Validez de un registro poblacional automatizado de demencia basado en las bases de datos clínicas / Validity of a computerized population registry of dementia based on clinical databases

Introducción: El manejo de la información mediante soportes digitales permite abordajes innovadores de la identificación de los casos de demencia mediante búsquedas automatizadas en las bases de datos clínicas con sistemas de codificación de los diagnósticos. El objetivo de este trabajo fue analizar la validez de un registro de demencia en Gipuzkoa basado en los sistemas de registro administrativos y clínicos existentes en el Servicio Vasco de Salud.MétodosEs un estudio descriptivo basado en la evaluación de las fuentes de datos disponibles. Primero, mediante revisión de historias clínicas se evaluó la validez diagnóstica en 2 muestras de casos identificados y no identificados como demencia. Se midió la sensibilidad, especificidad y valor predictivo positivo y negativo del diagnóstico de demencia. Posteriormente se buscaron los casos de demencia vivos a fecha 31 de diciembre de 2016 en toda la población guipuzcoana y se recogieron variables sociodemográficas y clínicas.ResultadosLas 2 muestras de validación incluyeron 986 casos y 327 no casos. La sensibilidad calculada fue del 80,2% y la especificidad del 99,9%. El valor predictivo negativo fue del 99,4% y el positivo del 95,1%. Los casos registrados en toda la población guipuzcoana fueron 10.551 que supone un 65% de los casos previstos según la literatura. Un 40% tomaban medicación antisicótica. La población institucionalizada fue del 25%.ConclusionesUn registro de demencias basado en las bases de datos clínicas y administrativas es válido y factible. Su principal aportación es mostrar la dimensión que tiene la demencia en el ámbito del sistema sanitario. (AU)

Introduction: The handling of information through digital media allows innovative approaches for identifying cases of dementia through computerized searches within the clinical databases that include systems for coding diagnoses. The aim of this study was to analyze the validity of a dementia registry in Gipuzkoa based on the administrative and clinical databases existing in the Basque Health Service.MethodsThis is a descriptive study based on the evaluation of available data sources. First, through review of medical records, the diagnostic validity was evaluated in 2 samples of cases identified and not identified as dementia. The sensitivity, specificity and positive and negative predictive value of the diagnosis of dementia were measured. Subsequently, the cases of living dementia in December 31, 2016 were searched in the entire Gipuzkoa population to collect sociodemographic and clinical variables.ResultsThe validation samples included 986 cases and 327 no cases. The calculated sensitivity was 80.2% and the specificity was 99.9%. The negative predictive value was 99.4% and positive value was 95.1%. The cases in Gipuzkoa were 10,551, representing 65% of the cases predicted according to the literature. Antipsychotic medication were taken by a 40% and a 25% of the cases were institutionalized.ConclusionsA registry of dementias based on clinical and administrative databases is valid and feasible. Its main contribution is to show the dimension of dementia in the health system. (AU)

Validity of a computerised population registry of dementia based on clinical databases.

INTRODUCTION: The handling of information through digital media allows innovative approaches for identifying cases of dementia through computerised searches within the clinical databases that include systems for coding diagnoses. The aim of this study was to analyse the validity of a dementia registry in Gipuzkoa based on the administrative and clinical databases existing in the Basque Health Service. METHODS: This is a descriptive study based on the evaluation of available data sources. First, through review of medical records, the diagnostic validity was evaluated in two samples of cases identified and not identified as dementia. The sensitivity, specificity and positive and negative predictive value of the diagnosis of dementia were measured. Subsequently, the cases of living dementia in December 31, 2016 were searched in the entire Gipuzkoa population to collect sociodemographic and clinical variables. RESULTS: The validation samples included 986 cases and 327 no cases. The calculated sensitivity was 80.2% and the specificity was 99.9%. The negative predictive value was 99.4% and positive value was 95.1%. The cases in Gipuzkoa were 10 551, representing 65% of the cases predicted according to the literature. Antipsychotic medication were taken by a 40% and a 25% of the cases were institutionalised. CONCLUSIONS: A registry of dementias based on clinical and administrative databases is valid and feasible. Its main contribution is to show the dimension of dementia in the health system.

Development and in vitro evaluation of a controlled release formulation to produce wide dose interval morphine tablets.

In this paper, a new pharmaceutical formulation for the administration of morphine has been developed. This system is based on a polymeric complex previously characterized. After the studies performed, it has been selected the following formulation: 62.5% of morphine complex, 15% of free morphine and 22.5% of Eudragit RS. The morphine formulation proposed has been characterized by means of the study of the influence of several parameters such as pH, ionic strength, mean particle diameter of the components and total morphine dose by means of the tablet dimensions. This assayed formulation is able to provide a specific in vitro release profile that will be no influenced by possible variations in the GIT conditions. Moreover, this formulation can reproduce the same biopharmaceutical behaviour in an independent manner of the mean diameter particle of the components and the dimension of the tablet produced with several doses inside a wide interval of doses.

Elaboration and "in vitro" characterization of 5-ASA beads.

The purpose of this research was to perform the design and in vitro evaluation of alginate beads containing 5-ASA in order to achieve an oral system that protects the drug until it reaches the colon. Alginate beads were prepared by the well-known ionic gelation reaction (Ca2+). The influence of the incorporation of several polymers (Eudragit FS 30D, Eudragit S100, and chitosan) in the initial formulation was studied. In all formulations, entrapment efficiencies of the drug higher than 70% were obtained. The scanning electron microscopy (SEM) study of beads showed homogeneous sizes and shapes in all cases. Finally, the release behavior of these polymeric beads were also studied and compared. The results indicated that Eudragit FS 30D (26%) showed the most favorable dissolution behavior in terms of achieving a controlled release of 5-ASA. To determine the mechanism of drug release from these beads, the Korsmeyer equation was applied. Qt/Qinfinity <0.9 can be described using a Higuchi model and Qt/Qinfinity=0.7 showed a zero-order release period. This formulation was assayed at other different pH values (pH=6; 6.8; 7.2) to assure that there is no release of 5-ASA until the system reaches the colon. No release was observed at pH 6.0. Release was very slow at pH 6.8; averages about 20% an hour at pH 7.2 and was complete within 4 hour at pH 7.4. So, these Eudragit FS beads exhibited interesting dissolution profiles for the therapy of colon pathologies.

[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy]. / Evaluación de un programa de atención farmacéutica dirigido a mejorar la adherencia al tratamiento antirretroviral.

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

[Review of scientific evidence on alternatives to methadone in the psychopharmacologic treatment of opiate dependence]. / Revisión de la evidencia científica sobre las alternativas a la metadona en el tratamiento psicofarmacológico de la dependencia a opiáceos.

The implementation of the methadone maintenance treatment programs marked a true milestone in the treatment of those opioid-dependent patients who had met with failure in the different treatment alternatives which had existed up until that time. The purpose of this paper is that of reviewing the scientific evidence regarding the advantages and drawbacks involved in the different drug-related alternatives for use in lieu of methadone for opioid-dependent individuals. To pinpoint the clinical tests conducted, searches were run on Medline (1966-1999), the IDIS (Iowa Drug Information System (1985-1999) and the Cochrane Library 1999 clinical testing database (3rd quarter). Screening and summarization of the literature. Based on the review made, the conclusion was reached that methadone is the chosen drug in substitution treatment for opiate-dependent patients. LAAM came forth as an alternative to methadone for stable patients not requiring close monitoring, although marketing approval was suspended at the recommendation of the Scientific Committee of the European Agency for the Evaluation of Medical Products as of March 2001. Buprenorphene may be one alternative to methadone, however the optimum dosage pattern is as yet unknown. Heroine is the alternative studied to the least degree, although the highly limited number of existing studies indicate that this could be a useful alternative for heroine addicts for whom other maintenance treatments have failed.

Resistencia antimicrobiana y política de antibióticos: MRSA, GISA y VRE / Antimicrobian resistance and antibiotics policy: MRSA, GISA and VRE

La utilización de antibióticos plantea problemas debido a la dificultad de elegir el adecuado entre la gran proliferación de productos existentes, lo que se traduce en un elevado porcentaje de utilización inadecuada ( entre un 31 y un 65 por ciento en estudios hospitalarios), y tiene como consecuencia -entre otras- la aparición de bacterias frente a las cuales apenas disponemos de antibióticos efectivos. Se revisa la problemática existente con determinados microorganismos: Staphylococus aureus resistentes a meticilina (MRSA) y con sensibilidad intermedia a glicopéptidos ( VISA, GISA), Enterococos resistentes a vancomicina (VRE), y otros gémenes multirresistentes, detallando las actuaciones a realizar para su prevención y control. Se recalca la importancia de dos factores que son susceptibles de modificación en la práctica clínica habitual: la utilización innecesaria de antibióticos que puede dar lugar a la aparición de cepas multirresistentes y limitar la propagación de dichas cepas ( mediante la adopción de las precauciones estándar y especialmente el lavado de las manos) (AU)

[The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers]. / Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral. Grupo de Estudio de SIDA (GESIDA) de la SEIMC, por la Sociedad Española de Farmacia Hospitalaria (SEFH) y por el Plan Nacional sobre el SIDA (PNS) del Ministerio de Sanidad y Consumo (MSC).

The main objective of HAART is to achieve a complete suppression of the viral replication for long time. However, when the therapeutic drug levels are low, HIV can replicate and it can develop resistances. This fact can be the reason of treatment failure, HIV transmission of resistant strains and therefore an inappropriate use of the economical resources. In order to get the adequate therapeutic drug levels it is necessary to have a good adherence to the treatment. We review the factors that influence the adherence, the evaluation methods and we recommend the possible intervention strategies which should be given by a multidisciplinary team, integrated by physicians, pharmacists, nurses, psychologists and other personal support. To start HAART is not an emergency. For this reason is very important to prepare to the patient and to identify the non-adherence factors in order to correct it. Once the HAART is indicated it is very important to offer information during the medical prescription and when the drugs are dispensed. During the therapy is necessary to follow actively all patients on HAART. In order to make therapeutical decisions we need to know the patient drug adherence rate. We recommend to use several methods to calculate the drug adherence rate, being the most commonly used the patient interview, the patient questionnaire, the refill count, the pharmacy visits rate together with the viral load evolution of the patient. In order to get all this information it is necessary to have a very good communication between all the people involved in HIV infected patients care. If non-adherence is detected it is necessary to start the intervention strategies to correct it and if they fail it might be necessary in some cases to stop HAART. The potential benefits of the adherence programs can justify the economical spend in human and hospital facilities resources.