ABSTRACT
Introducción: La conciliación de la medicación (CM) es el proceso que compara el tratamiento farmacológico previo del paciente con el prescrito tras una transición asistencial. En el ámbito hospitalario, es una estrategia que permite minimizar errores de medicación. Nuestro objetivo es analizar el impacto de la implantación de un circuito de CM entre neumología y farmacia al ingreso y al alta. Pacientes y métodos: Se incluyeron pacientes polimedicados ingresados en neumología entre mayo-2012 y diciembre-2013. Se evaluaron: número de discrepancias al ingreso y alta, tipos de discrepancias no justificadas, gravedad, grado de aceptación del neumólogo, número de fármacos. Resultados: Se conciliaron al alta 507 pacientes de 818 altas (61,8%). En 2012 se conciliaron al alta 134 pacientes, detectándose 134 discrepancias en 63 pacientes (47%), con una media de 2,12 discrepancias/paciente. Se entregaron 161 medicamentos de uso limitado. En 2013 se conciliaron al ingreso 318 pacientes. Se detectaron 226 discrepancias en 130 pacientes (40,9%). Se conciliaron al alta 373 pacientes de 554 altas (67,32%), detectándose 139 discrepancias en 96 pacientes (25,7%) con una media de 1,4 discrepancias/paciente. Se entregaron 520 medicamentos de uso limitado. El análisis comparativo al alta entre mayo-diciembre 2012/2013, mostró un aumento en el número de pacientes conciliados (50,8% vs 62,9%) y disminución significativa del número de pacientes con discrepancias del 47% al 22,4% (p=0,001). Conclusiones: El descenso en el número de discrepancias por paciente demuestra que la CM es una eficaz herramienta al ingreso y al alta, obteniéndose con la misma una racionalización del uso de fármacos. La perspectiva futura es fomentar la colaboración atención primaria-especializada. Sería necesario realizar estudios para evaluar el impacto sobre los reingresos
Introduction: Medication conciliation (MC) is the process of comparing the previous pharmaceutical treatment of the patient with the prescribed treatment after transitional medical assistance. It´s a strategy to minimize medicational errors within the hospital.Our goal is to analyze the impact of the implementation of a circuit of MC between pulmonology and pharmacy at admission and discharge. Methods: Polymedicated patients that were hospitalized in pulmonology between May 2012 and December 2013 were included. There were evaluated: number of discrepancies at admission and discharge, different types of not justified discrepancies, severity, acceptability of the pulmonologist and number of drugs. Results: There were 818 patients admited, 507 of which were conciliated at time of discharge (61.8%). In 2012, 134 patients were conciliated at the time of discharge detecting 134 discrepancies in 63 patients (47%), with an average of 2.12 discrepancies/patient. 161 drugs were distributed for limited use. In 2013, 318 patients were conciliated at the time of admission. There were 226 discrepancies detected in 130 patients (40.9%). At the time of discharge 373 patients were conciliated from 554 patients (67.32%), 139 discrepancies detected in 96 patients (25.7%) with a mean of 1.4 discrepancies/patient. 520 drugs were distributed for limited use. The comparative analysis of admissions between May 2012 and December 2013 showed an increase in the number of conciliated patients (50.8% and 62.9%) and a significant decrease in the number of patients with discrepancies of 47% to 22.4% (p=0,001). Conclusions: The decrease in the number of discrepancies per patient demonstrates that MC is an effective tool at admission and discharge, obtaining there in a rational use of drugs. The future vision is to foster the collaboration between primary and specialized care. Further studies would be necessary to evaluate the impact on readmissions
Subject(s)
Female , Humans , Male , Medication Reconciliation/methods , Medication Reconciliation/classification , Pulmonary Medicine/education , Pulmonary Medicine , Drug Therapy/classification , Drug Therapy/methods , Ambulatory Care , Medical Record Linkage/instrumentation , Societies/ethics , Prospective Studies , Medication Reconciliation/organization & administration , Medication Reconciliation , Pulmonary Medicine/methods , Drug Therapy/standards , Drug Therapy , Ambulatory Care/methods , Drug Control for Patient in Transit , Medical Record Linkage/standards , Societies/policies , Cross-Sectional Studies/methodsABSTRACT
El síndrome de Dressler (SD) se caracteriza por fiebre, dolor torácico de tipo pleurítico y derrame pericárdico después de 2-3 semanas de un infarto agudo del miocardio o lesión pericárdica; suele mejorar con AAS u otro AINE; los glucocorticoides se reservan para pacientes con dolor intenso y refractario. Se presenta el caso de un varón con derrame pleural (DP) secundario a SD en paciente con antecedente de cirugía cardiaca reciente recidivante y con mala evolución, en probable relación a tratamiento con dosis bajas de antiinflamatorios y rápido descenso de los mismos de forma inicial, presentando mejoría al reintroducir tratamiento a dosis altas y de forma prolongada
Dresslers syndrome (DS) is characterized by fever, chest pleuritic pain and pericardial effusion that may appear 2-3 weeks after an acute myocardial infarction or pericardial injury and usually improves with aspirin or other NSAIDs; glucocorticoids reserved for patients with severe and refractory pain. The case of a man with pleural effusion (PE) secondary to DS with history of recent heart surgery, which was recurrent and poor outcome, probably related to treatment with low doses of anti-inflammatory and rapid decline of the same initial presenting improvement to reintroduce treatment with high doses and for long periods
Subject(s)
Humans , Male , Pleural Effusion/diagnosis , Pleural Effusion/pathology , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/metabolism , Thrombosis/rehabilitation , Thrombosis/therapy , Pacemaker, Artificial/supply & distribution , Pleural Effusion/congenital , Pleural Effusion/metabolism , Myocardial Infarction/complications , Myocardial Infarction/genetics , Pulmonary Embolism/nursing , Pulmonary Embolism/physiopathology , Thrombosis/metabolism , Thrombosis/nursing , Pacemaker, ArtificialABSTRACT
El linezolid es un antibiótico perteneciente al grupo de las oxazolidinonas que tiene actividad frente a cocos gram positivos aerobios. Su empleo resulta útil en infecciones complicadas por patógenos multirresistentes. Aunque está indicado para el tratamiento de la neumonía e infecciones de la piel y tejidos blandos, ha demostrado eficacia en la tuberculosis multirresistente y en otras enfermedades infecciosas. Dentro de los efectos adversos del linezolid, destacan: cefalea, trastornos gastrointestinales, anemia, trombopenia, leucopenia, pancitopenia, acidosis láctica y neuropatía. Se presenta el caso de una mujer de 42 años con tuberculosis multirresistente tratada con etambutol, estreptomicina, ofloxacino y linezolid, que presentó meses después del inicio del tratamiento, anemia, leucopenia leve, trastornos gastrointestinales y neuropatía. Tras la suspensión del linezolid y transfusión de concentrados de hematíes, se objetivó mejoría clínica y analítica. La toxicidad hematológica del linezolid suele ser reversible y su gravedad depende de la duración del tratamiento
Linezolid is an antibiotic from the group of the oxazolidinone that has activity against aerobic gram -positive cocci. Its use is useful in complicated infections by multiresistant pathogens. Although it is indicated for the treatment of pneumonia and infections of the skin and soft tissues, it has shown efficacy in MDR-TB and other infectious diseases. The adverse effects of linezolid includes: headache, gastrointestinal distress, anemia, thrombocytopenia, leukopenia, pancytopenia, lactic acidosis, and neuropathy. The case of a 42 year old woman with MDR-TB treated with ethambutol, streptomycin, ofloxacin is presented, and linezolid show, months after the start of treatment, anemia, mild leukopenia, gastrointestinal disorders and neuropathy. After suspensionof linezolid and transfusion of packed red blood cells, clinical and analytical improvements were observed. The haematological toxicity of linezolid is usually reversible and its severity depends on the duration of treatment
