a shorter time to decision than UGT1A1*28.
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Affiliation(s)
- Adrián Bravo-Gómez
- Servicio de Bioquímica, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Sara Salvador-Martín
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Correspondence: (S.S.-M.); (L.A.L.-F.)
| | - Paula Zapata-Cobo
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Luis Andrés López-Fernández
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Correspondence: (S.S.-M.); (L.A.L.-F.)
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14
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Collado-Borrell R, Escudero-Vilaplana V, Narrillos-Moraza Á, Villanueva-Bueno C, Herranz-Alonso A, Sanjurjo-Sáez M. Patient-reported outcomes and mobile applications. A review of their impact on patients' health outcomes. Farm Hosp 2022; 46:173-181. [PMID: 36183211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To review the evidence of the mobile apps in collection patient- reported outcomes and their impact on health outcomes. Method: A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps' impact on patients' health outcomes. The search was carried out during April 2021 in Pubmed and Embase using the search terms "app", "mobile applications" , "patient-reported outcomes", "outcome assessment, health care", and "quality of life", To be included articles had to be written in English or Spanish and they were required to dwell on apps used by patients, family members and/or caregivers that measured at least one health outcome. No time restrictions were applied. RESULTS Of the 26 articles reviewed, 19 (73.1%) were clinical trials, 4 (15.4%) were quasi-experimental studies, and 3 (11.5%) were observational studies. A pharmacy department was involved in 4 studies (15.4%), and 3 (11.5%), were carried out in Spain. The sample size ranged from 14 to 411. Depending on the study population, the most frequent studies included cancer patients (42.3%) and patients with cardiovascular diseases (26.9%). Most of the studies focused on measuring the impact of the app on the patients' quality of life (50.0%), control of clinical parameters (46.2%), adherence (38.5%), and management of symptoms and/or reduction of complications (26.9%). Overall efficacy in terms of the percentage of studies where apps were found to result in a significant improvement was 73.1%. The most heavily impacted patient-reported outcomes were adherence, health-related quality of life and satisfaction. CONCLUSIONS There is emerging evidence that apps have a positive impact on patients' health outcomes. These tools have shown to lead to an improvement in the management of different conditions, with results showing a reduction in complications rates and in the consumption of resources as well as better adherence to medication and enhanced patient quality of life.
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Affiliation(s)
- Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
| | - Álvaro Narrillos-Moraza
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
| | - Cristina Villanueva-Bueno
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid. Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid. Spain..
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15
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Narrillos-Moraza Á, Gómez-Martínez-Sagrera P, Amor-García MÁ, Escudero-Vilaplana V, Collado-Borrell R, Villanueva-Bueno C, Gómez-Centurión I, Herranz-Alonso A, Sanjurjo-Sáez M. Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale. JMIR Mhealth Uhealth 2022; 10:e32826. [PMID: 35171109 PMCID: PMC8892317 DOI: 10.2196/32826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. Objective The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). Methods We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen κ coefficient. Results We identified 2100 apps in the initial search, and 4.19% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61% (54/88) were available on Android, 30% (26/88) were available on iOS, and 9% (8/88) were available on both platforms. Moreover, 7% (6/88) required payment, and 49% (43/88) were updated in the last year. Only 26% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68%), followed by preventive (23/88, 26%) and diagnostic (5/88, 6%). Most of the apps were intended for patients with anemia (23/88, 26%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). Conclusions There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality.
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Affiliation(s)
| | | | | | | | | | | | | | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Vicente-Valor J, García-González X, Ibáñez-García S, Durán-García ME, de Lorenzo-Pinto A, Rodríguez-González C, Méndez-Fernández I, Percovich-Hualpa JC, Herranz-Alonso A, Sanjurjo-Sáez M. PCSK9 inhibitors revisited: Effectiveness and safety of PCSK9 inhibitors in a real-life Spanish cohort. Biomed Pharmacother 2021; 146:112519. [PMID: 34968928 DOI: 10.1016/j.biopha.2021.112519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have emerged as a therapeutic option for patients with hypercholesterolemia who do not attain low-density lipoprotein cholesterol (LDL-C) goals and/or are intolerant to other lipid-lowering drugs. Our aim was to analyze the effectiveness and safety of PCSK9i in routine clinical practice and factors related to poor outcomes. MATERIALS AND METHODS We conducted an ambispective study in 115 patients who recieved alirocumab or evolocumab, in a tertiary level hospital. From February 2017 to April 2020, patients were recruited and followed up for a median of 20.4 months. The main outcomes were relative reduction in LDL-C, percentage of patients achieving the therapeutic goals established by 2016 ESC/EAS guidelines, incidence of major cardiovascular events (MACEs) and drug-related adverse events (ADRs). RESULTS The median LDL-C achieved was 57.0 mg/dL (relative reduction of 59.9% from baseline, p< 0.001). After adjusting for confounders, smaller LDL-C reductions were related to female sex, absence of concomitant lipid-lowering therapy and treatment with alirocumab. Overall, 84.6% of the patients achieved the therapeutic goals. During follow-up, 7 MACEs were detected. ADRs, generally considered mild, affected 38.1% of the participants (mainly mialgias and arthralgias) and triggered discontinuations in 8.7% of cases. CONCLUSIONS PCSK9i are effective and safe, although certain factors may influence their effectiveness. Interestingly, our results suggest that alirocumab and evolocumab may not be therapeutic equivalents, as initially suggested.
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Affiliation(s)
- Juan Vicente-Valor
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Xandra García-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sara Ibáñez-García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Esther Durán-García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carmen Rodríguez-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Irene Méndez-Fernández
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich-Hualpa
- Endocrinology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Hoyo-Muñoz A, Collado-Borrell R, Escudero-Vilaplana V, Bastos-Oreiro M, Herranz-Alonso A, Sanjurjo-Sáez M. Thalidomide as treatment of refractory thoracic Rosai-Dorfman disease. J Clin Pharm Ther 2021; 47:548-551. [PMID: 34514634 DOI: 10.1111/jcpt.13513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Rosai-Dorfman disease (RDD) is an infrequent entity of unknown aetiology. Currently, there is no clear consensus on the treatment, and nothing has shown definitive safety and efficacy. We describe the case of a woman diagnosed with pulmonary RDD, who responded to thalidomide treatment after failure of four previous lines of systemic chemotherapy. CASE DESCRIPTION We present the case of a 74-year-old woman diagnosed with pulmonary RDD and autoimmune complications. We decided to use thalidomide as a rescue treatment after the failure of corticosteroids and several chemotherapies. Our patient achieved remission of the disease and remained stable for years. WHAT IS NEW AND CONCLUSION To the authors' knowledge, this is the first reported case in which thalidomide treatment induced remission in refractory pulmonary RDD. Thalidomide showed a rapid onset of action, with lasting responses, which could make it an exciting option for treating this life-threatening.
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Affiliation(s)
- Angela Hoyo-Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mariana Bastos-Oreiro
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Amor-García MÁ, Rodríguez-González CG, Chamorro-de-Vega E, Herranz-Alonso A, Sanjurjo-Sáez M. Dolutegravir-Based Dual Therapies in HIV Pretreated Patients: A Real-Life Study in Madrid. Ann Pharmacother 2021; 56:401-411. [PMID: 34382435 DOI: 10.1177/10600280211038504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies describe the use of dolutegravir (DTG)-based dual therapies under routine clinical practice. OBJECTIVES To report real-life data on the use of DTG-based dual therapies in treatment-experienced patients. METHODS This was an observational, retrospective study. It included all treatment-experienced HIV patients starting a DTG-based dual therapy from 2014 to 2018. The primary end point was to identify the incidence and reasons for the switch. The secondary end points were to assess the effectiveness, safety, adherence, and costs after 48 weeks of treatment (W48). RESULTS The incidence of the switch to a DTG-based dual therapy increased from 1.6 patients per 1000 patient-years in 2014 to 38.6 in 2018. A total of 241 patients initiated this therapy: 113 (46.9%) patients started DTG plus rilpivirine (RPV), 72 (29.9%), DTG plus lamivudine (3TC), and 68 (28.2%), DTG plus boosted-darunavir (b-DRV). A total of 170 patients completed W48 of follow-up. By intention-to-treat analysis, 89.3% of virologically suppressed (VS) patients (94.3% with DTG plus b-DRV, 91.3% with DTG plus 3TC, and 87.2% with DTG plus RPV) and 56.7% of non-VS patients (71.4% with DTG plus RPV and 52.2% with DTG plus b-DRV) achieved a viral load <50 copies/mL at W48. The protocol-defined virological failure was 6.5%. Overall, 8.8% of patients had early discontinuation. The annual cost increased by €800 per patient ($916). CONCLUSIONS AND RELEVANCE The use of DTG-based dual therapies has increased in real life, showing a favorable effectiveness and safety profile. Treatment costs increased, except for the switch to DTG plus 3TC.
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Manrique-Rodríguez S, Heras-Hidalgo I, Pernia-López MS, Herranz-Alonso A, Del Río Pisabarro MC, Suárez-Mier MB, Cubero-Pérez MA, Viera-Rodríguez V, Cortés-Rey N, Lafuente-Cabrero E, Martínez-Ortega MC, Bermejo-López E, Díez-Sáenz C, López-Sánchez P, Gaspar-Carreño ML, Achau-Muñoz R, Márquez-Peiró JF, Valera-Rubio M, Domingo-Chiva E, Aquerreta-González I, Ariño IP, Martín-Delgado MC, Herrera-Gutiérrez M, Gordo-Vidal F, Rascado-Sedes P, García-Prieto E, Fernández-Sánchez LJ, Fox-Carpentieri S, Lamela-Piteira C, Guerra-Sánchez L, Jiménez-Aguado M, Sanjurjo-Sáez M. Standardization and Chemical Characterization of Intravenous Therapy in Adult Patients: A Step Further in Medication Safety. Drugs R D 2021; 21:39-64. [PMID: 33346878 PMCID: PMC7937591 DOI: 10.1007/s40268-020-00329-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. AIM The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. METHODS The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. RESULTS In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. CONCLUSIONS Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.
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Affiliation(s)
- Silvia Manrique-Rodríguez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain.
| | - Irene Heras-Hidalgo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Sagrario Pernia-López
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
| | - M Camino Del Río Pisabarro
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - M Belén Suárez-Mier
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Antonia Cubero-Pérez
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Verónica Viera-Rodríguez
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Noemí Cortés-Rey
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - Elizabeth Lafuente-Cabrero
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital del Mar, Barcelona, Spain
| | - M Carmen Martínez-Ortega
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Preventive Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Esther Bermejo-López
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Díez-Sáenz
- Nursing Department (Intensive Care), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Piedad López-Sánchez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital General de Tomelloso, Ciudad Real, Spain
| | - M Luisa Gaspar-Carreño
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Intermutual de Levante, Valencia, Spain
| | - Rubén Achau-Muñoz
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Intermutual de Levante, Valencia, Spain
| | - Juan F Márquez-Peiró
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Perpetuo Socorro, Alicante, Spain
| | - Marta Valera-Rubio
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Esther Domingo-Chiva
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Irene Aquerreta-González
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ignacio Pellín Ariño
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital de Torrejón de Ardoz, Madrid, Spain
| | - M Cruz Martín-Delgado
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital de Torrejón de Ardoz, Madrid, Spain
| | - Manuel Herrera-Gutiérrez
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Federico Gordo-Vidal
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Universitario del Henares, Madrid, Spain
| | - Pedro Rascado-Sedes
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Complejo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain
| | - Emilio García-Prieto
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Sara Fox-Carpentieri
- Nursing Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Carlos Lamela-Piteira
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Álvarez-Buylla, Mieres, Spain
| | - Luis Guerra-Sánchez
- Nursing Department (Coronary Unit), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Miguel Jiménez-Aguado
- Nursing Department (Coronary Unit), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
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Amor-García MÁ, Ibáñez-García S, García-González X, Mombiela T, Villanueva-Bueno C, Herranz-Alonso A, Sanjurjo-Sáez M. Clinical evaluation of pulmonary hypertension using patient-reported outcomes: a cross-sectional study. BMC Pulm Med 2021; 21:48. [PMID: 33530979 PMCID: PMC7852357 DOI: 10.1186/s12890-021-01416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation. Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.
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Affiliation(s)
- Miguel Ángel Amor-García
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Sara Ibáñez-García
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Xandra García-González
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Villanueva-Bueno
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
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Amor-García MÁ, Fernández-Llamazares CM, Manrique-Rodríguez S, Narrillos-Moraza Á, García-Morín M, Huerta-Aragonés J, Sanjurjo-Sáez M. Bromocriptine for the treatment of postoperative cerebellar mutism syndrome in pediatric patients: Three case reports. J Oncol Pharm Pract 2020; 27:1753-1757. [PMID: 33356885 DOI: 10.1177/1078155220982046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cerebellar mutism syndrome (CMS) is a common complication after posterior fossa tumor resection. It is characterized by a significant lack or loss of speech. Its biological origin remains unclear and there are no standardized treatments. However, bromocriptine seems to be a possible treatment for this condition. CASE REPORT In this paper, we present three cases of pediatric patients (4, 5, and 17-year old) who developed CMS after posterior fossa tumor surgery. They were treated with bromocriptine to improve neurological symptoms.Management and outcome: Bromocriptine was started at a low dose and was progressively increased to reach the minimum effective dose. After four months of treatment, a normal and fluid speech was observed in the three patients. No discontinuation due to adverse events were reported. DISCUSSION Bromocriptine has shown to be an effective and safe treatment for CMS in pediatric patients after posterior fossa tumor resection.
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Affiliation(s)
- Miguel Á Amor-García
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cecilia M Fernández-Llamazares
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Álvaro Narrillos-Moraza
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina García-Morín
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Huerta-Aragonés
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Marquinez-Alonso I, Escudero-Vilaplana V, Osorio S, Rodriguez-Gonzalez CG, González-Haba E, Sanjurjo-Sáez M. Evaluation of the use, effectiveness and safety of tyrosine kinase inhibitors in chronic myelogenous leukaemia in a general university hospital. Eur J Hosp Pharm 2020; 27:299-301. [DOI: 10.1136/ejhpharm-2017-001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/28/2017] [Accepted: 01/30/2018] [Indexed: 11/04/2022] Open
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Collado-Borrell R, Escudero-Vilaplana V, Ribed A, Jiménez RR, Peinado II, Herranz-Alonso A, Sanjurjo-Sáez M. Novel mobile application for direct communication between pharmacists and patients treated with oral antineoplastic agents. Am J Health Syst Pharm 2020; 77:1393-1402. [PMID: 32620958 DOI: 10.1093/ajhp/zxaa144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Initial experience with use of a smartphone application to enhance communication with and home monitoring of hematology/oncology patients under treatment with oral antineoplastic agents (OAAs) is described. SUMMARY Broad use of OAAs is changing the landscape of hematology/oncology patient care, with this form of therapy giving patients greater autonomy but also raising concerns about correct OAA administration and management of adverse effects (AEs) or interactions. Information and communication technologies, specifically mobile health technologies, are ideal tools in this new environment. A multidisciplinary team at a large hospital in Spain developed a smartphone application for patients receiving OAA therapy that consists of 5 modules or functionalities: (1) a treatment agenda, or electronic journal of patient activity, including medication use; (2) a treatment record; (3) continuous recording of vital signs (blood pressure and temperature), health-related quality of life, and AEs, with management of AEs based on an algorithm that displays different recommendations according to AE severity; (4) 2-way messaging capability; and (5) information and links to websites of interest. From June through November 2017, 37 patients downloaded and used the application. About two-thirds (68%) of the patients sent a total of 182 messages to the pharmacist on duty; 58% of the patients registered at least 1 AE. The mean time of registration of the first AE after initiation of OAA therapy was 8 days. As a result of patient use of the application, 2 emergency room visits were avoided and 3 patients were referred to a general practitioner. CONCLUSION The application has allowed real-time monitoring of patients treated with OAAs. This new patient-pharmacist communication channel has facilitated the early detection of AEs, contributing to the safety of treatment and patient satisfaction with healthcare.
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Affiliation(s)
- Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Almudena Ribed
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rosa Romero Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Amor-García MÁ, Collado-Borrell R, Escudero-Vilaplana V, Melgarejo-Ortuño A, Herranz-Alonso A, Arranz Arija JÁ, Sanjurjo-Sáez M. Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth 2020; 8:e17609. [PMID: 32706737 PMCID: PMC7413276 DOI: 10.2196/17609] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/06/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. OBJECTIVE The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. METHODS We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. RESULTS In total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: "Bladder cancer manager," "Kidney cancer manager," "My prostate cancer manager," "Target Ovarian Cancer Symptoms Diary," and "My Cancer Coach." We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). CONCLUSIONS MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality.
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Affiliation(s)
- Miguel Ángel Amor-García
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alejandra Melgarejo-Ortuño
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Ángel Arranz Arija
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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25
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Salvador-Martín S, Pujol-Muncunill G, Bossacoma F, Navas-López VM, Gallego-Fernández C, Segarra O, Clemente S, Muñoz-Codoceo R, Viada J, Magallares L, Martínez-Ojinaga E, Moreno-Álvarez A, Solar-Boga A, Loverdos I, Merino-Bohórquez V, Balboa-Vega MJ, Rodriguez-Martinez A, Alvarez-Vayo C, Sanchez C, Tolin M, Blanca-García JA, García-Romero R, Eizaguirre FJ, Sánchez-Hernandez JG, de Caldas RG, Millán-Jimenez A, Aznal E, Abarca-Zabalía J, Sanjurjo-Sáez M, López-Fernández LA. Pharmacogenetics of trough serum anti-TNF levels in paediatric inflammatory bowel disease. Br J Clin Pharmacol 2020; 87:447-457. [PMID: 32478906 DOI: 10.1111/bcp.14400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Identifying DNA variants associated with trough serum anti-tumour necrosis factor (TNF) levels could predict response to treatment in inflammatory bowel disease (IBD). To date, no specific studies have been performed in children. The aim of this study was to identify genetic variants associated with trough serum anti-TNF levels and whether these variants are differential markers for infliximab and adalimumab. METHODS We included 154 children (age < 18 years) from 17 hospitals who had been diagnosed with IBD and actively treated with infliximab or adalimumab. Twenty-one polymorphisms were genotyped using real-time PCR. Trough serum anti-TNF levels were measured using enzyme-linked immunosorbent assay (ELISA). The association between DNA polymorphisms and the therapeutic range or the absolute values of anti-TNF drugs was analysed by Fisher exact test, student's t-test and logistic regression. RESULTS The variants rs5030728 (TLR4) and rs11465996 (LY96) were associated with subtherapeutic infliximab levels. rs1816702 (TLR2) was associated with supratherapeutic levels and rs3397 (TNFRSF1B) with subtherapeutic levels of adalimumab (P < .05). In addition, rs1816702 (TLR2) and rs2569190 (CD14) were associated with absolute values of trough serum adalimumab, and rs2569190 (CD14) was associated with absolute values of trough serum adalimumab and infliximab (P < .05). CONCLUSION Genotyping of these DNA variants before starting treatment may help to select the best anti-TNF drug in paediatric patients. The SNP rs1816702 is the most promising marker for tailoring the anti-TNF regimen in children with IBD. For the first time, DNA variants are associated with trough serum anti-TNF levels.
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Affiliation(s)
- Sara Salvador-Martín
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ferran Bossacoma
- Fundació Sant Joan de Déu, Fundació Salut Emporda, Barcelona, Spain
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, IBIMA Multidisciplinary Group for Paediatric Research, Málaga, Spain
| | | | - Oscar Segarra
- Paediatric Gastroenterology Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Susana Clemente
- Pharmacy Service, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Rosana Muñoz-Codoceo
- Department of Paediatric Gastroenterology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Javier Viada
- Department of Paediatric Gastroenterology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lorena Magallares
- Department of Paediatric Gastroenterology, University Hospital La Paz, Madrid, Spain
| | - Eva Martínez-Ojinaga
- Department of Paediatric Gastroenterology, University Hospital La Paz, Madrid, Spain
| | - Ana Moreno-Álvarez
- Paediatric Gastroenterology Unit, Department of Paediatrics, A Coruña University Hospital, A Coruña, Spain
| | - Alfonso Solar-Boga
- Paediatric Gastroenterology Unit, Department of Paediatrics, A Coruña University Hospital, A Coruña, Spain
| | - Inés Loverdos
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Barcelona, Spain
| | | | | | - Alejandro Rodriguez-Martinez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cesar Sanchez
- Gastroenterology Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mar Tolin
- Gastroenterology Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Ruth García-Romero
- Paediatric Gastroenterology Unit, Hospital Infantil Miguel Servet, Zaragoza, Spain
| | | | | | | | | | - Elena Aznal
- Paediatry Department, Hospital Virgen del Camino, Pamplona, Spain
| | - Judith Abarca-Zabalía
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Luis Andrés López-Fernández
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Spanish Clinical Research Network, SCReN, Madrid, Spain
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Herranz-Alonso A, Rodríguez-González CG, Sarobe-González C, Álvarez-Díaz A, Sanjurjo-Sáez M. Pharmacy Department management and organization. Farm Hosp 2020; 44:5-10. [PMID: 32533661 DOI: 10.7399/fh.11514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The WHO declared the SARS- CoV-2 outbreak a pandemic in March 11, 2020. Spain has been the third country with the highest number of reported cases of COVID-19. In the face of the pandemic, the authorities of the Autonomous Community of Madrid led an unprecedented transformation of hospital services by increasing the number of beds available, setting up temporary field hospitals in fairgrounds, and transforming hotels into support centers for patients with mild symptoms of COVID-19. In the light that this crisis will continue to be a real threat for the years to come, our hospital pharmacies need to be better prepared for similar outbreaks in the future. During the COVID-19 pandemic, the Department of Hospital Pharmacy of Hospital General Universitario Gregorio Marañón has faced four challenges: an exponential increase in the demand for resources, constant changes to therapeutic protocols and approaches, regulatory changes, and a dramatic impact on hospital staff (strain on human resources and psychological impact). This article is aimed at describing the main organizational changes implemented to the Department of Hospital Pharmacy of Hospital GU Gregorio Marañón and its relationship with other hospital pharmacies of the Community of Madrid. An account is provided of the strategies to be adopted for reorganizing a Department of Hospital Pharmacy and achieve a safe and effective use of medications. Strategies range from the creation of integral hospital task groups (COVID-crisis task group, protocolization task group, research task group) to the adaptation of the internal organization of the Department of Hospital Pharmacy, which encompasses aspects related to management and leadership; a communication plan (internal and external); staff management, and the reorganization and adaptation of processes. People, patients and professionals are at the core of these strategies. This paper is a reflection on key factors of "humanization in COVID times".
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Affiliation(s)
- Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
| | | | | | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid. España.
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27
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de Lorenzo-Pinto A, García-Sánchez R, Herranz A, Miguens I, Sanjurjo-Sáez M. Promoting clinical pharmacy services through advanced medication review in the emergency department. Eur J Hosp Pharm 2020; 27:73-77. [PMID: 32133132 DOI: 10.1136/ejhpharm-2018-001599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine if an advanced medication review carried out in the emergency department (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors. Methods We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay. Results The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached. Conclusions An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Raquel García-Sánchez
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Iria Miguens
- Emergency Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gergorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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28
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García-Martín E, Manrique-Rodríguez S, Martínez Fernández-Llamazares C, Goicoechea-Diezhondino M, Álvarez-Blanco O, García-Morín M, Sanjurjo-Sáez M. Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1703108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Marian Goicoechea-Diezhondino
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Olalla Álvarez-Blanco
- Pediatric Nephrology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marina García-Morín
- Pediatric Oncohematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Director of Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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29
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Rodríguez-González CG, Sarobe-González C, Durán-García ME, Mur-Mur A, Sánchez-Fresneda MN, Pañero-Taberna MDLM, Pla-Mestre R, Herranz-Alonso A, Sanjurjo-Sáez M. Use of the EFQM excellence model to improve hospital pharmacy performance. Res Social Adm Pharm 2019; 16:710-716. [PMID: 31471210 DOI: 10.1016/j.sapharm.2019.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Quality management systems are widely used to improve the quality and efficiency of healthcare services. However, evidence regarding the value of the European Foundation for Quality Management (EFQM) model in improving the performance of hospital departments is lacking. OBJECTIVE To describe the value of the EFQM model as a quality framework for improving the performance of a hospital pharmacy department (PD). METHODS DESIGN A case study describing the development of the Enablers' criteria of the model and the results achieved. SETTING PD in a tertiary-care teaching hospital of the Madrid Public Health Service (Spain). INTERVENTIONS Four self-assessments were conducted using the questionnaire "Perfil" during the period 2008-2017. A quality improvement plan was developed on the basis of the results of each self-assessment. A balanced scorecard was used to track progress. Improvement in quality management was externally evaluated by the Spanish Management Excellence Club in 2010, 2013, and 2017. MAIN OUTCOME MEASURES Change in the scores obtained in the external assessments, the quality improvement initiatives implemented for each Enabler's criteria, and the results of key performance indicators. RESULTS The EFQM was a useful framework for self-assessment and a good system for identifying improvement initiatives. The model progressively improved the services provided for patients, the safety and efficiency of pharmacotherapy, productivity of the PD, and customer and staff satisfaction. The external assessment scores exceeded 300 points in 2010, 400 points in 2013, and 500 points in 2017. Scores for all of the criteria progressively improved, particularly in 'people'. CONCLUSIONS The EFQM was a practical tool for improvement of PD performance, especially in areas such as strategic planning, people management, and innovation. The main difficulties were the lack of decision-making capacity in relevant areas and benchmarking with other PDs.
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Affiliation(s)
- Carmen Guadalupe Rodríguez-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Camino Sarobe-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Esther Durán-García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Ana Mur-Mur
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Norberta Sánchez-Fresneda
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María de Las Mercedes Pañero-Taberna
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Rosa Pla-Mestre
- Quality Improvement Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón. c/ Doctor Esquerdo, 46, 28007, Madrid, Spain
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30
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Salvador-Martiín S, García-González X, García MI, Blanco C, García-Alfonso P, Robles L, Grávalos C, Pachón V, Longo F, Martínez V, Sanjurjo-Sáez M, López-Fernández LA. Comments on: “Clinical utility of ABCB1 genotyping for preventing toxicity in treatment with irinotecan”. Pharmacol Res 2019; 145:104288. [DOI: 10.1016/j.phrs.2019.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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31
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Revuelta-Herrero JL, García-Sánchez R, Anguita-Velasco J, de Lorenzo-Pinto A, Ortega-Navarro C, Sanjurjo-Sáez M. Drug safety surveillance within a strategy for the management of non-chemotherapy drug-induced neutropenia. Int J Clin Pharm 2019; 41:1143-1147. [PMID: 31256332 DOI: 10.1007/s11096-019-00873-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/22/2019] [Indexed: 01/23/2023]
Abstract
Background Severe non-chemotherapy drug-induced neutropenia is a rare idiosyncratic drug reaction that is considered potentially fatal. Objective To report, in terms of drug safety surveillance, the results of an institutional strategy for NCDIN. Method An observational and prospective study including all adult patients who received filgrastim for the treatment of NCDIN from June 2015 to December 2017 was carried out by hematologists and clinical pharmacists. Results 13 patients with severe NCDIN were included in the study. The median age was 51 (range 24-80) years old and 46.2% were male. Seven patients had one or more negative prognostic factors (age > 65 years, renal impairment, autoimmune diseases and/or a neutrophil count at diagnosis < 0.1 × 109 cells/L). A single drug was identified as causative in 3 patients, while in 10 cases, 2-3 drugs were considered as potentially causative. The most frequent drugs were metamizole, piperacillin/tazobactam, dexketoprofen and linezolid, among others. Seven patients developed NCDIN during their hospital stay while 6 were admitted to the emergency department. Patients were using a median of 11 drugs (IQR 8-15) at the time of diagnosis. No deaths were recorded. Conclusion Metamizole and piperacillin/tazobactam are the most common drugs linked to non-chemotherapy drug-induced neutropenia in our cohort.
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Affiliation(s)
- José Luis Revuelta-Herrero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Raquel García-Sánchez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Javier Anguita-Velasco
- Haematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, Madrid, 28007, Spain
| | - Ana de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Cristina Ortega-Navarro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
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Monje B, Giménez-Manzorro Á, Ortega-Navarro C, Herranz-Alonso A, Sanjurjo-Sáez M. Trends in hospital consumption of analgesics after the implementation of a pain performance improvement plan. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 30935672 PMCID: PMC9391869 DOI: 10.1016/j.bjane.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Pain management committee established a pain performance improvement plan in 2012. Objectives The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. Methods A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti-inflammatory and antirheumatic products non-steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed-days to analyze consumption trends. Main outcome measure: assessment of the analgesic consumption after the implementation of a pain performance improvement plan. Results Overall, non-steroidal anti-inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed-days (−28.3%), accounting for most of the total analgesic consumption decrease (−13%) and total cost (−44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 bed-days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed-days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed-days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed-days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed-days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. Conclusion Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non-steroidal anti-inflammatory and antirheumatic products.
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Monje B, Giménez-Manzorro Á, Ortega-Navarro C, Herranz-Alonso A, Sanjurjo-Sáez M. [Trends in hospital consumption of analgesics after the implementation of a pain performance improvement plan]. Rev Bras Anestesiol 2019; 69:259-265. [PMID: 30935672 DOI: 10.1016/j.bjan.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Pain management committee established a pain performance improvement plan in 2012. OBJECTIVE The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. METHODS A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti-inflammatory and antirheumatic products non-steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed-days to analyze consumption trends. MAIN OUTCOME MEASURE assessment of the analgesic consumption after the implementation of a pain performance improvement plan. RESULTS Overall, non-steroidal anti-inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed-days (-28.3%), accounting for most of the total analgesic consumption decrease (-13%) and total cost (-44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 bed-days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed-days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed-days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed-days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed-days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. CONCLUSION Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non-steroidal anti-inflammatory and antirheumatic products.
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Affiliation(s)
- Beatriz Monje
- Hospital General Universitario Gregorio Marañón, Pharmacy Department, Madrid, Espanha; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Espanha.
| | - Álvaro Giménez-Manzorro
- Hospital General Universitario Gregorio Marañón, Pharmacy Department, Madrid, Espanha; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Espanha
| | - Cristina Ortega-Navarro
- Hospital General Universitario Gregorio Marañón, Pharmacy Department, Madrid, Espanha; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Espanha
| | - Ana Herranz-Alonso
- Hospital General Universitario Gregorio Marañón, Pharmacy Department, Madrid, Espanha; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Espanha
| | - María Sanjurjo-Sáez
- Hospital General Universitario Gregorio Marañón, Pharmacy Department, Madrid, Espanha; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Espanha
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Collado-Borrell R, Escudero-Vilaplana V, Ribed A, Anglada-Martínez H, Martín-Conde M, Herranz-Alonso A, Codina-Jané C, Sanjurjo-Sáez M. Design of the functional requirements of a smartphone app for patients receiving oral antineoplastic agents: The e-OncoSalud® app. J Oncol Pharm Pract 2019; 26:105-115. [DOI: 10.1177/1078155219840419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To design a mobile app based on the needs of the onco-hematological patient receiving oral antineoplastic agents. Methods A multidisciplinary working group (pharmacy–oncology–hematology) was created to design the app. The study was developed in three phases: first, we analyzed the features of patients receiving oral antineoplastic agents. We then analyzed available apps for cancer patients. Finally, we designed the app's functionalities. Results We included 51 patients with middle-advanced age (68.7 years (SD=10.7)). They were polymedicated (mean: 5.3 (SD = 2.7), with numerous drug–drug interactions and adverse effects (all patients presented adverse effects). We then analyzed 166 apps. Most apps had more than one use, the most frequent being information (39.8%) and diagnosis (38.6%). Ten apps (6%) were for registering and monitoring treatment and adverse effects. Almost half of the apps (48.8%) were developed by healthcare organizations. Finally, we designed an app (e-OncoSalud®) with the following functionalities: (a) agenda; (b) treatment and drug interactions checker; (c) continuous recording of self-controls (weight, blood pressure, general condition) and adverse effects. The management of the adverse effects are based on an algorithm which provides different recommendations according to the adverse effects severity; (d) patient–pharmacist messaging in real-time; (e) education. Conclusions After analysis of the main problems affecting these patients and the needs not covered by the existing apps, we designed e-OncoSalud®. It integrates relevant information about their treatment, focused on drug interactions identification and the prevention, and management of adverse effects.
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Affiliation(s)
- Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Almudena Ribed
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | | | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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de Lorenzo-Pinto A, Ortega-Navarro C, Ribed A, Giménez-Manzorro Á, Ibáñez-García S, de Miguel-Guijarro Á, Ginel-Feito MD, Herranz A, Sanjurjo-Sáez M. Cancellations of elective surgical procedures due to inadequate management of chronic medications. J Clin Pharm Ther 2019; 44:561-564. [DOI: 10.1111/jcpt.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ana de Lorenzo-Pinto
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - Almudena Ribed
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - Sara Ibáñez-García
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | | | - Ana Herranz
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
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González-Haba-Peña E, Manrique-Rodríguez S, Herranz-Alonso AM, Iglesias-Peinado I, Sanjurjo-Sáez M. A comparative study of contamination in three closed systems for the preparation of hazardous drugs through simulations with fluorescein. Farm Hosp 2018; 42:234-238. [PMID: 30381043 DOI: 10.7399/fh.11024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study was to compare the environmental contamination generated during the preparation of cytostatic agents using three different methods through simulations using fluorescein, and the time required for preparation of each method. METHOD A comparative study of the processing of fluorescein mixtures using three types of closed systems was conducted at the centralized unit for hazardous drugs of the Pharmacy Department of a General Teaching Hospital. Environmental contamination was detected in critical points of connection, and in splashes produced at any other points. The main variable was qualitative detection of contamination through ultraviolet light when three methods were compared (method A: ChemoClave®, method B: SmartSite® valve and Texium® connector, method C: PhaSealTM with BD luer extension). A final number of 60 mixtures were prepared to detect differences of at least 5%. RESULTS Qualitative contamination at the critical points during preparation, was seen in groups A and B for every mixture that was processed. No contamination at all in critical points was seen in any of the mixtures prepared using PhaSealTM. Statistically significant differences were found between arms A and C (p < 0.001) and arms B and C (p < 0.001); no differences were found between arms A and B. CONCLUSIONS The combination of PhaSealTM system in conjunction with the BD luer extension for administering hazardous drugs from a tree modality system has been shown to be the system with the lowest level of contamination during processing without increasing the time required for preparation of the mixture.
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Affiliation(s)
- Eva González-Haba-Peña
- Servicio de Farmacia, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid.
| | - Silvia Manrique-Rodríguez
- Servicio de Farmacia, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid.
| | - Ana María Herranz-Alonso
- Servicio de Farmacia, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid.
| | | | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid.
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Salvador-Martín S, García-González X, García MI, Blanco C, García-Alfonso P, Robles L, Grávalos C, Pachón V, Longo F, Martínez V, Sanjurjo-Sáez M, López-Fernández LA. Clinical utility of ABCB1 genotyping for preventing toxicity in treatment with irinotecan. Pharmacol Res 2018; 136:133-139. [PMID: 30213564 DOI: 10.1016/j.phrs.2018.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/30/2018] [Accepted: 08/31/2018] [Indexed: 01/30/2023]
Abstract
Preventing severe irinotecan-induced adverse reactions would allow us to offer better treatment and improve patients' quality of life. Transporters, metabolizing enzymes, and genes involved in the folate pathway have been associated with irinotecan-induced toxicity. We analyzed 12 polymorphisms in UGT1A1, ABCB1, ABCG2, ABCC4, ABCC5, and MTHFR in 158 patients with metastatic colorectal cancer treated with irinotecan and studied the association with grade >2 adverse reactions (CTCAE). Among the most frequent ADRs, the SNPs rs1128503, rs2032582, and rs1045642 in ABCB1 and rs1801133 in MTHFR were associated with hematological toxicity and overall toxicity. The SNP rs11568678 in ABCC4 was also associated with overall toxicity. After correction of P values using a false discovery rate, only ABCB1 variants remained statistically significant. Haplotype analysis in ABCB1 showed an 11.3-fold and 4.6-fold increased risk of hematological toxicity (95% CI, 1.459-88.622) and overall toxicity (95% CI, 2.283-9.386), respectively. Consequently, genotyping of the three SNPs in ABCB1 can predict overall toxicity and hematological toxicity with a diagnostic odds ratio of 4.40 and 9.94, respectively. Genotyping of ABCB1 variants can help to prevent severe adverse reactions to irinotecan-based treatments in colorectal cancer.
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Affiliation(s)
- Sara Salvador-Martín
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Xandra García-González
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María I García
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Carolina Blanco
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Pilar García-Alfonso
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Luis Robles
- Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital Doce de Octubre, Madrid, Spain
| | - Cristina Grávalos
- Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital Doce de Octubre, Madrid, Spain
| | - Vanessa Pachón
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRICYS), CIBERONC, Madrid, Spain
| | - Federico Longo
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRICYS), CIBERONC, Madrid, Spain
| | - Virginia Martínez
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, Spain
| | - María Sanjurjo-Sáez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Luis A López-Fernández
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Spanish Clinical Research Network (SCReN), Spain.
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Revuelta-Herrero JL, Giménez-Manzorro A, Matilla-Peña A, Herranz-Alonso A, Sanjurjo-Sáez M. Concomitant use of sorafenib with ombitasvir/paritaprevir/ritonavir and dasabuvir: Effectiveness and safety in clinical practice. J Clin Pharm Ther 2018; 43:906-909. [DOI: 10.1111/jcpt.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/31/2018] [Indexed: 01/10/2023]
Affiliation(s)
- J. L. Revuelta-Herrero
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Giménez-Manzorro
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Matilla-Peña
- Gastroenterology Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Herranz-Alonso
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - M. Sanjurjo-Sáez
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
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Mañes-Sevilla M, Romero-Jiménez R, Herranz-Alonso A, Sánchez-Fresneda M, Gonzalez-Haba E, Collado-Borrel R, Benedi-González J, Sanjurjo-Sáez M. Drug cost avoidance in clinical trials of breast cancer. J Oncol Pharm Pract 2018; 25:1099-1104. [PMID: 29792122 DOI: 10.1177/1078155218775193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objectives of this study were to determine if clinical trials in breast cancer, with an investigational drug, created direct drug cost savings for the healthcare system related to cost avoidance of the best standard of care treatments used in these studies. The aim was to quantify this potential drug cost avoidance. METHODS We conducted a retrospective observational study of the drug cost avoidance during the study period (2014-2016). We included clinical trials with investigational drug, managed by pharmacy department and provided by the sponsor. The patients included had a therapeutic alternative defined as standard treatment that should have been received in case of not participating in the clinical trial. Direct cost savings, to national healthcare system, associated to clinical trials were calculated. RESULTS Thirty-seven clinical trials with a total of 89 breast cancer patients were included in the study. A total of 62.2% were phase III and 75.7% belonged to the pharmaceutical industry. They provided a total cost avoidance of 957,246€ (1,130,028$), an average cost avoidance per patient of 10,756€ (12,697$). CONCLUSIONS Our study suggests that those clinical trials in which investigational drug are provided or refunded by the sponsor provide substantial cost savings. Due to the shortage of published articles that calculate the cost avoided in medication, we cannot compare directly the results obtained in the different institutions.
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Affiliation(s)
- M Mañes-Sevilla
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - R Romero-Jiménez
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - A Herranz-Alonso
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - M Sánchez-Fresneda
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - E Gonzalez-Haba
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - R Collado-Borrel
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - J Benedi-González
- 2 Pharmacy Department, Universidad Complutense de Madrid, Spain, Plaza de Ramón y Cajal, Madrid, Spain
| | - M Sanjurjo-Sáez
- 1 Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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40
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Revuelta-Herrero JL, Chamorro-de-Vega E, Rodríguez-González CG, Alonso R, Herranz-Alonso A, Sanjurjo-Sáez M. Effectiveness, Safety, and Costs of a Treatment Switch to Dolutegravir Plus Rilpivirine Dual Therapy in Treatment-Experienced HIV Patients. Ann Pharmacother 2017; 52:11-18. [PMID: 28836468 DOI: 10.1177/1060028017728294] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence about the use of dolutegravir (DTG) and rilpivirine (RPV) as an antiretroviral therapy (ART) in treatment-experienced patients is scarce. OBJECTIVE To explore the effectiveness, safety, and costs of switching to a DTG plus RPV regimen in this population. METHODS This observational, prospective study included all treatment-experienced patients who switched to DTG plus RPV between November 2014 and July 2016. Patients were excluded if resistance mutations to integrase inhibitors or RPV were found. The effectiveness endpoint was the proportion of patients who achieved virological suppression (viral load [VL] <50 copies/mL) at week 48 (W48). Safety (incidence of adverse events leading to discontinuation and laboratory abnormalities), adherence, and costs were analyzed. RESULTS A total of 35 patients were included, and 91.4% were virologically suppressed at baseline. Patients were treated with ART for a median of 14 years (interquartile range = 7-20). At W48, 91.4% of patients were virologically suppressed (95% CI = 77.0-98.2). Two of the 3 patients not suppressed at baseline achieved undetectable VL at W48, and 2 patients discontinued DTG plus RPV (intolerance and a drug-drug interaction). None of the virologically suppressed patients at baseline showed virological rebound through W48. There were no significant changes in lipid, liver, and renal profiles. The proportion of patients with an ART adherence >90% increased from 65.6% to 93.8% ( P = 0.004). The annual per-patient ART costs dropped by €665 ( P = 0.265). CONCLUSIONS Switching to DTG plus RPV seems to be an effective and safe strategy. Significant improvements in patients' adherence and costs were achieved.
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Affiliation(s)
- José Luis Revuelta-Herrero
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Esther Chamorro-de-Vega
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Carmen Guadalupe Rodríguez-González
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Roberto Alonso
- 2 Microbiology and Infectious Diseases Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
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41
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Escudero-Vilaplana V, Osorio-Prendes S, Collado-Borrell R, González-Arias E, Sanjurjo-Sáez M. Eosinophilia secondary to lenalidomide therapy. J Clin Pharm Ther 2017; 43:273-275. [PMID: 28833364 DOI: 10.1111/jcpt.12611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Limited data are available on eosinophilia as a drug adverse event. We describe a case of eosinophilia from lenalidomide therapy. CASE DESCRIPTION A 50-year-old woman received lenalidomide, dexamethasone and cyclophosphamide as POEMS syndrome treatment. Eosinophil count rose during lenalidomide treatment and decreased in the periods off treatment. Naranjo nomogram suggested a probable association between the use of lenalidomide and eosinophilia. WHAT IS NEW AND CONCLUSION Eosinophilia has rarely been described with lenalidomide. This case shows a clear temporal relationship between lenalidomide and eosinophilia.
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Affiliation(s)
- V Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - S Osorio-Prendes
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - E González-Arias
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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42
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Arrabal-Durán P, Rodríguez-González CG, Chamorro-de-Vega E, Gijón-Vidaurreta P, Herranz-Alonso A, Sanjurjo-Sáez M. Switching to a rilpivirine/emtricitabine/tenofovir single-tablet regimen in RNA-suppressed patients infected with human immunodeficiency virus 1: Effectiveness, safety and costs at 96 weeks. Int J Clin Pract 2017; 71. [PMID: 28722790 DOI: 10.1111/ijcp.12968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study evaluates the effectiveness, safety and costs of switching to a rilpivirine/emtricitabine/tenofovir disoproxil fumarate (RPV/FTC/TDF) regimen in treatment-experienced HIV-1-infected patients with sustained virological suppression. METHODS Observational, prospective study. Study population included all treatment-experienced patients with sustained virological suppression who switched to RPV/FTC/TDF during 2013 in a tertiary hospital. Patients were followed until they completed 96 weeks of treatment. The effectiveness end-point was defined as the proportion of patients who maintained virological suppression at week 96 by intention-to-treat analysis (discontinuation=failure). The safety of RPV/FTC/TDF (incidence of adverse events leading to discontinuation and laboratory abnormalities) and adherence to this regimen were evaluated, and the cost of switching was analysed. RESULTS One-hundred forty-six patients were included. At week 96, 71.9% of patients remained virologically suppressed; 6.8% experienced virological failure. During follow-up, 25.3% of patients discontinued RPV/FTC/TDF (14.4% because of adverse events, mainly renal impairment). Throughout the 96 weeks, there were significant decreases in total cholesterol (TC) (14.0 mg/dL, P<.001), TC/HDL cholesterol ratio (0.4 mg/dL, P=.019) and triglycerides (42.0 mg/dL, P<.001). A slight decrease in glomerular filtration rate was observed (4.3 mL/min/1.73 m2 , P<.001). Switching to RPV/FTC/TDF improved adherence in the subgroup of patients whose previous treatment was based on a twice-daily schedule, although differences did not reach statistical significance. Switching to RPV/FTC/TDF reduced the annual per-patient antiretroviral cost by €1744 (P<.001). CONCLUSIONS In virologically suppressed patients, the switch to a RPV/FTC/TDF regimen was associated with a mild but maintained improvement in lipid parameters and a significant reduction in costs. However, the relatively high rates of virological failure and treatment discontinuation because of adverse events make this combination a less favourable choice over other regimens currently available.
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Affiliation(s)
- Paula Arrabal-Durán
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Carmen G Rodríguez-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Esther Chamorro-de-Vega
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Paloma Gijón-Vidaurreta
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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de Lorenzo-Pinto A, Herranz-Alonso A, Cuéllar-Basterrechea B, Bellón-Cano JM, Sanjurjo-Sáez M, Bueno H. Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome. ACTA ACUST UNITED AC 2017; 70:825-831. [PMID: 28411029 DOI: 10.1016/j.rec.2016.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. METHODS We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. RESULTS A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P=.20). The estimated avoided cost was €95 113.6 per year, meaning that €10.1 would be obtained in return for each euro invested during the first year and €36.3 during the following years. CONCLUSIONS This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive.
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Affiliation(s)
- Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Begoña Cuéllar-Basterrechea
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Bellón-Cano
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Metodología y Bioestadística, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Héctor Bueno
- Servicio de Cardiología e Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación Multidisciplinar Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Marzal-Alfaro MB, Martín Barbero ML, García Domínguez J, Romero-Delgado F, Martínez Ginés ML, Herranz A, Sanjurjo-Sáez M. Impact of fampridine on quality of life: clinical benefit in real-world practice. Eur J Hosp Pharm 2017; 25:138-143. [PMID: 31157008 DOI: 10.1136/ejhpharm-2016-001129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess the effectiveness and tolerability of fampridine in patients with multiple sclerosis (MS) in real clinical practice and to analyse adherence to treatment and general satisfaction of patients in terms of quality of life (QOL). Methods Patients who started treatment with fampridine from May 2014 to October 2014 were included. Primary and secondary outcomes were Timed 25-Foot Walk (T25FW) and MS Walking Scale-12 (MSWS-12) respectively, measured at baseline and 2 weeks, 3 and 6 months. Adherence was measured by the Morisky-Green questionnaire, patient satisfaction with a visual analogue scale (VAS) and QOL with improvement in mobility, self-care, daily activities, pain/discomfort or anxiety/depression. Results 30 patients (46.7% women) of mean age 39 years, mean MS duration 13.7 years, mean Expanded Disability Status Scale score 5.8, 57% with relapsing-remitting MS were included. 22 patients (73%) continued to take treatment throughout the study period. Two weeks after treatment initiation all measures improved significantly from baseline (T25FW: -7.5 s, p<0.05; MSWS-12: -36.7, p<0.05). At 6 months, walking speed and self-perceived walking ability were significantly improved (T25FW: -3.8 s, p<0.05; MSWS-12: -30.0, p<0.05). Adverse events were reported by 30% of patients. Seizures were registered in one patient. 70% of patients were adherent with treatment. Median (IQR) general satisfaction VAS score was 8 (7-9). Patients reported an improvement in mobility (70%), anxiety/depression (33.3%), self-care (23.3%), daily activities (23.3%) and pain/discomfort (3.3%). Conclusions Fampridine is effective and safe in patients with MS in real clinical practice up to 6 months. Adherence to treatment was suboptimal but patients' general satisfaction was high and fampridine improved several items of QOL.
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Affiliation(s)
- María Belén Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Luisa Martín Barbero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - JoseM García Domínguez
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Fernando Romero-Delgado
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Luisa Martínez Ginés
- Neurology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Manrique-Rodríguez S, de la Rubia-Nieto A, García-Robles JA, Goicoechea-Diezhandino M, Gimeno-Blanes JA, Pernía-López MS, Pellicer-Franco C, Sanjurjo-Sáez M. Individualized therapy in patients with Fabry disease: is it a feasible strategy for rare diseases? Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1253468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Collado-Borrell R, Escudero-Vilaplana V, Romero-Jiménez R, Iglesias-Peinado I, Herranz-Alonso A, Sanjurjo-Sáez M. Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account. J Cancer Res Clin Oncol 2016; 142:2319-2330. [PMID: 27316629 DOI: 10.1007/s00432-016-2190-8/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/09/2016] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To review interactions between oral antineoplastic agents (OAAs) for the treatment of solid and hematological tumors and common food and medicinal plants. MATERIALS AND METHODS All potential interactions between OAAs, medicinal plants and food were reviewed. OAAs were considered to be drugs for oral administration that have direct antitumor activity and were approved by the European Medicines Agency in April 2015. We performed the literature search in Pubmed(®) considering only medicinal plants and food. In addition, available data were analyzed from each OAA in secondary data sources taken from Thomson Micromedex(®) and Lexi-comp(®), as well as in the summary of product characteristics. RESULTS Fifty-eight OAAs were analyzed. We found interactions in 60.3 % of OAAs. Those with most interactions described were: imatinib and procarbazine (4 interactions) and erlotinib, vemurafenib, pomalidomide, medroxyprogesterone and methotrexate (3 interactions). MEDICINAL PLANTS We found 39 interactions (74.4 % important). St. John's wort was the medicinal plant with most interactions (92.6 % were considered important). The rest were: important (ginseng-imatinib, methotrexate-cola and tobacco-erlotinib and tobacco-pomalidomide) and moderate (caffeine-vemurafenib/medroxyprogesterone, medroxyprogesterone-ruxolitinib/St. John's wort, garlic-anagrelide and ginseng-procarbazine). FOODS Twenty-six interactions (61.5 % important). Grapefruit had most interactions (82.4 % were considered important). The rest were: important (alcohol-procarbazine) and moderate (dairy-estramustine, methotrexate-ethanol, procarbazine-tyramine, vitamin A-tretinoin/bexarotene and grapefruit-bexarotene/etoposide/sunitinib). CONCLUSION A review of interactions of medicinal plants and food should be taken into account in the management of OAAs, since more than half have interactions with MPs and food, of which 70.3 % are considered important. The most relevant are HSJ, grapefruit, ginseng and tobacco. This review is intended to serve as a support to all healthcare professionals at the time of prescribing or dispensing OAAs.
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Affiliation(s)
| | | | - Rosa Romero-Jiménez
- Pharmacy Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Ana Herranz-Alonso
- Pharmacy Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Gregorio Marañón General University Hospital, Madrid, Spain
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Arrabal-Durán P, de Lorenzo-Pinto A, García-Sánchez R, Sanjurjo-Sáez M. The challenges of the loading dose. Drugs Ther Perspect 2016. [DOI: 10.1007/s40267-016-0324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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48
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de Lorenzo-Pinto A, Giménez-Manzorro Á, Rodríguez-González CG, Ahumada-Jiménez A, Herranz-Alonso A, Marzal-Alfaro MB, Sanjurjo-Sáez M. Decreased INR after acenocoumarol, ombitasvir/paritaprevir/ritonavir and dasabuvir co-administration. J Clin Pharm Ther 2016; 41:444-446. [DOI: 10.1111/jcpt.12403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A. de Lorenzo-Pinto
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - Á. Giménez-Manzorro
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - C. G. Rodríguez-González
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Ahumada-Jiménez
- Gastroenterology Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - A. Herranz-Alonso
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - M. B. Marzal-Alfaro
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - M. Sanjurjo-Sáez
- Pharmacy Department; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
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De Lorenzo-Pinto A, García-Sánchez R, Durán-García E, Castuera-Gil A, Pascual-Izquierdo C, Marzal-Alfaro B, Arrabal-Durán P, Herranz-Alonso A, Andueza-Lillo JA, Sanjurjo-Sáez M. Level of concordance between two risk-assessment models for predicting venous thromboembolism in medical patients at admission. Eur J Hosp Pharm 2016; 23:141-144. [PMID: 31156835 DOI: 10.1136/ejhpharm-2015-000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/02/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the level of concordance between the 2007 PRETEMED guidelines and the 2012 American College of Chest Physicians (ACCP) guidelines in medical patients at admission. Methods A cross-sectional, observational and descriptive study was designed and included all adult medical patients admitted from an emergency department. Firstly, patients classified as low-moderate risk and high risk according to PRETEMED were compared to those classified by ACCP as low and high risk. Secondly, the same analysis was performed but this time low and moderate-high risk patients according to PRETEMED were compared to ACCP low and high risk patients. The level of concordance was calculated using the kappa concordance index. The study was approved by the Ethics Committee for Clinical Research of the hospital. Results The analysis was performed with 207 patients; 53.1% were male and the median age was 75.3 years (minimum 18, maximum 100 years old). The most common diagnosis at admission was related to a respiratory disease (37.2%). The level of concordance was 0.59 (95% CI 0.48 to 0.70) when moderate risk patients were grouped with low-risk patients and 0.53 (95% CI 0.42 to 0.65) when moderate risk patients were grouped with high-risk patients. Conclusions The level of concordance between both guides is moderate. It would be helpful to confirm whether the level of agreement improves when the patient's condition stabilises after several days of hospitalisation.
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Affiliation(s)
- Ana De Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Esther Durán-García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Castuera-Gil
- Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Belén Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paula Arrabal-Durán
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan A Andueza-Lillo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Manrique-Rodríguez S, Sánchez-Galindo AC, Fernández-Llamazares CM, Calvo-Calvo MM, Carrillo-Álvarez Á, Sanjurjo-Sáez M. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps. Med Intensiva 2016; 40:411-21. [PMID: 27026063 DOI: 10.1016/j.medin.2016.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted. DESIGN Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital. SETTING A tertiary level hospital pediatric intensive care unit. PARTICIPANTS Infusions delivered with infusion pumps in all pediatric intensive care unit patients. INTERVENTIONS Design of a drug library with safety limits for all intravenous drugs prescribed. MAIN VARIABLES Users' compliance with drug library as well as number and type of errors prevented were analyzed. RESULTS Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%. CONCLUSIONS Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process.
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Affiliation(s)
- S Manrique-Rodríguez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A C Sánchez-Galindo
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - M M Calvo-Calvo
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Á Carrillo-Álvarez
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España
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