Stock Management in Hospital Pharmacy using Chance-Constrained Model Predictive Control

One of the most important problems in the pharmacy department of a hospital is stock management. The clinical need for drugs must be satisfied with limited work labor while minimizing the use of economic resources. The complexity of the problem resides in the random nature of the drug demand and the multiple constraints that must be taken into account in every decision. In this article, chance-constrained model predictive control is proposed to deal with this problem. The flexibility of model predictive control allows taking into account explicitly the different objectives and constraints involved in the problem while the use of chance constraints provides a trade-off between conservativeness and efficiency. The solution proposed is assessed to study its implementation in two Spanish hospitals.Junta de Andalucía P12-TIC-240

Efecto de un sistema automático de dispensación de medicamentos sobre el gasto farmacéutico y el grado de satisfacción del usuario

Objective: To evaluate in economic terms, the effect of replacing traditional kits for the implementation of automated dispensing of medications in the Intensive Care Unit. Analyze the degree of acceptance of such changeon the part of users.   Method: For the economic analysis is considered tangible direct and indirect costs resulting from the implementation: initial capital investment, cost of staff involved, the political cost of drug consumption. All these aspects were evaluated before and after implantation. The degree of user satisfaction was assessed using a standardized questionnaire. Results: After the estimation of costs, we found that the expenditure incurred on the initial investment will be quickly offset by the cost mainly referred to the politics of consumption of drugs with a reduction of 24% over the previous delivery system. The cost in personal chapter is also reduced by 11%, and the cost per stay and cost / income fell by 26% and 30% respectively over the previous system. The evaluation questionnaire revealed that users are satisfied with the implementation and 84% of nurses would recommend it to other units. Conclusions: Automated Dispensing Systems Drugs are a new technological tool to control drug spending, with good acceptance by users.Objetivo: Evaluar en términos económicos el efecto de la sustitución de botiquines tradicionales por la implantación de Sistemas Automáticos de Dispensación de Medicamentos en la Unidad de Cuidados Intensivos. Analizar el grado de aceptación de dicho cambio por parte de los usuarios.   Método: Para el análisis económico, se consideraron los costes directos e indirectos tangibles, derivados de la implantación: inversión inicial de capital, coste del personal implicado, coste en política de consumo de medicamentos. Todos estos aspectos se evaluaron antes y después de la implantación. El grado de satisfacción de los usuarios se evaluó a través de un cuestionario estandarizado.   Resultados: Tras la estimación de los costes, comprobamos que el gasto realizado en la inversión inicial se verá rápidamente compensado fundamentalmente por el coste referido a la política de consumos de medicamentos con una reducción del 24% con respecto al sistema de dispensación anterior. El coste en el capitulo de personal también se ve reducido un 11%, así como el coste/estancia y coste/ingreso que disminuyen un 26% y 30% respectivamente en relación al sistema anterior. La evaluación del cuestionario reveló que los usuarios están satisfechos con la implantación y un 84% del personal de enfermería lo recomendaría a otras unidades.   Conclusiones: Los Sistemas Automáticos de Dispensación de Medicamentos constituyen una nueva herramienta tecnológica para el control del gasto farmacéutico, con buena aceptación por parte de los usuario

Stockout risk analysis and minimization applied to hospital pharmacy management

Permiso del editor Aula Médica para subir a idUS la versión editorial del artículoDeterminar el valor que debería tomar el stock de seguridad de los fármacos dispensados en un hospital de tercer nivel en función del nivel de riesgo y del número de días que se desee resistir sin rotura de stock

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Análisis farmacogenético de la ciclosporina en relación a los factores farmacocinéticos-farmacodinámicos y la incidencia de rechazo agudo tras el trasplante cardíaco

Tesis Univ. Granada. Departamento de Bioquímica y Biología Molecular. Leída el 19 de septiembre de 200

Efecto de un sistema automático de dispensación de medicamentos sobre el gasto farmacéutico y el grado de satisfacción del usuario

Objective: To evaluate in economic terms, the effect of replacing traditional kits for the implementation of automated dispensing of medications in the Intensive Care Unit. Analyze the degree of acceptance of such changeon the part of users.   Method: For the economic analysis is considered tangible direct and indirect costs resulting from the implementation: initial capital investment, cost of staff involved, the political cost of drug consumption. All these aspects were evaluated before and after implantation. The degree of user satisfaction was assessed using a standardized questionnaire. Results: After the estimation of costs, we found that the expenditure incurred on the initial investment will be quickly offset by the cost mainly referred to the politics of consumption of drugs with a reduction of 24% over the previous delivery system. The cost in personal chapter is also reduced by 11%, and the cost per stay and cost / income fell by 26% and 30% respectively over the previous system. The evaluation questionnaire revealed that users are satisfied with the implementation and 84% of nurses would recommend it to other units. Conclusions: Automated Dispensing Systems Drugs are a new technological tool to control drug spending, with good acceptance by users.Objetivo: Evaluar en términos económicos el efecto de la sustitución de botiquines tradicionales por la implantación de Sistemas Automáticos de Dispensación de Medicamentos en la Unidad de Cuidados Intensivos. Analizar el grado de aceptación de dicho cambio por parte de los usuarios.   Método: Para el análisis económico, se consideraron los costes directos e indirectos tangibles, derivados de la implantación: inversión inicial de capital, coste del personal implicado, coste en política de consumo de medicamentos. Todos estos aspectos se evaluaron antes y después de la implantación. El grado de satisfacción de los usuarios se evaluó a través de un cuestionario estandarizado.   Resultados: Tras la estimación de los costes, comprobamos que el gasto realizado en la inversión inicial se verá rápidamente compensado fundamentalmente por el coste referido a la política de consumos de medicamentos con una reducción del 24% con respecto al sistema de dispensación anterior. El coste en el capitulo de personal también se ve reducido un 11%, así como el coste/estancia y coste/ingreso que disminuyen un 26% y 30% respectivamente en relación al sistema anterior. La evaluación del cuestionario reveló que los usuarios están satisfechos con la implantación y un 84% del personal de enfermería lo recomendaría a otras unidades.   Conclusiones: Los Sistemas Automáticos de Dispensación de Medicamentos constituyen una nueva herramienta tecnológica para el control del gasto farmacéutico, con buena aceptación por parte de los usuario

An automatic dispensing system medications effect in pharmaceutical expenditure and satisfaction user level

Objetivo: Evaluar en términos económicos el efecto de la sustitución de botiquines tradicionales por la implantación de Sistemas Automáticos de Dispensación de Medicamentos en la Unidad de Cuidados Intensivos. Analizar el grado de aceptación de dicho cambio por parte de los usuarios. Método: Para el análisis económico, se consideraron los costes directos e indirectos tangibles, derivados de la implantación: inversión inicial de capital, coste del personal implicado, coste en política de consumo de medicamentos. Todos estos aspectos se evaluaron antes y después de la implantación. El grado de satisfacción de los usuarios se evaluó a través de un cuestionario estandarizado. Resultados: Tras la estimación de los costes, comprobamos que el gasto realizado en la inversión inicial se verá rápidamente compensado fundamentalmente por el coste referido a la política de consumos de medicamentos con una reducción del 24% con respecto al sistema de dispensación anterior. El coste en el capitulo de personal también se ve reducido un 11%, así como el coste/estancia y coste/ingreso que disminuyen un 26% y 30% respectivamente en relación al sistema anterior. La evaluación del cuestionario reveló que los usuarios están satisfechos con la implantación y un 84% del personal de enfermería lo recomendaría a otras unidades. Conclusiones: Los Sistemas Automáticos de Dispensación de Medicamentos constituyen una nueva herramienta tecnológica para el control del gasto farmacéutico, con buena aceptación por parte de los usuarios.Objective: To evaluate in economic terms, the effect of replacing traditional kits for the implementation of automated dispensing of medications in the Intensive Care Unit. Analyze the degree of acceptance of such changeon the part of users. Method: For the economic analysis is considered tangible direct and indirect costs resulting from the implementation: initial capital investment, cost of staff involved, the political cost of drug consumption. All these aspects were evaluated before and after implantation. The degree of user satisfaction was assessed using a standardized questionnaire. Results: After the estimation of costs, we found that the expenditure incurred on the initial investment will be quickly offset by the cost mainly referred to the politics of consumption of drugs with a reduction of 24% over the previous delivery system. The cost in personal chapter is also reduced by 11%, and the cost per stay and cost / income fell by 26% and 30% respectively over the previous system. The evaluation questionnaire revealed that users are satisfied with the implementation and 84% of nurses would recommend it to other units. Conclusions: Automated Dispensing Systems Drugs are a new technological tool to control drug spending, with good acceptance by users

Clinical and Biological Principles of Cold Atmospheric Plasma Application in Skin Cancer.

Plasma-based electrosurgical devices have long been employed for tissue coagulation, cutting, desiccation, and cauterizing. Despite their clinical benefits, these technologies involve tissue heating and their effects are primarily heat-mediated. Recently, there have been significant developments in cold atmospheric pressure plasma (CAP) science and engineering. New sources of CAP with well-controlled temperatures below 40 °C have been designed, permitting safe plasma application on animal and human bodies. In the last decade, a new innovative field, often referred to as plasma medicine, which combines plasma physics, life science, and clinical medicine has emerged. This field aims to exploit effects of mild plasma by controlling the interactions between plasma components (and other secondary species that can be formed from these components) with specific structural elements and functionalities of living cells. Recent studies showed that CAP can exert beneficial effects when applied selectively in certain pathologies with minimal toxicity to normal tissues. The rapid increase in new investigations and development of various devices for CAP application suggest early adoption of cold plasma as a new tool in the biomedical field. This review explores the latest major achievements in the field, focusing on the biological effects, mechanisms of action, and clinical evidence of CAP applications in areas such as skin disinfection, tissue regeneration, chronic wounds, and cancer treatment. This information may serve as a foundation for the design of future clinical trials to assess the efficacy and safety of CAP as an adjuvant therapy for skin cancer

Scoping Review on Use of Drugs Targeting Interleukin 1 Pathway in DIRA and DITRA.

Deficiencies in interleukin (IL)-1 receptor (IL-R) antagonist (DIRA) and IL-36R antagonist (DITRA) are rare genetic autoinflammatory diseases related to alterations in antagonists of the IL-1 pathway. IL-1 antagonists may represent therapeutic alternatives. Here, we aim to provide a scoping review of knowledge on use of IL-1-targeting drugs in DIRA and DITRA. An a priori protocol was published, and the study was conducted using the methodology described in the Joanna Briggs Institute Reviewer's Manual and the recently published PRISMA Extension for Scoping Review statement. A three-step search using MEDLINE and EMBASE databases until March 2018 with additional hand searching was performed. Data charting was performed. The search, article selection, and data extraction were carried out by two researchers independently. Twenty-four studies on use of anti-IL-1 drugs were included [15 studies including patients with diagnosis of DIRA (n = 19) and 9 studies including patients with diagnosis of DITRA (n = 9)]. Most studies followed a multicenter observational design. Among all patients who received treatment with anti-IL-1 drugs, nine and four mutations in IL1RN and IL36RN were found, respectively. Patients with DIRA were treated with anakinra (n = 17), canakinumab (n = 2), or rinolacept (n = 6). All patients with DITRA were treated with anakinra, and only one case was also treated with canakinumab. Time-to-response frequencies were evaluated as immediate, short, and medium-long term for DIRA (17/17, 15/17, and 9/10, respectively) and DITRA (7/9, 3/9, and 2/9, respectively). Most DITRA patients in whom anti-IL-1 treatment failed experienced good response to anti-tumor necrosis factor alpha or anti-IL-12/23 drugs. The safety profiles of treatments were similar in both diseases. Evidence on use of anti-IL-1 drugs in DIRA and DITRA is scarce and based on observational studies. Larger studies with better methodological quality are needed to increase confidence in use of these drugs in patients with DIRA and DITRA