Real time monitoring of glucose in whole blood by smartphone.

A combined thread-paper microfluidic device (µTPAD) is presented for the determination of glucose in blood. The device is designed to include all the analytical operations needed: red blood cell separation, conditioning, enzymatic recognition, and colorimetric transduction. The signal is captured with a smartphone or tablet working in video mode and processed by custom Android-based software in real-time. The automatic detection of the region of interest on the thread allows for the use of either initial rate or equilibrium signal as analytical parameters. The time needed for analysis is 12 s using initial rate, and 100 s using the equilibrium measurement with a LOD of 48 µM and 12 µM, respectively, and a precision around 7%. The µTPAD allows a rapid determination of glucose in real samples using only 3 µL of whole blood.

Sustained Neonatal Inflammation Is Associated with Poor Growth in Infants Born Very Preterm during the First Year of Life.

OBJECTIVE: To determine whether a sustained neonatal systemic inflammatory response was associated with poor postnatal growth among infants born very preterm during the first year of life. STUDY DESIGN: We studied prospectively 192 infants born preterm (birth weight ≤1.5 kg and gestational age ≤31 weeks). Weight, length, and head circumference were measured at birth, term, 4, and 12 months of corrected age. Serial C-reactive protein and procalcitonin were measured at 1, 3, 7, 14, and 28 days of age and averaged for each infant. A sustained neonatal systemic inflammatory response was defined as an average C-reactive protein level greater than the median for the group. Analysis was undertaken with linear mixed models. RESULTS: Decreases in mean z scores for weight, length, and head circumference were associated with the presence of a sustained neonatal systemic inflammatory response from birth to 12 months of corrected age (ß [95% CI] = -0.282 [-0.306 to -0.258]; -1.899 [-2.028,-1.769]; -0.806 [-0.910, to -0.701], P < .001, respectively) in main effect models. This association remained significant after including interaction terms for bronchopulmonary dysplasia, neonatal sepsis, and necrotizing enterocolitis (ß [95% CI] = -0.393 [-0.520 to -0.265]; -2.128 [-2.754, -1.503]; -1.102 [-1.604, -0.600]; P < .001; respectively) in interaction models. CONCLUSIONS: A sustained neonatal systemic inflammatory response was associated with poor postnatal growth, particularly poor linear growth. Serial C-reactive protein and procalcitonin may be useful markers for identifying infants at risk for postnatal growth failure.

Análisis del uso racional de antihipertensivos en la región de Murcia / Analysis of the rational use of anti-hypertensives in the murcia (Spain) region

Objetivo: El objetivo del presente estudio ha sido conocer el patrón de uso de los fármacos antihipertensivos en la Región de Murcia, contrastando los resultados con los datos nacionales (patrón de referencia), pudiendo de esta manera detectar posibles puntos de mejora o establecer hipótesis para posteriores estudios. Diseño: Estudio farmacoepidemiológico (2004 a 2008), conforme a las recomendaciones de la OMS. Emplazamiento: Región de Murcia. Participantes: Censo poblacional anual. Mediciones principales: El uso de antihipertensivos se ha medido mediante el cálculo de la dosis diaria definida por mil habitantes-día (DHD). Resultados: La utilización de antihipertensivos se ha incrementado significativamente de 196,6 DHD a 235,8 DHD. Los antihipertensivos más usados en 2008 eran los ARA-II (38,6%), seguido de los IECA (21,8%). Se ha producido un cambio de tendencia en el uso de los bloqueantes del sistema renina angiotensina (BSRA), con un incremento del 77,5% en los ARA-II y una disminución del 9,5% en los IECA. La comparación con los datos nacionales muestran un menor uso de antihipertensivos y un diferente patrón en la Región de Murcia. Conclusiones: Se constata un menor uso de antihipertensivos respecto a España, por lo que podría haber infratratamiento de esta u otras enfermedades cardiovasculares en las que se usan estos fármacos en la Región de Murcia. Se observa un mayor uso de ARA-II, así como un menor uso de IECA. Las diferencias encontradas ponen de manifiesto la necesidad de realizar estudios encaminados a esclarecer sus causas, para lograr un uso más racional y eficiente de los antihipertensivos(AU)

Objective: The objective of this study was to determine the pattern of use of antihypertensive drugs in the Murcia Region, comparing the results with the national data, and detecting problems in order to make improvements, or establish hypotheses and to plan new studies. Design: Pharmacoepidemiological study (from 2004 to 2008) in accordance with the recommendations from World Heath Organization. Setting: Murcia Region. Participans: Annual census of each year. Main measurements: The use of antihypertensive drugs was measured by the daily doses per 1000 inhabitans-day (DHD). Results: The use of antihypertensive drugs has significantly increased from 196.6 DHD to 235.8 DHD. The antihypertensives more used at the end of 2008 were: angiotensin II receptor blockers-ARB- (38.6%) and angiotensin converting enzyme inhibitors-ACEI- (21.8%). There has been a tendency to change the use of rennin-angiotensin system blockers-RASB-, with an increase in ARB of 77.5% and a decrease in ACEI 9.5%. The comparison with the national data shows qualitative and quantitative differences in the pattern of antihypertensive drugs used during the studied period. Conclusions: The use of antihypertensive drugs in Murcia is less than in the rest of Spain. Therefore, this may be due to a problem of under treatment of this illness or other cardiovascular illnesses in the region. A greater use of ARB in Murcia and a lower use of ACEI was observed in Murcia. The differences found suggest that further studies are required to clarify their origins and causes, with the objective of achieving a more rational and efficient use of these drugs(AU)

[Analysis of the rational use of anti-hypertensives in the Murcia (Spain) region]. / Análisis del uso racional de antihipertensivos en la región de Murcia.

OBJECTIVE: The objective of this study was to determine the pattern of use of antihypertensive drugs in the Murcia Region, comparing the results with the national data, and detecting problems in order to make improvements, or establish hypotheses and to plan new studies. DESIGN: Pharmacoepidemiological study (from 2004 to 2008) in accordance with the recommendations from World Heath Organization. SETTING: : Murcia Region. PARTICIPANTS: Annual census of each year. MAIN MEASUREMENTS: The use of antihypertensive drugs was measured by the daily doses per 1000 inhabitans-day (DHD). RESULTS: The use of antihypertensive drugs has significantly increased from 196.6 DHD to 235.8 DHD. The antihypertensives more used at the end of 2008 were: angiotensin II receptor blockers-ARB- (38.6%) and angiotensin converting enzyme inhibitors-ACEI- (21.8%). There has been a tendency to change the use of rennin-angiotensin system blockers-RASB-, with an increase in ARB of 77.5% and and a decrease in ACEI 9.5%. The comparison with the national data shows qualitative and quantitative differences in the pattern of antihypertensive drugs used during the studied period. CONCLUSIONS: The use of antihypertensive drugs in Murcia is less than in the rest of Spain. Therefore, this may be due to a problem of under treatment of this illness or other cardiovascular illnesses in the region. A greater use of ARB in Murcia and a lower use of ACEI was observed in Murcia. The differences found suggest that further studies are required to clarify their origins and causes, with the objective of achieving a more rational and efficient use of these drugs.

Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia / A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine

Objetivo: Localizar de forma efectiva los medicamentos más implicados en interacciones graves,como base para diseñar actividades de mejora en la seguridad de los pacientes en AtenciónPrimaria.Diseño: Estudio transversal de las prescripciones realizadas en OMI-AP, la historia clínica electrónicade Atención Primaria.Emplazamiento: Áreas I, VI, VII y IX de Murcia (723.664 habitantes).Participantes: 362.271 pacientes que disponen de OMI-AP, son mayores de 14 años y estánadscritos a un médico que usa OMI-AP habitualmente.Mediciones principales: Analizamos los fármacos que cada paciente pudiera estar tomando enbusca de interacciones graves. Construimos una escala de peligro para interacción grave (e-PIG)calculando: 1) la probabilidad de que un paciente no seleccionado este tomando un fármacodeterminado, y 2) la probabilidad de que un medicamento produzca una interacción grave. Conello estimamos el riesgo de producir interacción grave para cada medicamento, que se traducea una escala logarítmica de 5 puntos.Resultados: Hallamos 83.138 pacientes (22,9%) en riesgo (toman 2 o más fármacos). Identificamos466.940 prescripciones provenientes de 939 fármacos y 5.597 interacciones graves(prevalencia 5,8%). En ellas hay implicados 167 fármacos, de los que e-PIG identifica 5 (3%)con valor extremo: omeprazol, diazepam, acenocumarol, ibuprofeno y calcio.Conclusiones: e-PIG es una expresión logarítmica del riesgo de que prescribir un determinadomedicamento produzca una interacción grave en un escenario de lugar y tiempo determinados.Su monitorización puede convertirse en un elemento de priorización que facilite el diseño deestrategias de mejora de la seguridad del uso de medicamentos(AU)

Objective: To effectively locate the drugs most implicated in severe interactions as a basis ofdesigning actions to improve patient safety in Primary Care.Design: Cross-sectional study of prescriptions using the Primary Care computerised medicalrecords database (OMI-PC).Setting: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants).Participants: There are 362,271 patients over 14 years-old available in the OMI-PC and areassigned to a doctor who uses the OMI-PC regularly.Main measurements: We analysed the drugs that each patient could be taking, looking forsevere interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1]the probability that a non-selected patient may be taking a particular drug and [2] the probabilitythat a drug may produce a severe interaction. With this, we estimated the risk ofproducing a severe interaction for each drug, which was converted into a 5 point logarithmicscale.Results: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%).In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value:omeprazole, diazepam, acenocoumarol, ibuprofen and calcium.Conclusions: e-PIG is a logarithmic expression of the risk that prescribing a particular drug mayproduce a severe interaction in a determined setting and time. Its monitoring could become aprioritisation element that may assist the design of strategies for improving the safety of theuse of drugs(AU)

A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care.

The authors tested the effectiveness and estimated the cost of several interventions aimed at reducing drug interactions in primary care by designing a 15-month cluster-controlled trial. The trial involved 265 family physicians and their patients who were randomized into 4 groups: control, report (received feedback reports), session (group sessions), and face-to-face (personal interviews). The outcome was the mean of relevant interactions detected on electronic medical records. Cost-effectiveness was defined as the incremental cost to reduce drug interactions by 1%. The authors detected a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up. No improvement was seen in the report group when compared with the control group, whereas progressive improvement in the other groups was noted (P < .001). Incremental cost was higher in the face-to-face group (69.4€ vs 50.7€); cost-effectiveness results were slightly better in the session group (4.2€ vs 4.5€).

[A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine]. / Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia.

OBJECTIVE: To effectively locate the drugs most implicated in severe interactions as a basis of designing actions to improve patient safety in Primary Care. DESIGN: Cross-sectional study of prescriptions using the Primary Care computerised medical records database (OMI-PC). SETTING: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants). PARTICIPANTS: There are 362,271 patients over 14 years-old available in the OMI-PC and are assigned to a doctor who uses the OMI-PC regularly. MAIN MEASUREMENTS: We analysed the drugs that each patient could be taking, looking for severe interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1] the probability that a non-selected patient may be taking a particular drug and [2] the probability that a drug may produce a severe interaction. With this, we estimated the risk of producing a severe interaction for each drug, which was converted into a 5 point logarithmic scale. RESULTS: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified 466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%). In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value: omeprazole, diazepam, acenocoumarol, ibuprofen and calcium. CONCLUSIONS: e-PIG is a logarithmic expression of the risk that prescribing a particular drug may produce a severe interaction in a determined setting and time. Its monitoring could become a prioritisation element that may assist the design of strategies for improving the safety of the use of drugs.

Prevalence and typology of potential drug interactions occurring in primary care patients.

PURPOSE: To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. METHODS: Cross-sectional descriptive study. SETTING: Two areas in Spain comprising 715,661 inhabitants. PATIENTS: 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. RESULTS: On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. CONCLUSIONS: 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.