Validation of the electronic prescription as a method for measuring treatment adherence in hypertension.

OBJECTIVE: To validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension. METHODS: This prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC). RESULTS: We included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989). CONCLUSION: Measures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity. PRACTICE IMPLICATIONS: If patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.

Improved evaporative light scattering detection for carbohydrate analysis.

Optimization and validation of evaporative light scattering detector (ELSD), aided by response surface methodology (RSM), has been developed for the liquid chromatography analysis of a wide molecular weight (MW) range of carbohydrates, including polysaccharides and oligosaccharides. Optimal experimental parameters for the ELSD detection were: 88.8°C evaporator temperature, 77.9°C nebulizer temperature and 1.1 standard litres per minute nitrogen flow rate. Optimal ELSD detection, used together with high performance size exclusion chromatography (HPSEC) of carbohydrates, gave a linear range from 250 to 1000 mg L(-1) (R(2)>0.998), with limits of detection and quantitation of 4.83-11.67 and 16.11-38.91 mg L(-1), respectively. Relative standard deviation was lower than 1.8% for intra-day and inter-day repeatability for apple pectin, inulin, verbascose, stachyose and raffinose. Recovery ranged from 103.7% to 118.3% for fructo-oligosaccharides, α-galacto-oligosaccharides and disaccharides. Optimized and validated ELSD detection is proposed for the analysis of high- to low-MW carbohydrates with high sensitivity, precision and accuracy.

Resultados del uso de venas del brazo en cirugía de revascularización infrainguinal / The results of using arm veins in infrainguinal revascularisation surgery

Introducción. La vena safena interna es el conducto de elección en cirugía de revascularización infrainguinal. Su ausencia plantea una serie de alternativas entre las cuales se halla la utilización de venas del brazo. Objetivo. Evaluar los resultados del uso de venas del brazo en cirugía de revascularización infrainguinal. Pacientes y métodos. Se revisaron 27 procedimientos de derivación entre 1998 y de 2004. Se realizó un mapeo sistemático mediante eco-Doppler. 14 (52%) fueron procedimientos primarios debido a una isquemia crítica de la extremidad y 13 (48%) fueron intervenciones secundarias sobre injertos previos. El vaso receptor fue la tercera porción de la poplítea en tres casos, tibial anterior en siete, tibial posterior en otros siete, peronea en cinco y pedia en otros cinco. Se realizó el seguimiento mediante eco-Doppler previo al alta a los 3, 6, 9 y 12 meses, y posteriomente cada 6 meses. Los resultados se analizaron mediante la tabla de vida para el cálculo de las permeabilidades y la tasa de rescate de la extremidad. Resultados. El seguimiento medio fue de 21,3 meses. Durante un período de 7 años se realizaron 28 procedimientos secundarios. Las permeabilidades acumuladas fueron: primaria, a 30 días, 100%; al año, 45,3%, y a 3 años, 19,2%; primaria asistida, a 30 días, 100%; al año, 87,2%, y a 3 años, 80,2%. La tasa de rescate de la extremidad fue del 88,8% a 5 años. Conclusiones. Las venas del brazo ofrecen resultados aceptables en cirugía de revascularización infrainguinal. Un seguimiento estrecho mediante eco-Doppler combinado con los procedimientos secundarios adecuados permite obtener buenas tasas de permeabilidad y rescate de la extremidad a corto y medio plazo

INTRODUCTION. The great saphenous vein is the preferred conduit in infrainguinal revascularisation surgery. Its absence means that other alternatives must be considered, one of which is the utilisation of veins from the arm. AIM. To evaluate the outcomes of using arm veins in infrainguinal revascularisation surgery. PATIENTS AND METHODS. A total of 27 shunt procedures carried out between 1998 and 2004 were reviewed. Systematic mapping was performed by means of Doppler ultrasound recording. 14 (52%) were primary procedures carried out due to a critical ischaemia of the limb and 13 (48%) were secondary interventions over previous grafts. The receiving vessel was the third part of the popliteal in three cases, the anterior tibial in seven, the posterior tibial in another seven, the peroneal in five, and the dorsalis pedis in five others. Doppler ultrasound recording was used for the follow-up at 3, 6, 9 and 12 months prior to discharge from hospital, and then every 6 months. Outcomes were analysed using the life table to calculate the patencies and the limb salvage rate. RESULTS. Mean follow-up time was 21.3 months. A total of 28 secondary procedures were carried out over a period of 7 years. The accumulated patencies were as follows: primary, at 30 days, 100%; at one year, 45.3%, and at 3 years, 19.2%; assisted primary, at 30 days, 100%; at one year, 87.2%, and at 3 years, 80.2%. Limb salvage rate was 88.8% at 5 years. CONCLUSIONS. Acceptable results can be obtained using arm veins in infrainguinal revascularisation surgery. Close surveillance using Doppler ultrasound recording with suitable secondary procedures makes it possible to obtain good short and medium-term patency and limb salvage rates