Metformin-associated hyperlactacidaemia acidosis: Diagnosis rate in standard clinical practice and its relationship with renal failure. / Acidosis con hiperlactacidemia por metformina: frecuencia de su diagnóstico en la práctica clínica habitual y relación con la insuficiencia renal.

BACKGROUND AND OBJECTIVES: Observational study on the difference between the number of cases of acidosis with hyperlactacidaemia suspected of being caused by metformin diagnosed in standard clinical practice and the incidence of this condition according to the datasheet. The study also explored the relationship between renal function and metformin-associated hyperlactacidaemia acidosis. PATIENTS: We identified cases of acidosis between 2013 and 2014 by analysing the minimum basic data set and laboratory requests. We selected patients who presented venous lactate levels >2.7 mmol/L at the time they were treated and for whom the use of outpatient metformin was confirmed. The causal relationship with metformin was independently evaluated by several researchers. The incident cases were calculated based on the number of patients who had been dispensed a drug containing metformin during the same period in the study area. RESULTS: We identified 476 cases of acidosis. Metformin was suspected of causing the condition of acidosis with hyperlactacidaemia in 20 of these cases, which represents an incidence rate of 6.57/10,000 patients. Eighty-five percent of the cases presented acute renal failure. CONCLUSIONS: The apparent incidence of acidosis with hyperlactacidaemia in patients treated with metformin is greater than that established in the datasheet (<1/10,000). The onset of metformin-associated hyperlactacidaemia acidosis is related to acute renal impairment.

Enfermedad mental y seguridad vial / Mental illness and road safety

Introducción. Los trastornos psiquiátricos, bien por su psicopatología o por los tratamientos farmacológicos que precisan, pueden producir cambios en la percepción, en el procesamiento e integración de la información y en la actividad psicomotora que pueden alterar y/o interferir con la capacidad para una conducción segura. Método. El presente estudio valora la competencia para la conducción de vehículos de una muestra de pacientes psiquiátricos ambulatorios, con licencia de conducir y que conducen asiduamente, que cumplimentaron la batería psicotécnica computarizada homologada LNDETER 100 en diferentes situaciones clínicas. Resultados. De los 120 pacientes estudiados, únicamente 24 superaron las cuatro pruebas requeridas para la concesión o renovación del permiso de conducción, mientras que el 80% fracasó en al menos una de las pruebas exigidas. Ninguno de los participantes en el estudio declaró su enfermedad o su tratamiento a las autoridades de tráfico, ni a los centros de reconocimiento existentes. Ningún paciente dejó de conducir, aunque un 10% de ellos consideró que su capacidad estaba en algún modo deteriorada. Conclusiones. Los pacientes psiquiátricos con un funcionamiento psicomotor alterado deben ser una preocupación para los psiquiatras y médicos generales en precisión de su competencia para la conducción de vehículos. Se discuten las consideraciones clínicas, éticas y legales de los hallazgos del estudio (AU)

Introduction. Psychiatric disorders, either due to their psychopathology or the drug treatments required, may lead to changes in perception, information processing and integration, and psychomotor activity which may disturb and/or interfere with the ability to drive safely. Method. This study assesses competence to drive in a sample of psychiatric outpatients, with a driver's license, who drove regularly. This ability was assessed with the accredited LNDETER 100 battery, an electronic assessment unit measurement, in different clinical situations. Results. Only 24 of the 120 patients passed the four tests required to obtain or renew a driver's license, and 80% failed in at least one of the required tests. None of the patients studied had notified the traffic authorities or the examination centers that they had a psychiatric condition that could affect safe driving. No patient stopped driving, although 10% of them admitted that their ability to drive was somewhat deteriorated. Conclusions. Psychiatric patients with altered psychomotor performance should be a concern for psychiatrists and general practitioners regarding their competence to drive vehicles. Clinical, ethical and legal aspects of our findings are discussed (AU)

La evaluación cualitativa en la formación médica continuada / Qualitative evaluation in continuing medical education

Los métodos semicualitativos y cualitativos permiten realizar una evaluación de los programas de formación médica continuada de una forma más profunda. Dichos métodos son de utilidad para responder a preguntas evaluativas del cómo y por qué de los fenómenos. Las técnicas de recogidas de datos más frecuentemente utilizadas son la observación, la entrevista, los grupos focales de discusión, el análisis de documentos y las encuestasen la bibliografía se han publicado múltiples estudios enlos que se ha utilizado una o varias de las técnicas enumeradas con el fin de evaluar el proceso, el impacto, las necesidades o las barreras de un programa de formación médica continuada (AU)

Semi-qualitative and qualitative methods make it possible to carry out a more thorough evaluation of continuing medical education programmes. These methods are useful to answer evaluative questions about how and why phenomena take place. The most commonly used data collection techniques are observation, interviews, focus group discussions, document analysis and surveys. The literature offers many examples of studies in which one or several of the above-mentioned techniques have been used to evaluate the process, the impact, the needs or the hindrances of a continuing medical education programme (AU)

[Adverse reactions and other drug-related problems in an emergency service department]. / Reacciones adversas y problemas relacionados con medicamentos en un servicio de urgencia.

BACKGROUND: Adverse Drug Reactions (ADR) and Drug-Related Problems (DRP's) are a frequency cause of hospital emergency room visits and require better assessment. METHOD: An analysis was made of 1097 consecutive admission to the emergency room at the Nuestra Senora de los Volcanes, Hospital (currently the General Hospital of Lanzarote) in Arrecife de Lanzarote (Canary Islands) over a three-month period in order to detect any possible DAR or any other drug-related problems. RESULTS: Nineteen (19) of the 1097 admissions were due to Adverse Drug Reactions (ADR) (1.73%; 95% IC:0.96%-2.5%). Some of the most outstanding of the other "Drug-Related Problems" (DRP's) were medication overdose, which was diagnosed in 5 (0.45%) of the patients; the worsening of the symptoms due to ceasing to take the medication was involved in 8 (0.72%), and incorrect treatments which involved medical care at the emergency room totaled 11 (1.0%). The number of drug-related problems (DRP's) in the sample totaled 43 (3.9%). The drug-related problems (DRP's) led to hospitalization in 1.9% of the cases seen in the emergency room and led to hospitalization in 9.6% of all of hospital admission through the emergency room for the period of time under study. The ADR led to 4.1% of the hospital admissions. CONCLUSIONS: Drug-related problems are a frequent, major problem which has not been well-analyzed in the emergency rooms. Additionally, emergency rooms can function as the first point of detection of a ADR among an outpatient population.