Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada / Medication reconciliation at admission and discharge. A consolidated experience

La conciliación de la medicación es actualmente una de las principales estrategias para reducir los errores de medicación relacionados con la transición asistencial. Objetivo. Describir una metodología de trabajo que permita garantizar la continuidad asistencial del paciente en relación con la farmacoterapia, al ingreso y al alta hospitalaria. Material y método. Se describe la metodología implantada en un hospital de tercer nivel y los principales resultados de la conciliación de medicación al ingreso y alta de pacientes mayores de 75 años en el Servicio de Traumatología durante el año 2014. Resultados. Las fases de la metodología fueron: 1. obtención de la historia farmacoterapéutica (al menos 2 fuentes de información); 2. análisis de discrepancias y validación de la medicación al ingreso: se realizó un check list para estandarizar el proceso; 3. comunicación del perfil farmacoterapéutico: se diseñó un formulario en la historia clínica electrónica; y 4. conciliación de la medicación al alta hospitalaria e información al paciente: entrega de esquema posológico y recomendaciones al paciente. Aplicando esta metodología, en 2014 se conciliaron 318 pacientes ingresados en traumatología (294 al ingreso y alta). El 35,5% presentó al menos un error de conciliación. La media de errores por paciente conciliado fue de 0,69. En el 74,1% de los pacientes se entregó información escrita al alta. Conclusiones. Esta metodología ha permitido establecer un flujo de trabajo que facilita la coordinación interprofesionales; disminuir los errores de medicación y dar respuesta a uno de los principales problemas de la continuidad asistencial (AU)

Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. Objective. To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. Methods. A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. Results. The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. Conclusions. This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care (AU)

[Medication reconciliation at admission and discharge. A consolidated experience]. / Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada.

UNLABELLED: Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE: To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS: A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS: The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS: This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.

Localización de la arteria poplítea y su relación con el riesgo vascular en la sutura del cuerno posterior del menisco externo / Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus

Introducción: La proximidad del cuerno posterior del menisco externo a la arteria poplítea condiciona un riesgo de lesión vascular en su sutura. El objetivo es definir la localización de la arteria poplítea, establecer la distancia mínima del muro posterior del menisco externo a la arteria, al nervio ciático poplíteo externo (CPE) y su correlación con otras variables. Material y método: Se revisaron retrospectivamente 102 resonancias magnéticas nucleares de pacientes operados en nuestro centro. Se seleccionó el corte axial donde se identificase adecuadamente el menisco externo y se realizaron el conjunto de mediciones. Resultados: La arteria se localizó lateral a la línea media antero-posterior en el 94% de los casos. La distancia mínima media del muro posterior del menisco externo a la arteria poplítea fue de 1,01 cm. (0,32-1,74, SD: 0,304). La distancia mínima media al CPE fue de 1,74 cm. (0,75-2,87, SD: 0,374). No se encontró una correlación de la distancia del muro posterior a la arteria poplítea con la altura, el peso, el IMC, el diámetro del menisco externo ni el diámetro de la meseta tibial. Se encontró una correlación entre la distancia del muro posterior al CPE con el peso y el IMC. Conclusiones: La proximidad del muro posterior a la arteria poplítea debe ser tenida en cuenta a la hora de realizar suturas. Esta distancia está dentro de la profundidad recomendada en los dispositivos de sutura «todo-dentro» y no está en relación con la talla, el peso, el IMC, el tamaño del menisco externo ni la meseta tibial (AU)

Introduction: The proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables. Material and methods: A total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed. Results: The artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01 cm. (0.32-1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74 cm. (0.75-2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI. Conclusions: The proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters (AU)

Regeneración ósea en animales de experimentación, mediante cemento de fosfato cálcico en combinación con factores de crecimiento plaquetarios y hormona de crecimiento humana / Bone regeneration in experimental animals using calcium phosphate cement combined with platelet growth factors and human growth hormone

Determinadas sustancias (factores de crecimiento y hormonas) tienen propiedades osteoinductivas y añadidas a un biomaterial osteoconductivo aumentan sus propiedades de neoformación ósea. Materiales: Quince conejos de la raza Nueva Zelanda. Los biomateriales y factores utilizados fueron: cemento de fosfato tricálcico (Calcibon®), hormona de crecimiento humana y plasma rico en plaquetas PRP. Método: Cada conejo fue intervenido en ambas tibias donde se le realizó un defecto de 6 mm. Los animales de experimentación se repartieron en los siguientes grupos: - Grupo control (regeneración solo con TCP). - Grupo PRP (regeneración con TCP + PRP). - Grupo GH (regeneración con TCP + GH). Todos los animales fueron sacrificados a los 28 días. Se valoró el aspecto del defecto crítico comprobando su relleno. Histológicamente valoramos la respuesta tisular, la presencia de tejido óseo neoformado, y el aspecto del biomaterial. Se realizó la morfometría con analizador de imágenes MIP 45. Usamos el test ANOVA para el estudio estadístico mediante el programa Statgraphics. Resultados: El aspecto macroscópico del defecto crítico, fue mejor en el grupo PRP y en el grupo GH que en el grupo control. Histológicamente se observó mayor neoformación ósea en los grupos PRP y GH. El estudio morfométrico no detectó diferencias significativas en la neoformación ósea entre el grupo PRP y control. Se detectó mayor neoformación ósea en el grupo GH (p = 0,03) frente a los otros dos grupos. Conclusión: La GH facilita la regeneración ósea en defectos críticos, rellenos con cemento de fosfato cálcico, en el período de tiempo estudiado en conejos de Nueva Zelanda (AU)

Many substances (growth factors and hormones) have osteoinduction properties and when added to some osteoconduction biomaterial they accelerate bone neoformation properties. Materials: The materials included 15 New Zealand rabbits, calcium phosphate cement (Calcibon®), human growth hormone (GH), and plasma rich in platelets (PRP). Methods: Each animal was operated on in both proximal tibias and a critical size bone defect of 6 mm of diameter was made. The animals were separated into the following study groups: - Control (regeneration only by Calcibon®). - PRP (regeneration by Calcibon® and PRP). - GH (regeneration by Calcibon® and GH). All the animals were sacrificed at 28 days. An evaluation was made of the appearance of the proximal extreme of rabbit tibiae in all the animals, and to check the filling of the critical size defect. A histological assessment was made of the tissue response, the presence of new bone formation, and the appearance of the biomaterial. Morphometry was performed using the MIP 45 image analyser. ANOVA statistical analysis was performed using the Statgraphics software application. Results: The macroscopic appearance of the critical defect was better in the PRP and the GH group than in the control group. Histologically greater new bone formation was found in the PRP and GH groups. No statistically significant differences were detected in the morphometric study between bone formation observed in the PRP group and the control group. Significant differences in increased bone formation were found in the GH group (p=0.03) compared to the other two groups. Conclusion: GH facilitates bone regeneration in critical defects filled with calcium phosphate cement in the time period studied in New Zealand rabbits (AU)

Bone regeneration in experimental animals using calcium phosphate cement combined with platelet growth factors and human growth hormone.

UNLABELLED: Many substances (growth factors and hormones) have osteoinduction properties and when added to some osteoconduction biomaterial they accelerate bone neoformation properties. MATERIALS: The materials included 15 New Zealand rabbits, calcium phosphate cement (Calcibon(®)), human growth hormone (GH), and plasma rich in platelets (PRP). METHODS: Each animal was operated on in both proximal tibias and a critical size bone defect of 6mm of diameter was made. The animals were separated into the following study groups: Control (regeneration only by Calcibon®), PRP (regeneration by Calcibon® and PRP), GH (regeneration by Calcibon® and GH). All the animals were sacrificed at 28 days. An evaluation was made of the appearance of the proximal extreme of rabbit tibiae in all the animals, and to check the filling of the critical size defect. A histological assessment was made of the tissue response, the presence of new bone formation, and the appearance of the biomaterial. Morphometry was performed using the MIP 45 image analyser. ANOVA statistical analysis was performed using the Statgraphics software application. RESULTS: The macroscopic appearance of the critical defect was better in the PRP and the GH group than in the control group. Histologically greater new bone formation was found in the PRP and GH groups. No statistically significant differences were detected in the morphometric study between bone formation observed in the PRP group and the control group. Significant differences in increased bone formation were found in the GH group (p=0.03) compared to the other two groups. CONCLUSION: GH facilitates bone regeneration in critical defects filled with calcium phosphate cement in the time period studied in New Zealand rabbits.

Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus.

INTRODUCTION: The proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables. MATERIAL AND METHODS: A total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed. RESULTS: The artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01cm. (0.32-1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74cm. (0.75-2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI. CONCLUSIONS: The proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters.

Estructura y organización de un banco de huesos y tejidos / Structure and organization of a bone and tissue bank

En este artículo se revisan de forma pormenorizada la estructura y organización de un Banco de Huesos y Tejidos (BHT). La instauración de una red de BHT hará que los aloinjertos sean cada vez más disponibles para los pacientes que lo necesiten (AU)