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1.
Actas Dermosifiliogr (Engl Ed) ; 112(2): 134-141, 2021 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32910923

RESUMO

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients.


Assuntos
Diarreia/induzido quimicamente , Cefaleia/induzido quimicamente , Náusea/induzido quimicamente , Inibidores da Fosfodiesterase 4/efeitos adversos , Talidomida/análogos & derivados , Terapia Combinada , Diarreia/dietoterapia , Diarreia/tratamento farmacológico , Diarreia/fisiopatologia , Gerenciamento Clínico , Cefaleia/tratamento farmacológico , Cefaleia/fisiopatologia , Cefaleia/prevenção & controle , Humanos , Náusea/dietoterapia , Náusea/tratamento farmacológico , Náusea/fisiopatologia , Equipe de Assistência ao Paciente , Inibidores da Fosfodiesterase 4/uso terapêutico , Guias de Prática Clínica como Assunto , Psoríase/tratamento farmacológico , Talidomida/efeitos adversos , Talidomida/uso terapêutico
2.
HIV Med ; 17(1): 46-55, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26149493

RESUMO

OBJECTIVES: Large cohort studies have shown a high rate of first-line combination antiretroviral therapy (cART) regimen discontinuation in HIV-infected patients, attributed to characteristics of the cART regimen or toxicity. METHODS: A cohort study of 274 patients receiving a first-line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0-15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen. RESULTS: During 474.8 person-years of follow-up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient-years [95% confidence interval (CI) 11.1-16.4 per 100 patient-years]. An efavirenz (EFV)-based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient-years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62-0.93; P < 0.01] and higher satisfaction (HR 0.94; 95% CI 0.89-0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4-11.6; P < 0.01). One-third of patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04). CONCLUSIONS: Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Benzoxazinas/efeitos adversos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Satisfação Pessoal , Adulto , Alcinos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Benzoxazinas/uso terapêutico , Estudos de Coortes , Ciclopropanos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais , Resultado do Tratamento
3.
Farm. hosp ; 36(1): 24-32, ene.-feb. 2012. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-107806

RESUMO

Objetivo Aplicacion de un analisis modal de fallos y efectos al proceso de prescripcion, validacion y dispensacion de medicamentos en pacientes hospitalizados. Metodos Un grupo de trabajo analizo los pasos que componian el proceso desde la prescripcion medica hasta la dispensacion, identificandose los mas criticos y estableciendo los modos potenciales de fallo que podrian producir un error. Se analizaron posibles causas, sus efectos potenciales y los sistemas de control existentes para prevenir su aparicion. Se calculo el Hazard Score, seleccionandose los que tenian una puntuacion (..) (AU)


Objective To apply a failure modes and effects analysis to the prescription, validation and dispensing process for hospitalised patients. Methods A work group analysed all of the stages included in the process from prescription to dispensing, identifying the most critical errors and establishing potential failure modes which could produce a mistake. The possible causes, their potential effects, and the existing control systems were analysed to try and stop them from developing. The Hazard Score was calculated, choosing those that were ≥ 8, and a Severity Index = 4 was selected independently of the hazard Score value. Corrective measures and an implementation plan were proposed. Results A flow diagram that describes the whole process was obtained. A risk analysis was conducted of the chosen critical points, indicating: failure mode, cause, effect, severity, probability, Hazard Score, suggested preventative measure and strategy to achieve so. Failure modes chosen: Prescription on the nurse's form; progress or treatment order (paper); Prescription to incorrect patient; Transcription error by nursing staff and pharmacist; Error preparing the trolley. Conclusions By applying a failure modes and effects analysis to the prescription, validation and dispensing process, we have been able to identify critical aspects, the stages in which errors may occur and the causes. It has allowed us to analyse the effects on the safety of the process, and establish measures to prevent or reduce them (AU)


Assuntos
Humanos , Prescrições de Medicamentos , Dispensários de Medicamentos , Avaliação de Medicamentos/tendências , Prescrição Inadequada/tendências , Boas Práticas de Dispensação , Erros de Medicação/estatística & dados numéricos , Gestão de Riscos , Gestão da Segurança
4.
Farm Hosp ; 36(1): 24-32, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-21514867

RESUMO

OBJECTIVE: To apply a failure modes and effects analysis to the prescription, validation and dispensing process for hospitalised patients. METHODS: A work group analysed all of the stages included in the process from prescription to dispensing, identifying the most critical errors and establishing potential failure modes which could produce a mistake. The possible causes, their potential effects, and the existing control systems were analysed to try and stop them from developing. The Hazard Score was calculated, choosing those that were ≥ 8, and a Severity Index = 4 was selected independently of the hazard Score value. Corrective measures and an implementation plan were proposed. RESULTS: A flow diagram that describes the whole process was obtained. A risk analysis was conducted of the chosen critical points, indicating: failure mode, cause, effect, severity, probability, Hazard Score, suggested preventative measure and strategy to achieve so. Failure modes chosen: Prescription on the nurse's form; progress or treatment order (paper); Prescription to incorrect patient; Transcription error by nursing staff and pharmacist; Error preparing the trolley. CONCLUSIONS: By applying a failure modes and effects analysis to the prescription, validation and dispensing process, we have been able to identify critical aspects, the stages in which errors may occur and the causes. It has allowed us to analyse the effects on the safety of the process, and establish measures to prevent or reduce them.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Modelos Teóricos , Prescrição Eletrônica , Controle de Formulários e Registros , Registros Hospitalares , Hospitais Gerais , Humanos , Erros de Medicação/prevenção & controle , Registros de Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Melhoria de Qualidade , Medição de Risco , Design de Software , Espanha
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