Hepatitis C virus infection and the role of a pharmaceutical care program

PURPOSE

The design, implementation, and assessment of a comprehensive pharmaceutical care program (CPCP) for hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAA) are described.

SUMMARY

The advent of DAA regimens has caused the evolution of the role of hospital pharmacists, leading to the development of more specialized models of pharmaceutical care. Three clinical pharmacists were incorporated into the pharmacy department of a general tertiary teaching hospital in Madrid, Spain, with the aim of developing and implementing a CPCP for HCV-infected patients. Pharmacists were responsible for proposing standards and local guidelines to physicians, monitoring adherence to guidelines, managing drug interactions and adverse drug events (ADEs), providing patient education, and evaluating health outcomes and costs. Implementation steps included (1) estimation of the healthcare demand and pharmacy resources, (2) definition of the workflow of the CPCP, (3) definition of the treatment care plan, for which tools were developed to support pharmaceutical validation, detection, and management of ADEs and drug-drug interactions, and (4) program assessment in terms of safety and cost-effectiveness. The pharmacists' interventions performed, severity of errors intercepted, and patients' satisfaction with the CPCP were also assessed. This CPCP demonstrates that the involvement of the pharmacist throughout the care plan prevents harmful medication errors in this population (0.1 per patient) and prompts significant cost savings (€1.2 million for 1,930 treated patients).

CONCLUSION

The implementation of a CPCP developed by hospital pharmacists for patients treated with DAA for HCV infection is an effective approach for preventing harmful medication errors and improving cost- effectiveness.

Direct costs of a home parenteral nutrition programme

BACKGROUND & AIMS

Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital.

METHODS

Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists.

RESULTS

Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%).

CONCLUSIONS

The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.

¿Cómo se transportan los cerdos en España? Diferencias entre viajes para vida y matadero

Para conocer la logística de cerdos en España se estudiaron 566 viajes, relativos a 34 mataderos y 13 comerciantes, mediante cuestionarios que recogían información relativa a 119 aspectos del transporte. La carga se efectuó en una media de 1,5 granjas, transportando una media de 160 cerdos a sacrificio o 493 lechones destinados a granja de cebo, suponiendo una densidad media de 214,4 y 103,8 kg/m2 respectivamente. Los cerdos fueron ayunados antes del viaje una media de 14,5 horas en el 79,2% de los viajes a matadero, cuya duración media fue de 3,4 horas, menos de la mitad de la duración media de los transportes para vida (7,3 horas, p

Transporte de terneros en España. Aspectos técnicos, administrativos y de bienestar según el destino

Para conocer en detalle como se transporta el ganado vacuno en España según el destino del viaje, entre los años 2004 y 2005 se entrevistaron 44 operadores representativos del sector (27 mataderos, 10 comerciantes y 7 mercados) mediante cuestionarios que recogían información relativa a 119 parámetros. Más del 80% de los viajes fueron de animales cebados/para cebo, y algo más de un 3% de los viajes transportaban animales cebados/para cebo y reproductores. Los transportes a matadero cargaron en un menor número de explotaciones (1,2 vs. 1,4 granjas; p

[Medical students' knowledge of cardiovascular risk factors]

OBJECTIVES

To evaluate cardiovascular risk factor awareness among medical students at the University of Navarra.

MATERIAL AND METHODS

A descriptive cross-sectional study including 334 students of the 1st, 4th and 6th year. They answered an anonymous structured questionnaire, and the results were analyzed using SPSS 11.0.

RESULTS

Most 4th and 6th year students correctly identified the cardiovascular risk factors (CVRF). The 4th year students obtained better results on lipid values while the 6th year students performed better on body mass index and arterial hypertension. 97.8% of the sample considered the Mediterranean diet to be a protective factor.

CONCLUSION

University of Navarra's medical students are well informed about CVRF and their knowledge increases along the degree course.

[Bilateral axillary brachial plexus block guided by multiple nerve stimulation and ultrasound in a multiple trauma patient]

We present the case of a woman with multiple wounds and injuries after attempted suicide by jumping from a high place. She had multiple craniofacial injuries and fractures of both forearms requiring emergency osteosynthesis. The neurosurgeons requested that a level of consciousness be maintained for frequent assessment; therefore it was decided to provide a bilateral axillary brachial plexus block. The procedure was carried out with the aid of a nerve stimulator to locate a triple response in the left arm (radial, medial and musculocutaneous nerves) and with both ultrasound and double nerve stimulation in the right arm (medial and radial nerves). Surgery proceeded without adverse events. The location of nerves or nerve roots with both ultrasound and stimulators was highly useful in this patient in need of bilateral brachial plexus blockade. This combination, and ultrasound in particular, might be the technique of choice because it offers an image in real time and assessment of the least amount of anesthetic that seems to be needed for achieving a block.

Homocysteine, folic acid and B-group vitamins in obstetrics and gynaecology

The amino acid homocysteine is of considerable medical importance because it is involved in the etiopathogeny of cardiovascular diseases. Hyperhomocysteinemia is a factor in the vascular damage that predisposes thrombogenesis and arteriosclerosis. It has also been related to a range of obstetric and gynecologic complications. Numerous studies have demonstrated the association between increased levels of homocysteine and neural tube defects (NTD) and other congenital defects, spontaneous miscarriages, intrauterine growth retardation (IGR), preeclampsia and intrauterine fetal death. Folic acid and other B-group vitamins (B6 and B12) take part in the metabolism of homocysteine and the preventive administration of these vitamins may reduce some of the complications.

Tolcapone increases plasma catecholamine levels in patients with Parkinson's disease

Tolcapone is a catechol-ortho-methyl-tranferase (COMT) inhibitor that increases the L-DOPA half-life and the duration of effect in Parkinson's disease. We investigated the effect of tolcapone on the plasma catecholamine levels. We measured plasma catecholamines 2h after the first daily dose of L-DOPA or L-DOPA+tolcapone while resting and 2 and 10min after standing. We also measured the pharmacokinetics of L-DOPA and 3-OM-DOPA and the clinical response to the medication for 6h after the early morning dose. The levels of dopamine, norepinephrine, adrenaline and total catecholamines significantly increased and 3-OM-DOPA decreased with tolcapone. We did not observe significant changes in the plasma L-DOPA levels at the doses of tolcapone used in this study. Tolcapone side effects included worsening of dyskinesia and psychosis, diarrhea and elevation of liver enzymes. Twenty-four-hour ambulatory recording of arterial blood pressure and heart rate did not reveal cardiovascular side effects in patients treated with tolcapone for less than 1year. Since adrenergic stimulation may increase the hepatotoxic potential of commonly used drugs, usually thought of as safe for the liver, we postulate that some of the already reported life threatening complications of tolcapone could be related to excessive adrenergic stimulation by high catecholamine levels caused by inhibition of COMT activity.

Study of the diagnostic value of strontium, chloride, haemoglobin and diatoms in immersion cases

Tests of haemoglobin (Hb), strontium (Sr) and chloride (Cl), as well as diatoms, toxicological and pathological studies were performed in biological samples from 133 immersion fatalities occurred since 1991 to 1996 in central and northern Spain. Hb, Sr, and Cl where analyzed in blood samples where increasing decomposition could be demonstrated in most of the cases. The samples were frequently accompanied with well documented forensic reports, including autopsies findings and other circumstances of the death. The goal of our study is to evaluate the difference of blood Sr concentration between the left and right side of the heart (LVSr-RVSr) as a marker of drowning. For this purpose, the cases investigated were classified in 'typical drowning' (TD) cases and 'atypical drowning' (AD) cases. This last group was used as a control. The comparison of the LVSr-RVSr between TD and AD cases was highly significant (P = 0.0002) in blood specimens extracted from cases occurred in putative drowning media where Sr concentration was higher than 800 micrograms/l. No significant differences were found comparing neither Cl nor Hb biventricular concentrations between TD and AD cases in blood samples extracted from bodies found in both fresh and seawater.

Alcoholic cognitive deterioration and nutritional deficiencies

Chronic alcoholic patients frequently exhibit a mild to moderate cognitive impairment that has been related to Wernicke-Korsakoff encephalopathy and attributed tentatively to nutritional and vitamin deficiencies. To elucidate the possible relation between alcoholic cognitive deterioration (ACD) and nutritional and vitamin deficiencies, several tests of intelligence and memory were administered to 54 chronic alcoholic patients and 30 controls. Serum levels of thiamine, folic acid, vitamins B12, A, and E, and certain nutritional indexes were determined in most of the subjects. The alcoholics scored significantly lower in intellectual and visuospatial tasks but not in verbal memory tasks. They had a lower serum level for thiamine but not of the remaining vitamins. However, the correlations between serum thiamin and cognitive performance scores were low, and according to stepwise regression analysis, duration of alcohol intake and education were the variables with predictive value for intellectual and memory test performance. These results suggest that serum thiamin deficiency is not the main pathogenetic factor related to ACD.

Immortalized GABAergic cell lines derived from rat striatum using a temperature-sensitive allele of the SV40 large T antigen

Embryonic striatal cells were immortalized using the A58 temperature-sensitive allele of the SV40 large T antigen. Two cell lines, M213-2O and M26-1F, with gamma-aminobutyric acid (GABA)ergic properties were selected from 85 clones thus developed. M213-2O is a multipolar, polygonal cell line which expresses SV40 large T antigen and glutamate decarboxylase (GAD) at the permissive temperature (33 degrees C) and GAD and MAP-2 immunoreactivity at the nonpermissive temperature (39.3 degrees C). M26-1F has a fibroblast-like morphology and expresses SV40 large T antigen and GAD both at the permissive and nonpermissive temperatures and MAP-2 immunoreactivity at the nonpermissive temperature. Both lines contain GABA as measured by reversed-phase HPLC and M213-2O expresses nipecotic-sensitive [14C]GABA uptake.

[Cefotaxime treatment of osteomyelitis of the foot in the diabetic]

Osteomyelitis at the base of an ulcer the foot of diabetic patient is a serious complication usually produced because of the patient's neglect, and entailing difficulties in diagnosis and treatment. Several factors (neurological and vascular ...) favor the onset of the initial ulcer and its evolution, the ulcer subsequently converting into the main door for soft tissue infection with extension to the contiguous bone, with a bad prognosis. Cefotaxime is a 3rd generation cephalosporin, active against coccus gram positive and the majority of aerobic gram negative bacillus. This antibiotic was used in 25 diabetic patients with osteomyelitis at a dosage of 2 gr. IV a/d, during at least 30 days, adding metronidazole when anaerobic bacteria were isolated. The number of patients cured were 21 (84%), one improvement (4%), one resistant (4%) and two relapses (8%). There were no secondary effects.

Cefotaxime in the treatment of chronic osteomyelitis caused by gram-negative bacilli

Fifty patients with chronic osteomyelitis due to aerobic or facultative Gram-negative bacilli, alone or in mixed infections with Gram-positive cocci, were treated with cefotaxime. The diagnosis of osteomyelitis was made on the basis of clinical, roentgenographical, isotopic, microbiological and histopathological evidence of infection. Only those patients with infection sensitive to cefotaxime were treated. Most patients received 2 g cefotaxime qid iv for 30-60 days (mean 40 days). Some patients received metronidazole in addition. The following results were obtained at the six month follow-up: 40 patients cured, six improved, no failures and four relapses. The surgical technique had an impact on these results. No clinically important side-effects were encountered, nor were any cefotaxime resistant strains found.

An experimental model of chronic osteomyelitis caused by Escherichia coli treated with cefotaxime

An experimental model in Wistar rats, of osteomyelitis caused by Escherichia coli, was used to evaluate the efficacy of cefotaxime in two treatment regimens of different durations. Four groups of rats were set up: a group of rats receiving short-term treatment (14 days) with subcutaneous cefotaxime (100 mg bd), killed after 56 days; a control group receiving no treatment, killed after 56 days; a group of rats undergoing long-term treatment (28 days) with subcutaneous cefotaxime as above, killed after 70 days and a control group of rats receiving no treatment, killed after 70 days. Analysis of histopathological and microbiological findings revealed significantly better results in the long-term treatment group. No side-effects were observed during treatment or afterwards.