ABSTRACT
ObjetivoAyudar a los médicos de familia a detectar y a prevenir problemas relacionados con interacciones medicamentosas para lograr una prescripción de más calidad y mejorar la seguridad de los pacientes.Material y métodosEstudio de intervención no controlado basado en metodología de evaluación y mejora de calidad. Emplazamiento: 2 áreas de salud de la Región de Murcia. Participantes: pacientes de 139 médicos de familia que utilizan habitualmente la historia clínica electrónica (más de 100 prescripciones electrónicas por semana: 188.353 individuos y 334.088 prescripciones al inicio del estudio y 202.988 individuos y 335.198 prescripciones al final del estudio). Intervención: 1) diseño de un programa informático detector de pacientes con interacciones clínicamente importantes que deberían evitarse (tipos 1 y 2 de la base de datos del Colegio Oficial de Farmacéuticos); 2) elaboración automatizada de un informe sobre éstas para cada médico, que incluye identificación del paciente, medicamentos, evidencias disponibles y recomendaciones de actuación, y 3) realización de sesiones clínicas por farmacéutico entrenado en el centro de salud coincidentes a su entrega.ResultadosInteracciones preintervención: prevalencia del 1,29%; por paciente en riesgo el 6,57% y por médico de familia el 20,2%. Postintervención: prevalencia del 1,06% (mejora del 17,6%; p<0,000001); por paciente en riesgo el 5,17% (mejora del 21,4%; p<0,000001) y por médico de familia el 17,7 (mejora del 12,1%; p<0,001).ConclusionesImplantar este tipo de tecnología puede ser útil para la seguridad del paciente, por lo que debería extenderse a todos nuestros médicos. Deben valorarse otras tecnologías, como sistemas de alerta electrónica concurrentes con la prescripción para las interacciones de especial frecuencia o trascendencia(AU)
PurposeTo help family doctors to detect and prevent problems related to drug-drug interactions in order to attain a higher quality prescription and an improvement in patient safety.MethodsUncontrolled study of an intervention based on quality evaluation and improvement methods.SettingTwo health areas in Murcia Region (Spain).PatientsSubjects appointed to 139 family doctors regularly using electronic clinical records (including doctors who were producing over 100 electronic prescriptions per week: 188,953 subjects and 334.088 prescriptions at the start, and 202,988 subjects and 335.198 prescriptions at the end of study). Intervention: (1) A software able to collect patients who had clinically important drug-drug interactions those that should be avoided (BOT I+II) was designed. (2) A report on these interactions was drawn up and delivered periodically to every single doctor, including patient identification and information on the drugs involved, possible consequences, and recommendations about what to do. (3) Clinical and educative sessions given by a trained pharmacist were carried out in doctors health centre coinciding with their delivery.ResultsDrug-drug interactions pre-intervention: prevalence 1.29%; by patient at risk 6.57%; by doctor 20.2. Post-intervention: prevalence 1.06% (improvement 17.6%, P<.000001), by patient at risk 5.17% (improvement 21.4%, P<.000001), by doctor 17.7 (improvement 12.1, P<.001).ConclusionsDeveloping this technology leads to progress in patient safety, therefore it should be extended to all our family doctors. Other technologies such as an electronic alert when prescribing should be considered, particularly for either higher frequency or important consequences interactions(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Biomedical Technology/methods , Biomedical Technology/statistics & numerical data , Information Technologies and Communication Projects , Drug Prescriptions/statistics & numerical data , Drug Information Services/organization & administration , Information Services/organization & administration , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Physicians, Family/trends , Physicians, Family , Medication Therapy Management/organization & administration , Medication Therapy Management/statistics & numerical data , Information Systems/trends , Information Systems , Family Practice/organization & administrationABSTRACT
PURPOSE: To help family doctors to detect and prevent problems related to drug-drug interactions in order to attain a higher quality prescription and an improvement in patient safety. METHODS: Uncontrolled study of an intervention based on quality evaluation and improvement methods. SETTING: Two health areas in Murcia Region (Spain). PATIENTS: Subjects appointed to 139 family doctors regularly using electronic clinical records (including doctors who were producing over 100 electronic prescriptions per week: 188,953 subjects and 334.088 prescriptions at the start, and 202,988 subjects and 335.198 prescriptions at the end of study). INTERVENTION: (1) A software able to collect patients who had clinically important drug-drug interactions those that should be avoided (BOT I+II) was designed. (2) A report on these interactions was drawn up and delivered periodically to every single doctor, including patient identification and information on the drugs involved, possible consequences, and recommendations about what to do. (3) Clinical and educative sessions given by a trained pharmacist were carried out in doctors' health centre coinciding with their delivery. RESULTS: Drug-drug interactions pre-intervention: prevalence 1.29%; by patient at risk 6.57%; by doctor 20.2. Post-intervention: prevalence 1.06% (improvement 17.6%, P<.000001), by patient at risk 5.17% (improvement 21.4%, P<.000001), by doctor 17.7 (improvement 12.1, P<.001). CONCLUSIONS: Developing this technology leads to progress in patient safety, therefore it should be extended to all our family doctors. Other technologies such as an electronic alert when prescribing should be considered, particularly for either higher frequency or important consequences interactions.
Subject(s)
Drug Interactions , Drug Prescriptions/standards , Electronic Prescribing , Primary Health CareABSTRACT
The induction of cell death in leukemic HL-60 cells by the ether lipid 1-O-octadecyl-2-O-methyl-rac-glycero-3-phosphocholine (ET-18-OCH(3); edelfosine) followed the typical apoptotic changes in ultrastructural morphology, including blebbing, chromatin condensation, nuclear membrane breakdown and extensive vacuolation. Using a cytofluorimetric approach, we found that ET-18-OCH(3) induced disruption of the mitochondrial transmembrane potential (DeltaPsi(m)) followed by production of reactive oxygen species (ROS) and DNA fragmentation in leukemic cells. ET-18-OCH(3) also induced caspase-3 activation in human leukemic cells, as assessed by cleavage of caspase-3 into the p17 active form and cleavage of the caspase-3 substrate poly(ADP-ribose) polymerase (PARP). ET-18-OCH(3) analogues unable to induce apoptosis failed to disrupt DeltaPsi(m) and to activate caspase-3. ET-18-OCH(3)-resistant Jurkat cells generated from sensitive Jurkat cells showed no caspase-3 activation and did not undergo DeltaPsi(m) disruption upon ET-18-OCH(3) incubation. Cyclosporin A partially inhibited DeltaPsi(m) dissipation, caspase activation and apoptosis in ET-18-OCH(3)-treated leukemic cells. Overexpression of bcl-2 by gene transfer prevented DeltaPsi(m) collapse, ROS generation, caspase activation and apoptosis in ET-18-OCH(3)-treated leukemic T cells. Pretreatment with the caspase inhibitor Z-Asp-2, 6-dichlorobenzoyloxymethylketone prevented ET-18-OCH(3)-induced PARP proteolysis and DNA fragmentation, but not DeltaPsi(m) dissipation. ET-18-OCH(3) did not affect the expression of caspases and bcl-2-related genes. ET-18-OCH(3)-induced apoptosis did not require protein synthesis. Our data indicate that DeltaPsi(m) dissipation and caspase-3 activation are critical events of the apoptotic cascade triggered by the antitumor ether lipid ET-18-OCH(3), and that the sequence of events in the apoptotic action of ET-18-OCH(3) on human leukemic cells is: DeltaPsi(m) disruption, caspase-3 activation and internucleosomal DNA degradation.
