Calidad de la asistencia al paciente con diabetes mellitus tipo II en el ámbito de una consulta de Atención Primaria

Se hace un estudio transversal descriptivo mediante el que evaluamos la calidad de la atención prestada a los pacientes diabéticos tipo II en nuestro Centro de Salud, para determinar los puntos a mejorar de dicha atención. La muestra la obtenemos de los diabéticos tipo II con historia clínica abierta mediante un muestreo aleatorio simple, seleccionando una de cada tres historias y analizando los indicadores de calidad propuestos por el GEDAPS (Grupo de Estudios de la Diabetes en A.P.) en el programa informático diseñado por este grupo. La edad media de estos pacientes es de 69,2 años; un alto porcentaje no tiene datos de estudio de exploración renal, fondo de ojo y hemoglobina glicada. La tensión arterial y el pie diabético son las variables mejor controladas. Así que las conclusiones son: que según los indicadores de calidad, se han encontrado déficits que han de mejorar, sobre todo en la determinaciónde hemoglobina, albuminuria y realización de fondo de ojo. También deben ser mejorados los niveles de colesterol, HDL y hemoglobina glicada (AU)

Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation - a compassionate use experience.

Respiratory syncytial virus (RSV) pneumonia in BMT recipients carries a mortality rate of approximately 50-70% despite ribavirin (Virazole) treatment. In both immunocompetent and immunocompromised animal models, RSV neutralizing antibodies rapidly reduce pulmonary virus load after a single dose. RSV-IGIV (RespiGam) is an IgG immune globulin with high concentrations of RSV neutralizing antibody (>19 200 MU/ml). From June 1991 to February 1996, a compassionate-use protocol using RSV-IGIV for treatment of RSV infections was conducted. Eleven children at multiple centers, mean age 3.3 years (4 months to 9 years), were undergoing BMT and met the protocol criteria. They received a single 1500 mg/kg dose of RSV-IGIV infused over 12 h at a median of 5 days (1-37 days) after RSV symptom onset. Ten of these patients received prior or concurrent aerosolized ribavirin. Serum RSV neutralizing titers were measured in five patients and showed a 3- to 30-fold increase 24 h after RSV-IGIV infusion. Adverse events were mild. One of 11 (9.1%) patients died from their RSV illness (91% RSV survival). In comparison to previously published reports, RSV-IGIV treatment of RSV pneumonia in BMT patients may increase survival above that in such patients treated with ribavirin alone. Bone Marrow Transplantation (2000) 25, 161-165.

Pharmacist-operated drug information centers in the United States.

Pharmacist-operated drug information centers (DICs) in the United States were surveyed to obtain current information on the availability and scope of their services. Questionnaires were mailed in late 1991 to 179 institutions believed to have organized DICs. Topics covered in the questionnaire included staffing, resources, funding, and services provided. The results were compared with previous survey results to identify trends. Through 1992, 120 usable responses were received. Compared with findings from earlier surveys, DICs' affiliations with medical centers and hospitals have declined and affiliations with pharmacy schools have increased. More personnel work in DICs than ever. Computers are now used by nearly every DIC, there is an increased emphasis on quality-assurance programs for services rendered, and many DICs have increased revenue with new and expanded services. Although DICs are no longer increasing in number, their services are becoming more sophisticated.

Comparative content evaluation of the de Haen and Drugdex drug information systems.

The Missouri evaluation protocol was used for comparing the contents of the Drugdex and de Haen drug information systems. Criteria for evaluating (1) general information content and (2) content of drug-drug interactions are given in the Missouri protocol. To check the two drug information systems for content, 113 sample drugs were randomly selected to represent all pharmacologic-therapeutic categories of the American Hospital Formulary Service. A list of 215 sample drug-drug interactions was randomly selected from Hansten's Drug Interactions. Each system was then search, applying each general content criterion and drug interaction criterion to each sample drug and sample interaction, respectively. Raw data were transformed into the Missouri protocol's seven weighted variables, and aggregate scores were obtained by summing the weighted scores for the variables. All scoring measurements were done by one investigator. Both raw (unweighted) and weighted scores were analyzed. Aggregate scores showed no significant differences between Drugdex and de Haen for either general information content or content of drug-drug interactions. However, analysis of raw data contradicted these results by showing differences between systems for several variables. The de Haen system included general information on a greater percentage of the sample drugs, but Drugdex covered more information criteria per drug. Drugdex contained a greater percentage of the sample drug-drug interactions, but de Haen covered more criteria for a listed interaction. The results of this study suggest that neither Drugdex nor the de Haen system can be recommended for use in lieu of the other. The Missouri protocol has flaws that preclude its routine use for comparative evaluation of drug information systems.

Objective and subjective evaluations of a TV-program versus small group instruction for the Iowa Drug Information Service.

The purpose of this study was to determine if the TV approach for instructing drug information systems is more efficient in terms of cost and learning effectiveness vs. traditional educational programming. The Iowa Drug Information Service system was selected as a typical representative for a study model. Second professional year pharmacy students (N = 66) were evaluated in a random selection, pre-test post-test, controlled experimental procedure. A 19 minute UTCHS in-house production served as the experimental variable. The control group received equivalent training (time and content) via lecture notes, and on-site practice coaching. Outcomes were assessed according to objective test score criteria and 10 subjective self-rating opinion scales. The data revealed that students subjected to the TV variable achieved significantly better post-exposure test scores (P = 0.002). A one-time cost of +500 was expended for complete TV production and three tapes, resulting in unlimited teaching capacity and recoverable within two years relative to instructor time expenditures for this system. Five of 10 opinion scales were significantly different in comparison, and students clearly preferred traditional teaching over our TV production. This investigation substantiates previous reports from medical disciplines wherein TV was an effective teaching approach but only mildly popular. The repetitive nature of didactic drug information systems training, superior TV outcomes, and cost-effectiveness warrants a mix of TV and limited personalized instruction as a policy approach.