[Factors associated with adherence in HIV patients]. / Factores relacionados con la adherencia en pacientes infectados por el virus de la inmunodeficiencia humana.

OBJECTIVE: To establish the relationship between the adherence to ARVT and the clinical situation and detect those factors which relate to the lack of adherence. METHOD: Observational study on HIV patients who had attended the Pharmacy Service in Navarra Hospital between February and May 2005. The SMAQ questionnaire and pharmacy dispensing records were used to assess adherence to treatment. Socio-demographic variables and other factors which could influence adherence were recorded. Statistical analysis was carried out using the SPSS programme, version 14.0. RESULTS: No concordance was noted between the two measurements of adherence, although there was an association between the viral load and compliance, irrespective of the method used. The questionnaire recorded a higher percentage of non-adhering female patients, substance users and psychiatric patients. Non-adhering patients indicated more frequently factors which made taking the medication difficult. The multivariate analysis showed that the lack of a suitable social-familial environment negatively influenced the adherence level, according to the SMAQ questionnaire, and that the high number of tablets per dose was related to the lack of adherence according to the pharmacy dispensing records. CONCLUSIONS: Patients who adhere to ARVT have a lesser risk of virological failure. An unsuitable social-familial environment and the complexity of treatment are associated with a lack of adherence. The method of using dispensing records should be combined with a patient interview to define the factors which reduce adherence and to propose intervention strategies.

Síndrome tóxico del segmento anterior: investigación de un brote / Toxic anterior segment syndrome (TASS): studying an outbreak

Introducción: En los últimos años se ha descrito una complicación asociada a la cirugía de cataratas, el síndrome tóxico del segmento anterior. Es un proceso inflamatorio que aparece en las primeras horas tras la cirugía, de carácter no infeccioso y que generalmente se resuelve bien con corticoides tópicos si el tratamiento se instaura con prontitud. En el presente trabajo se describe este síndrome y se analizan las posibles causas de un brote que tuvo lugar en nuestro centro y que afectó a 5 pacientes. Métodos: Se creó un grupo de investigación en el centro que revisó todos los procedimientos implicados, puesto que las causas del síndrome pueden ser múltiples. Se analizaron desde los métodos de lavado y esterilización de material hasta los medicamentos y sustancias utilizadas que pudieron ser causa del brote. Entre estos últimos, se revisaron las sustancias elaboradas en el servicio de farmacia, en especial la solución salina irrigadora, utilizada en todos los casos. Resultados: Los resultados bioquímicos, microbiológicos, de pH, osmolaridad y de endotoxinas indicaron que las soluciones elaboradas en el servicio de farmacia eran correctas. Discusión: Dado que los resultados de los análisis de las sustancias empleadas eran correctos, corroborados con su reintroducción sin efecto adverso alguno, se llegó a la conclusión de que el brote más bien estaría relacionado con el proceso de lavado previo a la esterilización del instrumental utilizado en la cirugía, ya que no se estaban siguiendo las recomendaciones de uso de agua destilada y estéril para este fin, sino que, por el contrario, se estaba utilizando agua corriente de la red (AU)

Introduction: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. Methods: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. Results: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. Discussion: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used (AU)

[Toxic Anterior Segment Syndrome (TASS): studying an outbreak]. / Síndrome tóxico del segmento anterior: investigación de un brote.

INTRODUCTION: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. METHODS: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. RESULTS: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. DISCUSSION: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used.

[Taxanes in the adjuvant therapy of breastcancer with positive nodes: a meta-analysis]. / Taxanos en el tratamiento adyuvante del cáncer de mama con ganglios positivos: metanálisis.

INTRODUCTION: Taxanes have demonstrated high activity in the treatment of metastatic breast cancer. Based on these promising results, clinical trials were initiated to assess their efficacy in non-metastatic breast cancer both in the adjuvant and neoadjuvant setting. OBJECTIVE: To collect scientific evidence as needed for future decision making on the use of taxanes in the adjuvant therapy of breast cancer with positive nodes, and to assess the efficacy of chemotherapy regimens including a taxane using a meta-analysis. SEARCH STRATEGY: a systematic search of randomized controlled phase-Ill trials comparing poly-chemotherapy with taxanes versus other drug combinations with-out taxanes was performed. Patients were to have non-metastatic breast cancer with positive nodes, and should have received chemotherapy following surgery. The search was performed by two investigators separately. DATA COLLECTION AND ANALYSIS: data(relapses and mortality) were separately collected from clinical tri-als by two investigators to assess disease-free survival and overall survival at 5 years. Selected data underwent a meta-analysis using Peto's method. Peto odds ratio (ORp) and 95% confidence interval were calculated for each measured variable. RESULTS: Only 3 clinical trials met inclusion criteria; 7,671 patients were studied. Combined OR was ORp 0.79 (95% Cl:0.71-0.87) for disease-free survival and OR, 0.82 (95% Cl: 0.73-0.92) for overall survival. CONCLUSIONS: Chemotherapy regimens including a taxane in the adjuvant therapy setting for breast cancer with positive nodes provide a significant improvement regarding increased disease-free survival and overall survival at 5 years.

Taxanos en el tratamiento adyuvante del cáncer de mama con ganglios positivos: metanálisis / Taxanes in the adjuvant therapy of breast cancer with positive nodes: a meta-analysis

Introducción: Los taxanos han demostrado tener alta actividad en el tratamiento del cáncer de mama metastásico. Basándose en estos prometedores resultados, se iniciaron ensayos clínicos para evaluar su eficacia en el cáncer de mama no metastásico, tanto como terapia adyuvante como neoadyuvante. Objetivo: Recopilar la evidencia científica necesaria para fundamentar futuras decisiones clínicas sobre el uso de los taxanos en el tratamiento adyuvante de cáncer de mama con ganglios positivos; y evaluar, mediante un metanálisis, la eficacia de los regímenes quimioterápicos que incluyan un taxano. Material y métodos: Estrategia de búsqueda: se realizó una búsqueda sistemática de ensayos clínicos aleatorizados y controlados, fase III, que compararan poliquimioterapia con taxanos, frente a otras combinaciones de fármacos quimioterápicos sin taxano. Las pacientes debían presentar cáncer de mama no metastático con ganglios positivos y haber recibido el tratamiento quimioterápico después de cirugía. La búsqueda fue realizada por dos investigadores por separado. Recolección de datos y análisis: la extracción de datos (recaídas y mortalidad) de los ensayos clínicos, fue realizada por dos investigadores por separado para valorar la supervivencia libre de enfermedad y la supervivencia global a los cinco años. Los datos seleccionados se sometieron a metanálisis utilizando el método de Peto. Para cada una de las variables medidas se calcularon las odd ratio de Peto (ORP) junto con su intervalo de confianza (IC) de 95%. Resultados: Sólo 3 ensayos clínicos cumplían los requisitos de inclusión. Se estudiaron 7.671 pacientes. La OR combinada fue ORP 0,79 (IC 95%: 0,71-0,87) en la supervivencia libre de enfermedad y en supervivencia global ORP 0,82 (IC 95%: 0,73-0,92). Conclusión: Los regímenes quimioterápicos que incluyen un taxano como tratamiento adyuvante del cáncer de mama con ganglios positivos, aportan una mejora significativa en aumento de la supervivencia libre de enfermedad y la supervivencia global a los cinco años

Introduction: Taxanes have demonstrated high activity in the treatment of metastatic breast cancer. Based on these promising results, clinical trials were initiated to assess their efficacy in nonmetastatic breast cancer both in the adjuvant and neoadjuvant setting. Objective: To collect scientific evidence as needed for future decision making on the use of taxanes in the adjuvant therapy of breast cancer with positive nodes, and to assess the efficacy of chemotherapy regimens including a taxane using a meta-analysis. Material and methods: Search strategy: a systematic search of randomized controlled phase-III trials comparing polychemotherapy with taxanes versus other drug combinations without taxanes was performed. Patients were to have non-metastatic breast cancer with positive nodes, and should have received chemotherapy following surgery. The search was performed by two investigators separately. Data collection and analysis: data (relapses and mortality) were separately collected from clinical trials by two investigators to assess disease-free survival and overall survival at 5 years. Selected data underwent a meta-analysis using Peto's method. Peto odds ratio (ORP) and 95% confidence interval were calculated for each measured variable. Results: Only 3 clinical trials met inclusion criteria; 7,671 patients were studied. Combined OR was ORP 0.79 (95% CI: 0.71-0.87) for disease-free survival and ORP 0.82 (95% CI: 0.73- 0.92) for overall survival. Conclusions: Chemotherapy regimens including a taxane in the adjuvant therapy setting for breast cancer with positive nodes provide a significant improvement regarding increased diseasefree survival and overall survival at 5 years

Encuesta de opinión a los pacientes sobre el medicamento en el hospital y la atención en el servicio de farmacia / Survey of patient opinion of hospital medication and the pharmacy service

El objetivo del estudio fue valorar la opinión del paciente sobre el medicamento en el hospital y la atención en el servicio de farmacia y diseñar una herramienta para medir la calidad percibida por el usuario. Se realizó un estudio transversal multicéntrico encuestando a 337 pacientes ingresados y 179 ambulatorios. El 93 por ciento de los ingresados están satisfechos en general y el 94 por ciento de los ambulatorios lo está con la información que recibe. Pocos pacientes ingresados tienen contacto directo con el farmacéutico (2 por ciento). Al 77 por ciento de los ingresados les informan sobre los medicamentos y sólo el 37 por ciento conoce los efectos secundarios de éstos. En cuanto a los pacientes ambulatorios, su satisfacción aumenta si se les da información escrita, se les atiende en un lugar separado y se les ofrece la posibilidad de llamar. En definitiva, los pacientes están satisfechos, aunque la información al paciente ofrece al farmacéutico oportunidades de mejora (AU)