Ana Ortega Eslava - Academia.edu (original) (raw)
Papers by Ana Ortega Eslava
Current Treatment Options in Allergy
Purpose of Review The goal of this paper is to review drug allergy alert systems (DAAS), to summa... more Purpose of Review The goal of this paper is to review drug allergy alert systems (DAAS), to summarise their key components, and to overview potential benefits and challenges associated with these tools. Methods for validation of their effects on patient safety, alternative uses, and strategies to streamline DAAS’ functions and reduce system fatigue are discussed. Recent Findings DAAS are clinical decision support systems (CDSS) that focus on preventing drug adverse events within healthcare settings. The advent of electronic medical records has facilitated the development of digital DAAS. Existing versions use different methods to document diagnosed allergies, and rely on distinct rules and matching strategies for the generation of real-time alerts. DAAS promote the automation of several processes, facilitate prompt patient referral, and may be customised. Information overload, alert overrides by clinicians, and the development of “alert fatigue” may interfere with their usefulness. ...
Universidad de Navarra, 2020
The prevalence of drug allergies is increasing, with as many as 25% of the general adult populati... more The prevalence of drug allergies is increasing, with as many as 25% of the general adult population affected in USA. In hospitals, drug-allergy interactions are one important cause of adverse drug events (ADEs). These events are preventable when the patient had a previous documented allergy to the drug that is prescribed. Computerized physician order entry (CPOE) with clinical decision support (CDS) has been implemented in most Health Care Systems to improve patient safety and the quality of care. These systems generate alert warnings regarding potential ADEs. CPOE with a drug allergy alert system (DAAS) is an important tool to prevent the prescription of medications to which the patient has a documented allergy and allergy-related medication events. However, these systems are not free of drawbacks (e.g. alert fatigue, unnecessary alerts) and their evaluation is necessary to improve their effectiveness. In our hospital, a homemade DAAS was implemented in 2007 and its evaluation was warranted. The objectives of this study were to review the evidence regarding DAAS, and to evaluate the DAAS of our information system (Clínica Universidad de Navarra Information System (SI-CUN)) analysing drug allergy alerts triggered by our DAAS, and the clinical consequences of drug allergy alert overrides. A PubMed and Cochrane databases search was conducted looking for articles describing electronic DAAS. Seventeen different DAAS were identified. Systems differ in recorded drug allergy information, rule bases that generate the alerts, type of matches or the information shown in the alerts. We found no comparative studies between them to identify the most effective system. However, we can extract some general recommendations. For example, to codify drug allergies information and override reasons and to register reactions suffered by patients. Alerts information has to be easy to understand. To evaluate SI-CUN drug allergy system, we conducted a retrospective observational study of DAA generated from 2014 to 2016. A total of 6,123 drug allergy alerts were triggered and after duplicated alerts were eliminated, 4,564 alerts remained for analysis. DAA were more frequently triggered by a non-exact match and when ordering antiinfectives and nervous system drugs. The override rate was 44.8% and the main reasons given by prescribers were that the patient had tolerated the ordered drug or had not allergy or the allergy was uncertain, and that the patient had a prior administration of the drug or was taking it already. Clinical consequences of alert overrides were analysed in a retrospective observational study of a random sample of 194 overridden DAA generated between 2014 and 2016. A chart review was conducted to identify allergic ADEs. Six (3.09%) allergic ADEs were identified. Most ADEs were cutaneous and were classified as mild. Most alerts were appropriately overridden. The literature analysis together with the SI-CUN drug allergy alerts analysis and the clinical consequences of overrides evaluation allow making recommendations for systems improvement. Drug allergy information has to be to be accurate, codified and updated. It is necessary to identify important and clinical value alerts to reduce alert override and alert fatigue; some alerts that are frequently overridden with no clinical consequences, such as non-antibiotic sulfonamide alerts, can be eliminated or changed to non-interruptive information. Every medication has to be prescribed through the standard procedure to generate alerts when needed. Intelligent systems, that automatically update the information and change to non-interruptive information those alerts that are continuously overridden, would make the process easier. A committee must be created to regularly analyse the system, implement improvements and evaluate their impact as part of a quality control process to improve patients safety
Farmacia Hospitalaria, Mar 9, 2021
Los artículos publicados en esta revista se distribuyen con la licencia Articles published in thi... more Los artículos publicados en esta revista se distribuyen con la licencia Articles published in this journal are licensed with a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. http://creativecommons.org/licenses/by-nc-sa/4.0/ La revista Farmacia no cobra tasas por el envío de trabajos, ni tampoco por la publicación de sus artículos.
Reporting systems are a valuable tool for detecting errors, analysing them, and for designing ini... more Reporting systems are a valuable tool for detecting errors, analysing them, and for designing initiatives to promote patient safety. The aims of this study were: to describe the design and implementation of a medication error reporting system in the clinical practice context and included in a hospital quality plan, to evaluate the reporting system as an improvement tool, and to analyse notified medication errors in order to propose measures to increase patient safety. We retrospectively analysed all medication errors reported since the introduction of the system, the root cause analyses carried out, and the proposed and implemented improvement actions. We evaluated the tool validity and utility analysing the congruence between narrative descriptions and options selected from pull-down menus on the medication errors forms, and between information on the report and reality, as well as analysing the possibility of classifying medication errors based on the information included in the t...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2015
economic evaluation is a fundamental criterion when deciding a drug's place in therapy. The M... more economic evaluation is a fundamental criterion when deciding a drug's place in therapy. The MADRE method (Method for Assistance in making Decisions and Writing Drug Evaluation Reports) is widely used for drug evaluation. This method was developed by the GENESIS group of the Spanish Society of Hospital Pharmacy (SEFH), including economic evaluation. We intend to improve the economic aspects of this method. As for the direction to take, we have to first analyze our previous experiences with the current methodology and propose necessary improvements. economic evaluation sections in collaboratively conducted drug evaluation reports (as the scientific society, SEFH) with the MADRE method were reviewed retrospectively. thirty-two reports were reviewed, 87.5% of them included an economic evaluation conducted by authors and 65.6% contained published economic evaluations. In 90.6% of the reports, a Budget impact analysis was conducted. The cost per life year gained or per Quality Adjuste...
Describir y analizar la labor del Servicio de Farmacia en el portal sanitario www.viatusalud.com ... more Describir y analizar la labor del Servicio de Farmacia en el portal sanitario www.viatusalud.com Métodos: El Servicio de Farmacia trabaja en la creación y actualización de un vademécum de medicamentos y en la respuesta a las consultas que los usuarios demandan del farmacéutico a través del portal. Resultados: A fecha de 31 de diciembre de 2002, se ofrecen más de 750 fichas diferentes de medicamentos y se han respondido 3.030 consultas. Conclusiones: Con este servicio de información sobre medicamentos y de respuesta a consultas on-line, el Servicio de Farmacia contribuye a satisfacer la demanda de información sanitaria originada por la sociedad y por pacientes que han sido atendidos en la Clínica Universitaria anteriormente. Además, permite identificar puntos de mejora en la información que se puede ofrecer a los pacientes desde el Servicio de Farmacia y supone una fuente terciaria de información a profesionales de la salud.
Farmacia Hospitalaria, 2012
![Research paper thumbnail of [Classification and variability of drug assessment reports on the GENESIS group (SEFH) webpage]](https://attachments.academia-assets.com/100091300/thumbnails/1.jpg)
](Farmacia hospitalaria : órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria
To analyse the assessment reports published on the GENESIS webpage (Group for Innovation, Assessm... more To analyse the assessment reports published on the GENESIS webpage (Group for Innovation, Assessment, Standardisation and Research in the Selection of Drugs) and assess the variability of the group's proposals to include drugs in the Formulary. We analysed reports published by hospitals on the GENESIS webpage between 2004 and 2007. Data were collected on drugs and indications, ATC group, open or restricted access publications, hospital, and publication date. We drafted a questionnaire that would measure to what extent to what extent the 9-section model recommended by GENESIS was included in each report. For drugs with two or more reports, we analysed whether the recommendation coincided and the possible cause in the event of conflict. We analysed 416 reports corresponding to 185 different drug indications. 93% included 6 or more of the recommended sections, a number which increased over time. The most frequently included sections were: approved indications (92%), mechanism of ac...
Up to 52% of the patients in acute care hospitals may receive an antibiotic, and 30-50% of the tr... more Up to 52% of the patients in acute care hospitals may receive an antibiotic, and 30-50% of the treatments are estimated to be inadequate. Pharmacists have an important role in their optimization. In addition, critically ill patients may benefit more from pharmacist interventions (PIs). Few comparative studies have evaluated the clinical and the economic impact of PIs on antimicrobials in these patients, and none of them was conducted in Europe. Moreover, there have been no reviews analyzing the clinical and economic impact of interventions on antimicrobials conducted specifically by pharmacists (not by a multidisciplinary group, even though it includes a pharmacist) in the hospital setting. Therefore, our main objective was to determine the clinical and economic impact of PIs related to antimicrobials in critical care. Firstly we conducted a review of the evidence in Pubmed from 2003 to March 2016 of the clinical and economic impact of PIs in the hospital setting, in general. Second...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2015
to determine the incidence of linezolid-induced haematological toxicity and study the influence o... more to determine the incidence of linezolid-induced haematological toxicity and study the influence of renal clearance on its appearance and the preventive effect of pyridoxine. a retrospective observational study was conducted. Every patient treated with linezolid in a university hospital during 6 months was included. Haematological toxicity was defined as a decrease of 25% in hemoglobin, of 25% in platelets and/or 50% in neutrophils from baseline. The incidence of haematological toxicity and the percentage decrease in analytical variables were compared in patients with and without renal failure (creatinine clearance lower than 50 mL/min), using the 30 mL/min threshold, and with or without pyridoxine; using Chi -Square and U Mann-Whitney tests, respectively. thirty-eight patients were evaluated. Sixteen (42%) presented haematological toxicity (2 due to a decrease in haemoglobin, 9 in platelets and 8 in neutrophils). Two patients (5%) discontinued treatment due to thrombocytopenia. Toxi...
Farmacia Hospitalaria, 2017
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2020
The addition of a fourth year to the hospital pharmacy residency program has allowed trainees to ... more The addition of a fourth year to the hospital pharmacy residency program has allowed trainees to rotate through various inpatient clinical units where they can, under the supervision of a specialist pharmacist, work shoulder to shoulder with other healthcare providers to ensure that patients receive the care they need. In addition to sharing their pharmacotherapeutic and pharmacokinetic knowledge (among others) with their colleagues, hospital pharmacists can and should contribute with their expertise in the areas of drug evaluation, selection and positioning. As no other healthcare professional masters like a pharmacist the intricacies of treatment efficacy or effectiveness, or of therapeutic safety, conveying this knowledge is yet another of the many clinical activities a hospital pharmacist must perform as a member of a multidisciplinary team, while assisting fellow-team members in deciding what medications are best suited to each patient. Both the public authorities and...
La gentamicina es un antibiotico aminoglucosido ampliamente utilizado en la profilaxis y tratamie... more La gentamicina es un antibiotico aminoglucosido ampliamente utilizado en la profilaxis y tratamiento de infecciones en pacientes oncologicos. El objetivo del presente estudio es reducir al maximo la toxicidad y aumentar la eficacia del tratamiento con gentamicina en los pacientes oncologicos, para lo que se pretende caracterizar el comportamiento de este farmaco esta poblacion. El estudio se ha realizado en 198 pacientes. Se han estimado los parametros poblacionales medios, la variabilidad interindividual y se ha establecido la relacion entre las variables fisiopatologicas del individuo y los parametros farmacocineticos mediante un metodo de dos etapas y mediante un metodo de una etapa npem (non parametric expectation maximization), no encontrandose diferencias significativas entre ambos. Asimismo se ha establecido una pauta de dosificacion inicial de gentamicina para la poblacion oncologica. Debido a la gran variabilidad farmacocinetica es necesaria la monitorizacion de la gentamic...
Integracion y aplicaciones de los estudios de farmacoeconomia e investigacion de resultados en sa... more Integracion y aplicaciones de los estudios de farmacoeconomia e investigacion de resultados en salud en los diferentes niveles asistenciales.
OBJECTIVE Patients included in MAINRITSAN2 trial received either an individually tailored or a fi... more OBJECTIVE Patients included in MAINRITSAN2 trial received either an individually tailored or a fixed-schedule therapy with rituximab as maintenance treatment of antineutrophil cytoplasm antibody associated vasculitides. The aim of this study was to compare the real-world costs of both arms. METHOD We performed a cost-minimization analysis over an 18-month time period, estimating direct costs -drug acquisition, preparation, administration and monitoring costs- from the health system perspective. We conducted a number of additional sensitivity analyses with different assumptions for unit costs, with further scenarios including the interquartile range of the tailored-infusion group results, different number of monitoring visits for fixed-schedule regimen and different number of reported severe adverse events. A cost- effectiveness analysis was conducted as a sensitivity analysis using the absolute difference in the relapse rate and its confidence interval. RESULTS The individu...
La especialidad de Farmacia Hospitalaria incorporo con el cuarto ano de su programa formativo un... more La especialidad de Farmacia Hospitalaria incorporo con el cuarto ano de su programa formativo una parte importante de rotacion por unidades clinicas de hospitalizacion en las que el farmaceutico en formacion, acompanado de farmaceuticos especialistas, tiene la oportunidad de trabajar conjuntamente con otros profesionales en la atencion directa al paciente. Ademas de contribuir a esta atencion con sus conocimientos de farmacoterapia y farmacocinetica, el farmaceutico de hospital puede y debe aportar al equipo su liderazgo en evaluacion, seleccion y posicionamiento de medicamentos. Ningun profesional conoce como el los aspectos relativos a la eficacia o efectividad, seguridad y eficiencia de los tratamientos, y estos conocimientos constituyen una actividad clinica mas de las que debe desempenar en los equipos multidisciplinares, ayudando a la toma de decisiones sobre medicamentos en cada paciente. Es necesario que tanto desde los organismos publicos como desde nuestra propia ...
Current Treatment Options in Allergy
Purpose of Review The goal of this paper is to review drug allergy alert systems (DAAS), to summa... more Purpose of Review The goal of this paper is to review drug allergy alert systems (DAAS), to summarise their key components, and to overview potential benefits and challenges associated with these tools. Methods for validation of their effects on patient safety, alternative uses, and strategies to streamline DAAS’ functions and reduce system fatigue are discussed. Recent Findings DAAS are clinical decision support systems (CDSS) that focus on preventing drug adverse events within healthcare settings. The advent of electronic medical records has facilitated the development of digital DAAS. Existing versions use different methods to document diagnosed allergies, and rely on distinct rules and matching strategies for the generation of real-time alerts. DAAS promote the automation of several processes, facilitate prompt patient referral, and may be customised. Information overload, alert overrides by clinicians, and the development of “alert fatigue” may interfere with their usefulness. ...
Universidad de Navarra, 2020
The prevalence of drug allergies is increasing, with as many as 25% of the general adult populati... more The prevalence of drug allergies is increasing, with as many as 25% of the general adult population affected in USA. In hospitals, drug-allergy interactions are one important cause of adverse drug events (ADEs). These events are preventable when the patient had a previous documented allergy to the drug that is prescribed. Computerized physician order entry (CPOE) with clinical decision support (CDS) has been implemented in most Health Care Systems to improve patient safety and the quality of care. These systems generate alert warnings regarding potential ADEs. CPOE with a drug allergy alert system (DAAS) is an important tool to prevent the prescription of medications to which the patient has a documented allergy and allergy-related medication events. However, these systems are not free of drawbacks (e.g. alert fatigue, unnecessary alerts) and their evaluation is necessary to improve their effectiveness. In our hospital, a homemade DAAS was implemented in 2007 and its evaluation was warranted. The objectives of this study were to review the evidence regarding DAAS, and to evaluate the DAAS of our information system (Clínica Universidad de Navarra Information System (SI-CUN)) analysing drug allergy alerts triggered by our DAAS, and the clinical consequences of drug allergy alert overrides. A PubMed and Cochrane databases search was conducted looking for articles describing electronic DAAS. Seventeen different DAAS were identified. Systems differ in recorded drug allergy information, rule bases that generate the alerts, type of matches or the information shown in the alerts. We found no comparative studies between them to identify the most effective system. However, we can extract some general recommendations. For example, to codify drug allergies information and override reasons and to register reactions suffered by patients. Alerts information has to be easy to understand. To evaluate SI-CUN drug allergy system, we conducted a retrospective observational study of DAA generated from 2014 to 2016. A total of 6,123 drug allergy alerts were triggered and after duplicated alerts were eliminated, 4,564 alerts remained for analysis. DAA were more frequently triggered by a non-exact match and when ordering antiinfectives and nervous system drugs. The override rate was 44.8% and the main reasons given by prescribers were that the patient had tolerated the ordered drug or had not allergy or the allergy was uncertain, and that the patient had a prior administration of the drug or was taking it already. Clinical consequences of alert overrides were analysed in a retrospective observational study of a random sample of 194 overridden DAA generated between 2014 and 2016. A chart review was conducted to identify allergic ADEs. Six (3.09%) allergic ADEs were identified. Most ADEs were cutaneous and were classified as mild. Most alerts were appropriately overridden. The literature analysis together with the SI-CUN drug allergy alerts analysis and the clinical consequences of overrides evaluation allow making recommendations for systems improvement. Drug allergy information has to be to be accurate, codified and updated. It is necessary to identify important and clinical value alerts to reduce alert override and alert fatigue; some alerts that are frequently overridden with no clinical consequences, such as non-antibiotic sulfonamide alerts, can be eliminated or changed to non-interruptive information. Every medication has to be prescribed through the standard procedure to generate alerts when needed. Intelligent systems, that automatically update the information and change to non-interruptive information those alerts that are continuously overridden, would make the process easier. A committee must be created to regularly analyse the system, implement improvements and evaluate their impact as part of a quality control process to improve patients safety
Farmacia Hospitalaria, Mar 9, 2021
Los artículos publicados en esta revista se distribuyen con la licencia Articles published in thi... more Los artículos publicados en esta revista se distribuyen con la licencia Articles published in this journal are licensed with a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. http://creativecommons.org/licenses/by-nc-sa/4.0/ La revista Farmacia no cobra tasas por el envío de trabajos, ni tampoco por la publicación de sus artículos.
Reporting systems are a valuable tool for detecting errors, analysing them, and for designing ini... more Reporting systems are a valuable tool for detecting errors, analysing them, and for designing initiatives to promote patient safety. The aims of this study were: to describe the design and implementation of a medication error reporting system in the clinical practice context and included in a hospital quality plan, to evaluate the reporting system as an improvement tool, and to analyse notified medication errors in order to propose measures to increase patient safety. We retrospectively analysed all medication errors reported since the introduction of the system, the root cause analyses carried out, and the proposed and implemented improvement actions. We evaluated the tool validity and utility analysing the congruence between narrative descriptions and options selected from pull-down menus on the medication errors forms, and between information on the report and reality, as well as analysing the possibility of classifying medication errors based on the information included in the t...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2015
economic evaluation is a fundamental criterion when deciding a drug's place in therapy. The M... more economic evaluation is a fundamental criterion when deciding a drug's place in therapy. The MADRE method (Method for Assistance in making Decisions and Writing Drug Evaluation Reports) is widely used for drug evaluation. This method was developed by the GENESIS group of the Spanish Society of Hospital Pharmacy (SEFH), including economic evaluation. We intend to improve the economic aspects of this method. As for the direction to take, we have to first analyze our previous experiences with the current methodology and propose necessary improvements. economic evaluation sections in collaboratively conducted drug evaluation reports (as the scientific society, SEFH) with the MADRE method were reviewed retrospectively. thirty-two reports were reviewed, 87.5% of them included an economic evaluation conducted by authors and 65.6% contained published economic evaluations. In 90.6% of the reports, a Budget impact analysis was conducted. The cost per life year gained or per Quality Adjuste...
Describir y analizar la labor del Servicio de Farmacia en el portal sanitario www.viatusalud.com ... more Describir y analizar la labor del Servicio de Farmacia en el portal sanitario www.viatusalud.com Métodos: El Servicio de Farmacia trabaja en la creación y actualización de un vademécum de medicamentos y en la respuesta a las consultas que los usuarios demandan del farmacéutico a través del portal. Resultados: A fecha de 31 de diciembre de 2002, se ofrecen más de 750 fichas diferentes de medicamentos y se han respondido 3.030 consultas. Conclusiones: Con este servicio de información sobre medicamentos y de respuesta a consultas on-line, el Servicio de Farmacia contribuye a satisfacer la demanda de información sanitaria originada por la sociedad y por pacientes que han sido atendidos en la Clínica Universitaria anteriormente. Además, permite identificar puntos de mejora en la información que se puede ofrecer a los pacientes desde el Servicio de Farmacia y supone una fuente terciaria de información a profesionales de la salud.
Farmacia Hospitalaria, 2012
Farmacia hospitalaria : órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria
To analyse the assessment reports published on the GENESIS webpage (Group for Innovation, Assessm... more To analyse the assessment reports published on the GENESIS webpage (Group for Innovation, Assessment, Standardisation and Research in the Selection of Drugs) and assess the variability of the group's proposals to include drugs in the Formulary. We analysed reports published by hospitals on the GENESIS webpage between 2004 and 2007. Data were collected on drugs and indications, ATC group, open or restricted access publications, hospital, and publication date. We drafted a questionnaire that would measure to what extent to what extent the 9-section model recommended by GENESIS was included in each report. For drugs with two or more reports, we analysed whether the recommendation coincided and the possible cause in the event of conflict. We analysed 416 reports corresponding to 185 different drug indications. 93% included 6 or more of the recommended sections, a number which increased over time. The most frequently included sections were: approved indications (92%), mechanism of ac...
Up to 52% of the patients in acute care hospitals may receive an antibiotic, and 30-50% of the tr... more Up to 52% of the patients in acute care hospitals may receive an antibiotic, and 30-50% of the treatments are estimated to be inadequate. Pharmacists have an important role in their optimization. In addition, critically ill patients may benefit more from pharmacist interventions (PIs). Few comparative studies have evaluated the clinical and the economic impact of PIs on antimicrobials in these patients, and none of them was conducted in Europe. Moreover, there have been no reviews analyzing the clinical and economic impact of interventions on antimicrobials conducted specifically by pharmacists (not by a multidisciplinary group, even though it includes a pharmacist) in the hospital setting. Therefore, our main objective was to determine the clinical and economic impact of PIs related to antimicrobials in critical care. Firstly we conducted a review of the evidence in Pubmed from 2003 to March 2016 of the clinical and economic impact of PIs in the hospital setting, in general. Second...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2015
to determine the incidence of linezolid-induced haematological toxicity and study the influence o... more to determine the incidence of linezolid-induced haematological toxicity and study the influence of renal clearance on its appearance and the preventive effect of pyridoxine. a retrospective observational study was conducted. Every patient treated with linezolid in a university hospital during 6 months was included. Haematological toxicity was defined as a decrease of 25% in hemoglobin, of 25% in platelets and/or 50% in neutrophils from baseline. The incidence of haematological toxicity and the percentage decrease in analytical variables were compared in patients with and without renal failure (creatinine clearance lower than 50 mL/min), using the 30 mL/min threshold, and with or without pyridoxine; using Chi -Square and U Mann-Whitney tests, respectively. thirty-eight patients were evaluated. Sixteen (42%) presented haematological toxicity (2 due to a decrease in haemoglobin, 9 in platelets and 8 in neutrophils). Two patients (5%) discontinued treatment due to thrombocytopenia. Toxi...
Farmacia Hospitalaria, 2017
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria, 2020
The addition of a fourth year to the hospital pharmacy residency program has allowed trainees to ... more The addition of a fourth year to the hospital pharmacy residency program has allowed trainees to rotate through various inpatient clinical units where they can, under the supervision of a specialist pharmacist, work shoulder to shoulder with other healthcare providers to ensure that patients receive the care they need. In addition to sharing their pharmacotherapeutic and pharmacokinetic knowledge (among others) with their colleagues, hospital pharmacists can and should contribute with their expertise in the areas of drug evaluation, selection and positioning. As no other healthcare professional masters like a pharmacist the intricacies of treatment efficacy or effectiveness, or of therapeutic safety, conveying this knowledge is yet another of the many clinical activities a hospital pharmacist must perform as a member of a multidisciplinary team, while assisting fellow-team members in deciding what medications are best suited to each patient. Both the public authorities and...
La gentamicina es un antibiotico aminoglucosido ampliamente utilizado en la profilaxis y tratamie... more La gentamicina es un antibiotico aminoglucosido ampliamente utilizado en la profilaxis y tratamiento de infecciones en pacientes oncologicos. El objetivo del presente estudio es reducir al maximo la toxicidad y aumentar la eficacia del tratamiento con gentamicina en los pacientes oncologicos, para lo que se pretende caracterizar el comportamiento de este farmaco esta poblacion. El estudio se ha realizado en 198 pacientes. Se han estimado los parametros poblacionales medios, la variabilidad interindividual y se ha establecido la relacion entre las variables fisiopatologicas del individuo y los parametros farmacocineticos mediante un metodo de dos etapas y mediante un metodo de una etapa npem (non parametric expectation maximization), no encontrandose diferencias significativas entre ambos. Asimismo se ha establecido una pauta de dosificacion inicial de gentamicina para la poblacion oncologica. Debido a la gran variabilidad farmacocinetica es necesaria la monitorizacion de la gentamic...
Integracion y aplicaciones de los estudios de farmacoeconomia e investigacion de resultados en sa... more Integracion y aplicaciones de los estudios de farmacoeconomia e investigacion de resultados en salud en los diferentes niveles asistenciales.
OBJECTIVE Patients included in MAINRITSAN2 trial received either an individually tailored or a fi... more OBJECTIVE Patients included in MAINRITSAN2 trial received either an individually tailored or a fixed-schedule therapy with rituximab as maintenance treatment of antineutrophil cytoplasm antibody associated vasculitides. The aim of this study was to compare the real-world costs of both arms. METHOD We performed a cost-minimization analysis over an 18-month time period, estimating direct costs -drug acquisition, preparation, administration and monitoring costs- from the health system perspective. We conducted a number of additional sensitivity analyses with different assumptions for unit costs, with further scenarios including the interquartile range of the tailored-infusion group results, different number of monitoring visits for fixed-schedule regimen and different number of reported severe adverse events. A cost- effectiveness analysis was conducted as a sensitivity analysis using the absolute difference in the relapse rate and its confidence interval. RESULTS The individu...
La especialidad de Farmacia Hospitalaria incorporo con el cuarto ano de su programa formativo un... more La especialidad de Farmacia Hospitalaria incorporo con el cuarto ano de su programa formativo una parte importante de rotacion por unidades clinicas de hospitalizacion en las que el farmaceutico en formacion, acompanado de farmaceuticos especialistas, tiene la oportunidad de trabajar conjuntamente con otros profesionales en la atencion directa al paciente. Ademas de contribuir a esta atencion con sus conocimientos de farmacoterapia y farmacocinetica, el farmaceutico de hospital puede y debe aportar al equipo su liderazgo en evaluacion, seleccion y posicionamiento de medicamentos. Ningun profesional conoce como el los aspectos relativos a la eficacia o efectividad, seguridad y eficiencia de los tratamientos, y estos conocimientos constituyen una actividad clinica mas de las que debe desempenar en los equipos multidisciplinares, ayudando a la toma de decisiones sobre medicamentos en cada paciente. Es necesario que tanto desde los organismos publicos como desde nuestra propia ...