Contemporary management of perianal conditions in febrile neutropenic patients.

INTRODUCTION: The aim of this study was to examine the type and frequency of perianal conditions in a contemporary series of febrile neutropenic patients and to examine the risk factors, management options and outcome of septic perianal conditions. METHODS: Medical records of all adult febrile neutropenic patients (933 patients) who were admitted during the period from January, 2009 to December 2011 were retrospectively review. All patients with perianal complaints or conditions were included. The clinical features, management and outcome of septic conditions were recorded. RESULTS: Of all the reviewed charts, 101 (10.8%) had perianal complaints or conditions. Most of them were non septic (74.3%), like piles and fissures, and were treated conservatively. In 26 patients the diagnosis was a septic condition: abscess (12 patients), fistula (4), inflammation (9) and necrotizing fasciitis (1). Septic conditions were more commonly found in males younger than 40 years. Surgery was done in 13 patients to drain a collection and in 2 patients to debride necrotic tissue. Most patients who had no collection had conservative management. There was 1 fatality only (3.8%) in those 26 patients. CONCLUSION: Most of the perianal conditions in febrile neutropenic patients are non septic and are managed conservatively. Septic perianal conditions are not associated with a poor prognosis as in the past. Surgical drainage should be reserved to conditions where there is a collection; otherwise patients should be managed conservatively but with close monitoring.

Appropriate use of oral drops: perception of health professionals and assessment of package insert information.

OBJECTIVES: To evaluate the perception of health professionals and industry personnel towards the appropriate use of oral drops and to assess their package inserts with regard to presence of proper instructions for use and storage. METHODS: The first part was a cross-sectional self-administered questionnaire. The questionnaires were distributed randomly to physicians, pharmacists and decision makers in local pharmaceutical companies. In the second part, the package inserts of medications with oral drops were reviewed to check for presence of proper instructions for storage and proper use. RESULTS: The majority of physicians and pharmacists (73.3% and 71.2%) thought that oral drops can be delivered from the dropper directly into the patient's mouth. 60.8% of physicians and 54.3% of pharmacists thought that the dropper should be clamped vertically when oral drop are dispensed. 72.7% of industry personnel agreed that the angle of inclination affects the drop size. Many of these personnel said their companies did not perform the recommended tests for dose uniformity and calibration. Instructions for storage and proper use were not available in package inserts of many oral drop products in Palestine. CONCLUSIONS: Health professionals should have complete and correct information regarding all factors that affect the proper delivery of oral drops and should counsel patients on the proper method of delivery. Pharmaceutical companies should take into consideration the formulation issues that may affect drop size and provide leaflets and labels with complete and correct instructions on the proper use and storage of oral drops. Package insert information in oral drops needs to be more comprehensive with regard to instructions for use and storage.

Adverse drug events in hospitalized patients with chronic kidney disease.

BACKGROUND AND OBJECTIVE: Adverse drug events (ADEs) are a common cause of hospitalization and in-hospital complications. The aim of this study was to determine the rates, types, severity and preventability of pre-admission and in-hospital ADEs in patients with chronic kidney disease (CKD). METHODS: This study was conducted at the nephrology unit at Penang General Hospital. A random sample of 300 adult patients with CKD was included. Medical records and charts were reviewed by a clinical pharmacist every work day to find any evidence of errors or complications related to drug use. If a suspected ADE was found, further investigations were carried out to assess the causality, severity and preventability of the event. RESULTS: A total of 159 ADEs were reported in 122 (40.7%) of the patients. We found 86 suspected pre-admission ADEs in 68 (22.7%) of the patients. These were either the cause of admission for some patients or discovered by the initial physical examination and laboratory investigations. During hospitalization, 64 (21.3%) patients had 73 suspected ADEs. Out of the total 159 suspected ADEs, it was highly probable that 31 events were due to medication, while 61 were of lower probability, and 67 were merely possible. A total of 48 (30.2%) events was considered preventable. 46 events (28.9%) were serious, 93 (58.5%) were less serious and 20 (12.6%) were insignificant. The medication classes most frequently involved in ADEs were diuretics, antibacterials, drugs used for diabetes mellitus, antithrombotic agents, mineral supplements and antihypertensive drugs. CONCLUSION: ADEs are very common in hospitalized CKD patients, and some of these events are preventable. The service of a clinical pharmacist may help to reduce ADEs.