ABSTRACT
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Subject(s)
Humans , Biosimilar Pharmaceuticals , Drug Utilization , Biosimilar Pharmaceuticals/classification , Hospitals, UniversityABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Stiff-person syndrome (SPS) is an uncommon and disabling disorder characterized by progressive rigidity and episodic painful spasms involving axial and limb musculature. SPS treatment is mostly based on benzodiazepines, baclofen, immunosuppressants and intravenous immunoglobulin. Cannabis derivatives [tetrahydrocannabinol (THC) and cannabidiol (CBD)] are available as an oromucosal spray (Sativex(®)), indicated as add-on treatment, for symptom improvement in patients with moderate to severe spasticity because of multiple sclerosis (MS). Our objective is to report a case of seronegative SPS successfully treated with THC-CBD oromucosal spray. CASE SUMMARY: We report a case of a 40-year-old man presenting with progressive muscle stiffness and intermittent spasms for 6-years. The diagnosis of stiff-person syndrome was based on the clinical features and neuroelectrophysiologic findings of continuous motor unit activity. Glutamic acid decarboxylase autoantibodies was absent in our patient, in both serum and cerebrospinal fluid (CSF). Cannabis derivatives oromucosal spray was introduced after a series of unsatisfactory traditional medical treatments. After 14 months treated with THC-CBD oromucosal spray, improvement was verified in the eight dimensions of the scale of SF-36 quality of life questionnaire. WHAT IS NEW AND CONCLUSION: Clinical experience with cannabis derivatives in patients with multiple sclerosis is accumulating steadily, but there is no current literature about its efficacy for SPS. Because MS and SPS share some neurological symptoms such as spasticity and rigidity, it is thought that THC-CBC can be an option for SPS patient. Our case report suggests that THC-CBD oromucosal spray is an alternative treatment for patients with refractory SPS, and further validation is appropriate.
Subject(s)
Plant Extracts/therapeutic use , Quality of Life , Stiff-Person Syndrome/drug therapy , Administration, Mucosal , Adult , Cannabidiol , Dronabinol , Drug Combinations , Humans , Male , Plant Extracts/administration & dosage , Stiff-Person Syndrome/physiopathology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
INTRODUCTION: Due to its iatrogenic potential and economic impact, drug prescription is one of the most complex tasks within the health care process. Electronic prescription systems (EPS), and particularly expert systems, increase quality by reducing errors in the prescribing and dispensing processes. Besides, electronic prescription reduces costs. On the other hand, it demands a new equilibrium in the delivery of pharmaceutical services. METHOD: The EPS established at "Hospital de la Ribera" is described. This system is basically characterised by: (1) its integration within the electronic global system throughout a computer network; (2) drugs are ordered directly by physicians in the electronic system; (3) pharmacists access the whole clinical record of patients "in situ"; (4) and integration of clinical activities by pharmacists in the patient medical record. The impact of this system on pharmaceutical care activities such as identification, reporting and documentation of drug-related problems (DRPs) versus traditional approaches is analysed. RESULTS: Access to patient information throughout the system facilitates DRP identification, with a resulting overall prevalence of clinically relevant drug-related problems of 9%. CONCLUSION: The model implemented in our hospital favours the development of clinical activities by pharmacists as it allows communication among health care professionals, activities are permanently recorded in patient medical charts, and a formal document of pharmacist involvement and compromise with the clinical progress and outcome of patients ensues.
Subject(s)
Drug Prescriptions , Hospitalization , Medical Records Systems, Computerized/organization & administration , Pharmacy Service, Hospital , Humans , Pharmacy Service, Hospital/methods , Pharmacy Service, Hospital/organization & administration , SpainABSTRACT
Introducción: La prescripción de medicamentos es una de las tareas más complejas dentro del proceso asistencial, tanto por su potencial iatrogénico, como por su impacto económico. El desarrollo de los sistemas de prescripción informatizada (SPI), y en particular los sistemas expertos, supone una mejora en la calidad asistencial en la medida en que disminuyen los errores en la prescripción y dispensación al tiempo que reducen los costes. Por otra parte, su implantación motiva el establecimiento de un nuevo equilibrio en la provisión de los servicios farmacéuticos. Método: Se describe el sistema de prescripción electrónica establecido en el Hospital de la Ribera que se caracteriza por: a) formar parte del sistema informático integral del hospital; b) la prescripción la realiza directamente el médico en el sistema informático; c) dispone de acceso in situ a la totalidad de la historia clínica del paciente; y d) integra las actividades de atención farmacéutica en la historia clínica del paciente. Se analiza la repercusión del sistema sobre las actividades de atención farmacéutica de identificación, comunicación y documentación de problemas relacionados con los medicamentos (PRM) frente al sistema tradicional de revisión de la historia farmacoterapéutica. Resultado: El acceso a la información del paciente a través del sistema facilita la identificación de PRM, de manera que la prevalencia global de problemas relacionados con el medicamento con relevancia clínica se sitúa en el 9 por ciento. Conclusiones: El sistema descrito facilita la identificación de problemas relacionados con los medicamentos, la comunicación con el equipo asistencial y permite documentar las actividades de atención farmacéutica en la historia clínica del paciente. (AU)
