Feasibility and reliability of a quality indicator system for an ambulatory dispensing service.

Background: For a medication dispensing service to function with quality, continuous evaluation is required, which is why it is necessary to have reliable measurement tools that make it possible. Quality indicators can serve as tools for managing quality, as they are variables that directly or indirectly measure changes in a situation and help evaluate the progress made in addressing it. This article aims to determine the feasibility and reliability of a quality indicator system for a drug dispensing service for paediatric outpatients in two Mexican hospitals. Methods: A study of the development type of health systems and services at a microlevel was conducted from October 2020 to October 2021 in the pharmaceutical service of two Mexican hospitals. To determine the feasibility of the quality indicators, a retrospective evaluation was performed, which considered the indicators that could be calculated with the available information to be feasible. To determine reliability, an inter-observer agreement study (Kappa (κ)) was performed. Results: The feasibility analysis revealed that all five reference indicators related to the structure were feasible in both hospitals. In the Infantil of the Californias hospital, all six process indicators evaluated were feasible, whilst only one was found feasible in H+ Querétaro. As for outcome indicators, only one was feasible in the Infantil of the Californias hospital. The causes of non-feasibility in both hospitals were the non-documentation of the primary data related to the stages of the process and the lack of instruments to measure patient satisfaction. The reliability of the indicators showed little variability. Conclusion: Although not all indicators were feasible, solutions were proposed so that the 15 reference indicators could be used if an organization decided to do so. The reliability of the indicators was demonstrated, evidencing the importance of the data sheet as a tool to generate valid reliable measures.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.

Methodological - Theoretical approach to phenomenological studies on the experience of medication use: A systematic review.

BACKGROUND: The study of medication use should include pharmacological, family, and social dimensions to explain how the lived experiences, beliefs, and perceptions of everyone, and their social and cultural environment affects consumption, using for this purpose the qualitative approach. OBJECTIVE: To conduct a systematic review of the theoretical-methodological approaches to phenomenology to identify studies that allow an understanding of patients' experiences with the use of medications.a. METHODS: A systematic literature search was conducted following the PRISMA guidelines to identify studies that address phenomenological research on patients' experiences of medications used and to apply them in subsequent studies. A thematic analysis was performed using ATLAS.ti software to facilitate data management. RESULTS: Twenty-six articles were identified, most of them including adult patients diagnosed with chronic degenerative diseases. The semantic network obtained places Phenomenology at the center as the interpretative referential framework, with three theoretical approaches: descriptive, interpretative, and perceptual under the philosophies of Husserl, Heidegger, and Merleau-Ponty respectively; two techniques to collect data which are in-depth interview and focus groups; and to explore the life experiences of patients and understand the meaning in the context of their lives, thematic analysis, content analysis, and interpretative phenomenological analysis were identified. CONCLUSIONS: It was evidenced that Qualitative Research approaches, methodologies, and techniques are applicable to describe people's experiences towards the use of medications. Phenomenology constitutes a useful referential framework in qualitative research to explain the experiences and perceptions about the disease and the use of medicines.

Design and validation of quality indicators for drug dispensing in a pediatric hospital.

OBJECTIVES: This article presents a methodological strategy to design and validate quality indicators for drug dispensing in a pediatric hospital. SETTING: The literature evaluation, design, and validation of indicators by experts were carried out from September 2017 to March 2018 in the pharmaceutical services of a pediatric hospital at the Autonomous University of the State of Hidalgo, Mexico. PRACTICE DESCRIPTION: The design and validation of quality indicators for dispensing allow the evaluation, planning, and follow-up of this activity. PRACTICE INNOVATION: The development of the indicators follows a holistic vision considering the relationship between the structure on which the pediatric dispensation is based, the involved processes, and the outcomes and provide a simple tool to improve the quality of the dispensing service. EVALUATION: A methodological investigation for the development of systems and health services in drug dispensing was performed. For the indicator's design, the Mexican standards for establishments dedicated to the sale and supply of drugs, the Good Dispensation Practices, and the Donabedian model were considered. The validation of such indicators was carried out using the Delphi method and the Torgerson mathematical model. RESULTS: Indicators of structure, process, and results were designed; of the 16 indicators designed, 15 reached the average score of greater than 3.5, and the percentage of experts who qualified each indicator in the highest categories was greater than 50%. CONCLUSION: The design of indicators guarantees the quality of the dispensing service and can be extrapolated to the pharmaceutical services of any pediatric hospital.

Effect of dichloromethylene diphosphonate on liver regeneration following thioacetamide-induced necrosis in rats.

AIM: To study the effect of dichloromethylene diphosphonate (DMDP), a selective Kupffer cell toxicant in reference to liver damage and postnecrotic liver regeneration in rats induced by sublethal dose thioacetamide (TA). METHODS: Rats, intravenously (iv) pre-treated with a single dose of DMDP (10 mg/kg), were intraperitoneally (ip) injected with TA 6.6 mmol/kg (per 500 mg/kg body weight). Hepatocytes were isolated from rats at 0, 24, 48 and 72 h following TA intoxication and blood and liver samples were obtained. To evaluate the mechanisms involved in the postnecrotic regenerative state, DNA distribution and ploidy time course were assayed in isolated hepatocytes. Circulating cytokine tumor necrosis factor-alpha (TNF-α) was assayed in serum and determined by reverse transcriptase-polymerase chain reaction in liver extract. RESULTS: The effect of DMDP induced noticeable changes in postnecrotic regeneration, causing an increased percentage of hepatocytes in the cell cycle S phase. The increase at 24 h in S1 population in rats pretreated with DMDP + TA was significantly (P < 0.05) different compared with that of the TA group (18.07% vs 8.57%). Hepatocytes increased their proliferation as a result of these changes. Also, TNF-α expression and serum level were increased in rats pre-treated with DMDP. Thus, DMDP pre-treatment reduced TA-induced liver injury and accelerated postnecrotic liver regeneration. CONCLUSION: These results demonstrate that Kupffer cells are involved in TA-induced liver, as well as in postnecrotic proliferative liver states.

Estudio de farmacovigilancia de ácido valproico en tres Servicios Clínicos de un Hospital Pediátrico / No disponible

Objetivo: Dado que el ácido valproico es uno de los medicamentos más empleados en el hospital pediátrico en estudio y es utilizado en una de las principales causas de morbilidad en México, se realizó este estudio para detectar sus reacciones adversas, valorar la relación beneficio/riesgo, determinar su imputabilidad, gravedad y significancia clínica, con el objetivo de prevenir o minimizar las reacciones adversas, y con la finalidad de promover políticas del uso de éste. Material y Método: Se realizó un estudio retrospectivo (2002) en 3 Servicios Clínicos. Se analizaron 425 expedientes clínicos y notas de farmacia, obteniéndose datos de incidencia y frecuencia de reacciones adversas (RA), imputabilidad y gravedad significancia clínica de las RA y la relación beneficio/riesgo. Resultados: La incidencia y frecuencia de RA fue 0.263 y 6.68%, principalmente hematológicas y dermatológicas. La imputabilidad: 46% probables, 29% definidas y 25% posibles. La gravedad y significancia clínica: 57% moderadas y 32% graves, principalmente. Relación beneficio-riesgo: 47 casos igual a 1.0 y 40 casos menor a 1.0. Conclusiones: Este estudio permitió tener datos de incidencia y frecuencia de reacciones de ácido valproico en pacientes mexicanos, conocer algunos indicadores relacionados al beneficio-riesgo, con la finalidad de apoyar el uso racional de éste en el hospital (AU)

Purpose: The valproic acid is a drug used frecuently in the paediatric hospital studied and it is used in the main morbidity causes in Mexico. This study was performed to detect the adverse reactions, to evaluate the relationships benefit/risk, to determine its imputability, severity and clinical signification with the objetive to prevent and minimize the adverse reactions and the aim to promote the valproic acid use polices. Methods: A retrospective study was performed (2002) in three clinical services, analyzing 425 clinical histories and the pharmacy files, obtaining different data, such as, incidence and frequency of adverse reactions (AR), imputability and severity-clinical signification of AR and relationship benefit/risk. Results: The incidence and frecuency of adverse reactions was0.263 and 6.68%. The main adverse reactions were hematologic and dermatologic reactions. The imputability was 46% probable, 29% definite and 25% possible. The severity and clinical significations of adverse reactions was 57% moderate and 32% serious, mainly. The relationship benefit/risk was 47 cases is same to one and 40 cases was less than one. Conclusions: This study permitted to have data both incidence and frequency of valproic acid adverse reactions, in Mexican paediatric patients, moreover to know some indicators in relation with benefit and risk of utilization of valproic acid, with the objetive to support the rational use of this drug (AU)