Cutaneous angiosarcoma: own experience over 13 years. Clinical features, disease course and immunohistochemical profile.

BACKGROUND: Cutaneous angiosarcoma (AS) is a rare malignant tumour of endothelial origin with very poor prognosis, frequent recurrences and high metastatic potential. Clinical suspicion is often raised too late, but histological findings and immunohistochemical assays have proved to be very helpful in the diagnostic process. PATIENTS AND METHODS: Over the last 13 years, nine patients with AS were found in our archives. Clinical features, evolution, treatment and outcome were analysed and all biopsy specimens were reviewed by a trained dermatopathologist, with subsequent immunohistochemical assessment. RESULTS AND CONCLUSIONS: Cutaneous AS was clinically diagnosed in 4 of 9 patients, while systemic lupus erythematosus was the most common misdiagnosis. Radiotherapy was the most prescribed treatment, but many different combinations of surgery, chemotherapy and radiotherapy were observed. Mean disease-free and overall survival (15.4 and 23.7 respectively) were consistent with previous series, with local recurrence rate (2/9) lower than previously reported data. CD31 was positive in all patients. Vimentin, D2-40 and VEGFR-3 were expressed by the vast majority, Factor VIII by 3/7 and CD34 by about 1/3 of patients. Cytokeratin was negative in all patients. The patients with the most unfavourable course showed a strong expression of Ki-67, while those with the best outcome only had a slight positive Ki-67 staining. Larger studies regarding tumour cell expression of Ki-67 and other markers such as D2-40 will be helpful to evaluate a potential prognostic value of these stainings.

Economic burden of unjustified medications at hospital discharge.

QUESTION UNDER STUDY: Medication errors are a major concern for health care since they may cause or lead to inappropriate medication use or patient harm. However, little is known regarding the economic burden of unjustified medications. METHODS: Hospital discharge records of 577 patients were prospectively screened for the presence of unjustified medications. From this sample population, 318 (55%) were eligible and their data were used to assess the monthly costs of unjustified discharge medications, their relationship to the total and each individual's drug expenditure, and the relative cost weights of relevant unjustified drug classes. RESULTS: The results found that 619 out of 3691 prescriptions (16.8%) were unjustified. The mean (median; 95% CI) monthly costs of unjustified discharge medications were 32 euro (27 euro; 29 euro to 35 euro). The percentage of unnecessary treatments was inversely linked to the amount of total individual drug expenditure. For this collective, monthly extra costs due to unjustified medications were 18585 euro, and the relative cost weights of the relevant drug classes were 45.8% for gastrointestinal agents (33.8% for proton pump inhibitors), 17.7% for cardiovascular drugs, and 17.2% for psychiatric drugs. CONCLUSIONS: There is a considerable financial burden imposed by unjustified medications at hospital discharge. Discharge medications not motivated by appropriate diagnoses should be questioned. This study should be repeated in other institutions and in a larger population.

Omitted and unjustified medications in the discharge summary.

BACKGROUND: Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary (DS). OBJECTIVE: To evaluate the incidence and types of drug omissions and unjustified medications in the DS, and to assess their potential impact on patient health. METHODS: A prospective observational review of the DSs of all patients discharged from our Internal Medicine Department over a 3-month period. Data assessment was made by internists using a structured form. RESULTS: Of the 577 evaluated DSs, 66% contained at least one inconsistency accounting for a total of 1012 irregularities. There were 393 drug omissions affecting 251 patients, 32% of which were potentially harmful. Seventeen per cent of all medications (619/3691) were unjustified, affecting 318 patients. The unjustified medication was potentially harmful in 16% of cases, occurred significantly more frequent in women than in men (61% vs 50%; p = 0.008) and increased linearly with the number of drugs prescribed (p<0.001). Drug omission had a twofold higher potential to cause harm than unjustified medication. CONCLUSIONS: Drug omissions and unjustified medications are frequent, and systemic changes are required to substantially reduce these inconsistencies.