Cefepime Associated With Phenytoin Induced Stevens-Johnson Syndrome.

We describe a recent case of Stevens-Johnson Syndrome. A 49-year-old man was admitted to the Intensive Care Unit of an Anaesthesia and Resuscitation Department because of a Fournier gangrene that derived in a sepsis, ventilator-associated pneumonia, and renal failure. He was under treatment with cefepime and suffered a generalized status epilepticus, so started treatment with phenytoin. The next day he developed a "maculous cutaneous eruption in trunk and lower limbs" compatible with a Stevens-Johnson Syndrome. Stevens-Johnson Syndrome is a very severe and potentially fatal multiorganic disease, especially when present in critically ill patients, with a strong drug-related etiology, especially with antiepileptic drugs.

Drug Interaction Between Oral Cyclosporine Modified and Iron.

OBJECTIVE: To describe a recent case of suspected interaction between oral cyclosporine modified and iron. CASE SUMMARY: A 33-year-old man underwent urgent cardiac transplantation for refractory cardiogenic shock caused by acute myocarditis. The patient had persistently low levels of cyclosporine despite a dose increase of the drug after the change of administration route from intravenous to oral. Spacing the administration of cyclosporine modified from oral iron resolved the problem. This drug interaction was reported as "probable" as determined by a Drug Interaction Probability Scale score of 7. Using this scoring system, the patient experienced a probable drug interaction between cyclosporine and iron both administered orally, and we surmise that the mechanism is that iron physicochemically destabilizes the cyclosporine microemulsion when both are administered concurrently. DISCUSSION: This may be because of the interaction between cyclosporine microemulsion and iron because this cation can destabilize the immunosuppressant dosage form. CONCLUSIONS: Taking into account that joint administration of oral iron and cyclosporine modified can generate a physicochemical interaction that involves a decrease in the absorption of cyclosporine modified, we believe that it is necessary to recommend spacing administrations of both drugs as well as monitoring levels of cyclosporine in order to ensure optimal levels of immunosuppression.

Atención Farmacéutica en casos clínicos. Enfermedades raras

Manual en el que a través de casos clínicos se aborda la farmacoterapia de enfermedades con baja prevalencia, que disponen de tratamientos huérfanos y que afectan a pacientes de Castilla-La Mancha. Incluye diversas patologías como la enfermedad de Behcet, de Fabry, de Menkes, de Pompe, de Wilson, hemoglobinuria paroxística nocturna, mielofibrosis idiopática, tirosinemia, trombocitopenia inmune primaria y defectos del Ciclo de la Urea.

[Computer-aided electronic prescribing in Spanish hospitals]. / Características de la prescripción electrónica asistida en hospitales españoles.

OBJECTIVE: To describe electronic prescribing in a sample of Spanish hospitals and activities derived from its implementation in Hospital Pharmacy Departments, software features and acceptance. METHOD: A survey that included data related to program implantation and performance in hospitals with diverse characteristics was designed. It was posted at the Sociedad Española de Farmacia Hospitalaria website for a 6-month period and completed by phone. RESULTS: A total of 47 hospitals answered the survey. 13 (27.7%) had electronic prescribing systems, and of these, 8 of them had more than 75% of beds included in the system. In 15 (31.9%) hospitals that did not have it, its implementation was in project in the near future. Software applications used in this new health technology were not homogeneous, while integration of applications that facilitate Pharmaceutical Care tasks was infrequent. In 61.5% of the hospitals with electronic prescribing, transcription used to be the pharmacist s task. In 92.3% of these hospitals, order validation is currently carried out by pharmacists. The degree of satisfaction with the system was rated as good or very good by 92.3% of pharmacists. CONCLUSIONS: Computer-aided electronic prescribing appears to be a helpful tool for restructuring Department organization and investing time in new activities. A more ambitious and effective approach to clinical activities will therefore be possible. System optimization requires taking into account factors such as worker time investment, since new activities will be developed, along with the need for training courses.

Características de la prescripción electrónica asistida en hospitales españoles / Computer-aided electronic prescribing in spanish hospitals

Objetivo: Conocer las características de la prescripción electrónicaen una muestra de hospitales españoles, describir las actividadesderivadas de su implantación en los Servicios de Farmacia,características de los programas utilizados y su aceptación.Método: Se diseñó una encuesta que recogía datos de implantacióny funcionamiento del programa en hospitales con distintascaracterísticas. Se publicó en la web de la SEFH durante 6 mesesy se completó telefónicamente.Resultados: De 47 hospitales encuestados, 13 (27,7%) disponende prescripción electrónica asistida, en 8 de ellos estáimplantada en más del 75% de sus camas. En 15 (31,9%) de loscentros donde no disponen de ella, la implantación es un proyectoa corto-medio plazo. Existe dispersión en los programas utilizadosy son de instauración reciente. La integración de aplicacionescruzadas para desarrollar atención farmacéutica está poco explotada.En el 61,5% de los centros con prescripción electrónica asistida,la transcripción tradicionalmente era función del farmacéutico.En un 92,3% valida los tratamientos. Su satisfacción es buena omuy buena en un 92,3%.Conclusiones: Las capacidades de la prescripción electrónicaasistida y los cambios graduales en las funciones que desarrolla elfarmacéutico a raíz de su implantación podrían potenciar el desarrollode programas más amplios de atención farmacéutica.Para la optimización del uso del sistema es importante considerarfactores como la inversión en tiempo del personal, teniendoen cuenta que se asumen nuevas actividades, y la necesidad deformación de los usuarios

Objective: To describe electronic prescribing in a sample of Spanish hospitals and activities derived from its implementation in Hospital Pharmacy Departments, software features and acceptance. Method: A survey that included data related to program implantation and performance in hospitals with diverse characteristics was designed. It was posted at the Sociedad Española de Farmacia Hospitalaria website for a 6-month period and completed by phone. Results: A total of 47 hospitals answered the survey. 13 (27.7%) had electronic prescribing systems, and of these, 8 of them had more than 75% of beds included in the system. In 15 (31.9%) hospitals that did not have it, its implementation was in project in the near future. Software applications used in this new health technology were not homogeneous, while integration of applications that facilitate Pharmaceutical Care tasks was infrequent. In 61.5% of the hospitals with electronic prescribing, transcription used to be the pharmacist’s task. In 92.3% of these hospitals, order validation is currently carried out by pharmacists. The degree of satisfaction with the system was rated as good or very good by 92.3% of pharmacists. Conclusions: Computer-aided electronic prescribing appears to be a helpful tool for restructuring Department organization and investing time in new activities. A more ambitious and effective approach to clinical activities will therefore be possible. System optimization requires taking into account factors such as worker time investment, since new activities will be developed, along with the need for training courses

Síndrome coronario agudo en paciente tratado previamente con capecitabina y 5-fluorouracilo / Acute coronary syndrome in a patient previously treated with capecitabine and 5-fluorouracil

No disponible

Requisitos de uniformidad para manuscritos remitidos a revistas biomédicas: redacción y edición de la publicación biomédica Comité Internacional de Editores de Revistas Médicas (ICMJE) / Uniformity requirements for manuscripts submitted to biomedical journals-writing and editing biomedical reports

No disponible

[Analyzing the evolution of a Pharmacy Department using a relative value unit system]. / Análisis de la evolución de un Servicio de Farmacia a través del sitema de unidades relativas de valor.

INTRODUCTION: This study proposes the use of relative value units (RVU) as a clinical management tool to evaluate departmental services. OBJECTIVES: To measure productivity from 2000 to 2002 by estimating RVU. To determine RVU cost in constant Euros and evaluate system efficiency during this period of time. METHODS: Retrospective, observational study of a pharmacy department s production. RVU assigned to each activity have been obtained from a standardized document drawn up by the Sociedad Española de Farmacia Hospitalaria. Cost of each RVU was determined based on total cost assigned to the pharmacy department and the total number of RVUs produced. RESULTS: Drug dispensation activities account for 76% of the total production, followed by elaboration activities (21%). CONCLUSIONS: Productivity in our department has increased 46.48% in this period of time, while efficiency has increased by 23.8%.

[Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care and Emergency Units]. / Análisis coste-beneficio de la implantación de los sistemas automáticos de dispensación de medicamentos en las Unidades de Críticos y Urgencias.

OBJECTIVE: To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. METHODS: We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. RESULTS: Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. CONCLUSION: Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).

Análisis coste-beneficio de la implantación de los sistemas automáticos de dispensación de medicamentos en las unidades de críticos y urgencias / Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care Emenrgency Units

Objetivo: Determinar en términos económicos las consecuencias de la sustitución de botiquines de planta por la implantación de sistemas automáticos de dispensación de medicamentos (SADME) en las Unidades de Unidad de Cuidados Intensivos (UCI), Reanimación (Rea) y Urgencias. Material y método: Para nuestro estudio, se han considerado cuatro flujos, determinantes a la hora de implantar los SADME en un hospital, y éstos han sido: inversiones de capital, coste del personal implicado, costes del inventariado de medicamentos y costes en política de consumo. Resultados: Los resultados han sido estimados mediante el cálculo del valor actualizado neto. Tras su análisis, comprobamos cómo el gasto realizado por la inversión inicial se ve compensado por el beneficio generado por los otros tres flujos, siendo el referido a la política de consumos de medicamentos, aquél que genera un mayor beneficio. Globalmente el movimiento de fondos o flujos de caja es de -300.525 ¤, estimados para un periodo de amortización de cinco años. Conclusión: La sustitución de botiquines de planta por sistemas automáticos de dispensación de medicamentos en las Unidades de UCI, Rea y Urgencias, presenta una favorable relación beneficio/coste (1,95) (AU)

Encuesta sobre el estado de la docencia a farmacéuticos internos residentes de farmacia hospitalaria / Survey on the status of teaching to In-Hospital Pharmacy internal residents pharmacists

Objetivo: El presente trabajo expone los resultados de una encuesta realizada en colaboración con la Sociedad Española de Farmacia Hospitalaria (SEFH) para conocer la percepción que los farmacéuticos tenemos de la formación y docencia que desarrollamos en los Servicios de Farmacia, así como conocer la opinión de los farmacéuticos de aquellos Servicios con programa acreditado para la formación de especialistas en Farmacia Hospitalaria, sobre las posibilidades de implantar con éxito los contenidos que el cuarto año de la especialidad demanda. Métodos: Se diseñaron tres modelos de encuesta destinados a FIR, tutores y resto de personal facultativo que fueron enviadas a 83 hospitales españoles con docencia acreditada. Resultados: En su mayoría los tutores (71 per cent) han sido designados por el Jefe de Servicio y disponen (92 per cent) de menos de 3 horas semanales para realizar dicha tarea. Un 33 per cent de los mismos dejaría la tutoría y a un 54 per cent le gustaría que esta labor fuera recompensada con el pago de cursos o congresos. Los resultados reflejan que más del 80 per cent de los farmacéuticos opina que la formación que se da a los residentes es buena. Es casi unánime la creencia entre los farmacéuticos internos residentes (94 per cent), tutores (92 per cent) y facultativos de plantilla (90 per cent) de que es positiva la ampliación del periodo de residencia a cuatro años. El 54 per cent de los tutores cree que, actualmente, estamos capacitados para formar en las áreas clínicas en el cuarto año y el 30 per cent opina que, aunque no lo estamos ahora, lo estaremos dentro de dos años. Conclusión: La opinión mayoritaria de los farmacéuticos encuestados sobre la formación que se imparte a los FIR es positiva, al igual que lo es la consideración sobre la posibilidad de adaptación de los Servicios de Farmacia a los requerimientos del nuevo Programa de la Especialidad (AU)