Errors of prescription, transcription and administration according to pharmacological group at hospital

Fundamentos: La mayoría de los estudios sobre errores de medicación se centran sólo en hallar prevalencias globales por pacientes, por fases del proceso o según un determinado grupo de fármacos, por lo que se da una visión parcial. El objetivo de este trabajo fue analizar y comparar la prevalencia de errores en prescripción, trascripción y administración y sus repercusiones clínicas en los principales grupos farmacológicos en un hospital de tercer nivel. Métodos: Estudio de inclusión prospectiva con observación directa disfrazada de la administración de medicamentos y comparación con prescripciones médicas y trascripciones presentes en la historia clínica. Los errores de medicación y sus efectos fueron clasificados por consenso de expertos. Se calcularon las diferentes tasas de errores y sus repercusiones con sus intervalos de confianza al 95% y se compararon utilizando la prueba de Chi cuadrado. Resultados: Se estudiaron 5578 fármacos prescritos, aunque se observó sólo la administración de 1879 dosis. Se encontraron un total de 117 grupos farmacológicos, donde el 50,1% (2795) de las prescripciones pertenecían sólo a 9 tipos. La prevalencia de errores de prescripción global fue de 4,79%, de trascripción de 14,61% y de administración 9,32%. Por grupos, las Heparinas tuvieron una menor prevalencia de errores en la fase de prescripción y en la de trascripción. Se obtuvo mayor número de errores en trascripción de los Analgésicos como el Paracetamol y el Metamizol y de los Laxantes, y una prevalencia de errores en administración superior al resto en Analgésicos como el Paracetamol y en los Inhibidores de la Bomba de Protones. Las repercusiones clínicas de los errores de medicación en la fase de prescripción fueron parecidas entre grupos farmacológicos. En trascripción Heparinas y Corticoides presentaron errores más graves, mientras que en la administración fueron los IECAS y las Estatinas (p<0,05). Conclusiones: Los fármacos considerados clásicamente como de alto riesgo presentaron menos errores (Heparinas, Corticoides), pero más graves. Los fármacos con mayor prevalencia de errores fueron los Analgésicos (Paracetamol) y los Inhibidores de la Bomba de Protones, pero tuvieron una menor repercusión clínica.Background: Most studies of medication errors are focused only on finding global prevalence by patients, by phases or according to a certain group of medication. It’s just a partial view of the problem. To analyze and compare the prevalence of errors in prescription, transcription and administration, and their clinical repercussions in different pharmacological groups in a third-level hospital. Methods: Prospective inclusion study with direct observation disguised as medication administration and comparison with prescriptions and transcriptions at history clinical. The ME and its clinical effects were classified by expert consensus. We calculated the different error rates and their repercussions with their confidence intervals at 95%. Then we compared using Chi-square tests. Results: We studied 5,578 prescribed drugs and we observed the administration of 1,879 doses. A total of 117 different pharmacological groups were found, although 50.1% of the prescriptions belonged to only 9 types. We found heparins had a lower prevalence of errors in prescription and transcription and aspirin also had a lower prevalence of prescription errors. On the opposite side, a greater number of errors were obtained in transcription of Paracetamol, Metamizole and Laxatives and a prevalence of errors in the administration phase superior to rest in Paracetamol and in Proton Pump Inhibitors. The impact of medication error increased as medication process progressed, being similar between groups in prescription. In transcription, Heparins and Corticosteroids presented more serious errors. In administration, medication error are more serious for Diuretics and Statins (p <0.05). Conclusions: Drugs considered potentially dangerous present fewer errors (Heparins, Corticoids), but more serious. Drugs with the highest prevalence of errors were Paracetamol and Inhibitors of proton pump but had a lower impact.Este estudio fue objeto de una beca FIS (Fondo de Investigación Sanitaria) con número PI051524, desarrollado durante 2 año

Short communication: Reply to Comment by Domínguez-Villar on “Land surface temperature changes in Northern Iberia since 4000 yr BP, based in δ13C of speleothems” (Martín-Chivelet et al., 2011)

We have considered the additional data that Domínguez-Villar (this issue) has provided, as well as his criticisms of the interpretations of Martín-Chivelet et al. (2011). We argue that with or without the additional data, our original interpretations are the most likely interpretations, on the basis of Ockham's Razor. Those of Domínguez-Villar violate Ockham's Razor, and in the final analysis do not offer an alternative explanation for the Martín-Chivelet et al. (2011) and Domínguez-Villar (this issue) data. In particular, all of the 230Th ages (reported by both Martín-Chivelet et al. (2011) and Domínguez-Villar (this issue)) are in stratigraphic order, within quoted errors, so that our original chronology is robust, with no reason to invoke diagenetic processes. Given this chronology, the empirical relationship between δ13C and temperature also hold. Finally, our original mechanism for the cause of this relationship (prior calcite precipitation) has been invoked in a number of other studies to explain carbon isotopic variations and remains a perfectly plausible explanation for the observations at the studied caves

4000 years of climate change in Northern Spain from speleothem records

Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasTRUEpu

Inhibitory Effects of Antagonists of Growth Hormone-Releasing Hormone (GHRH) on Growth and Invasiveness of PC3 Human Prostate Cancer

New approaches are needed to the therapy of advanced prostate cancer. This study determined the effect of growth hormone- releasing hormone (GHRH) antagonists, JMR-132 and JV-1-38 on growth of PC3 tumors as well as on angiogenesis and metastasis through the evaluation of various factors that contribute largely to the progression of prostate cancer. Human PC3 androgen-independent prostate cancer cells were injected subcutaneously into nude mice. The treatment with JMR-132 (10 ug/day) or JV-1-38 (20 ug/day) lasted 41 days. We also evaluated the effects of JMR-132 and JV-1-38 on proliferation, cell adhesion and migration in PC-3 cells in vitro. Several techniques (Western blot, reverse transcription polymerase chain reaction, immunohistochemistry, ELISA and zymography) were used to evaluate the expression levels of GHRH receptors and its splice variants, GHRH, vascular endothelial growth factor (VEGF), hypoxia inducible factor (HIF)-1alpha, metalloproteinases (MMPs)-2 and -9, beta-catenin and E-cadherin. GHRH antagonists suppressed the proliferation of PC-3 cells in vitro and significantly inhibited growth of PC3 tumors. After treatment with these analogues, we found an increase in expression of GHRH receptor accompanied by a decrease of GHRH levels, a reduction in both VEGF and HIF-1alpha expression and in active forms of MMP-2 and MMP-9, a significant increase in levels of membrane-associated ?-catenin and a significant decline in E-cadherin. These results support that the blockade of GHRH receptors can modulate elements involved in angiogenesis and metastasis. Consequently, GHRH antagonists could be considered as suitable candidates for therapeutic trials in the management of androgen-independent prostate cancer.Junta de Comunidades de Castilla-La ManchaComunidad de MadridUniversidad de AlcaláMinisterio de Ciencia e Innovacio

Safety and efficacy clinical trials for SYL1001, a novel short interfering RNA for the treatment of dry eye disease

PURPOSE. To evaluate the efficacy and safety of SYL1001, a short interfering (si) RNA targeting the transient receptor potential cation channel subfamily V member 1 (TRPV1), for the treatment of dry eye disease (DED). METHODS. This study combines a phase I and two phase II clinical trials to test different doses of SYL1001 in a total of 156 healthy subjects and patients with DED. After 10 days of treatment, the primary efficacy endpoints were the effect on (1) the scoring in the Visual Analogue Scale (VAS) and Ocular Surface Disease Index (OSDI) questionnaires, and (2) ocular tolerance evaluated by corneal fluorescein staining and conjunctival hyperemia. Secondary endpoints included the assessment of systemic and local tolerance. RESULTS. Topical administration of SYL1001 1.125% once daily produced a significant decrease in VAS scores compared with placebo from day 4 until the end of treatment (change from baseline at day 10: -1.73 ± 0.32 vs. -0.91 ± 0.34; P = 0.013). For all treatments, OSDI scores were significantly reduced compared to their respective baseline values (P &lt; 0.01), although no significant changes were detected between groups. Conjunctival hyperemia (quantified as normal or abnormal) significantly improved after instillation of SYL1001 1.125% compared with placebo (50% vs. 20%; P &lt; 0.05). Excellent tolerability was reported, with no differences in the rates of occurrence of adverse events between groups. CONCLUSION. These trials achieved their primary endpoints of identifying the most effective dose of SYL1001 (1.125%). SYL1001 showed a large safety margin and may provide novel therapeutic opportunity for the relief of dry eye. (ClinicalTrials.gov numbers, NCT01438281, NCT01776658, and NCT02455999.) Eliminar seleccionadoSupported by a grant from the 2012 INNPACTO program of the Spanish Ministry of Science and Innovation: INDREYE (Innovative solutions for the treatment and diagnosis of dry eye disease) grant number IPT-2012-0438-010000 (Madrid, Spain)

Prediction of unplanned hospitalizations in older patients treated with chemotherapy

Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level &lt;3.5 g/dL, falls in the past 6 months ≥1, and weight loss &gt;5%. Three risk groups for UH were established according to the score in all patients: 0–1: 17.5%; 2: 34%; and 3–7: 57% (p &lt; 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67–0.77). Conclusion: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatmen

Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy

Simple Summary Chemotoxicity, unplanned hospitalizations (Uhs) and early death (ED) are common among older patients with cancer who receive chemotherapy. Our objective was to determine factors predicting these complications. A predictive score for these three complications based on geriatric, tumor and laboratory variables was developed in a series of 215 older patients with colorectal carcinoma receiving chemotherapy. The use of this score may reliably identify patients at risk to have excessive toxicity with chemotherapy, UH or ED, thus helping to plan treatment, implement adaptive measures, and intensify follow-up. Purpose: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. Methods: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3-5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 33% of patients developed grade 3-5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64-0.766), 0.726 (95% IC: 0.661-0.799) and 0.74 (95% IC: 0.678-0.809), respectively. Conclusion: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning

Sur8, a determinant protein in colorectal cancer tumor progression

Resumen del trabajo presentado en el 43rd Annual Meeting of the SEBBM, celebrado en Barcelona (España) del 19 al 21 de julio de 2021.Colorectal cancer (CRC) has the highest incidence rate in the Spanish population. The most important challenge consists on the discovery of efficient disease treatments, due to high mortality rates in highly developed stages. Sur8 is a scaffold protein that positively modulates ERK signaling pathway, which has a major role in the progression and metastasis in colorectal cancer. The main goals of our research are to determine the role that Sur8 plays in the development and progression of CRC and to analyze its possible therapeutic potential. For this purpose, our group has developed an inducible conditional mouse model msur8f/fVillinCreERT2. In order to determine Sur8 action in the colonic tissue, we have developed organoids from the colon epithelium of healthy mice and have analyzed gene expression pattern by an RNAseq approach. Sur8 KO affects oncogenic CRC transcription factors expression, as well as the modulation of some Wnt pathway regulators. In regard to miRNA data, we have observed deregulation of miRNAs related to CRC in Sur8 KO organoids. To determine the role that Sur8 plays in the development and progression of CRC, we have subjected our inducible conditional mice to chemical carcinogenesis and we have observed that Sur8 KO males display less and smaller tumors and do not present any adenocarcinoma. In addition, we have carried out Sur8 silencing in human CRC cell lines by infection with constitutive shRNA lentiviruses. We have observed that Sur8 silencing produces decreases of cell tumor proliferation, and reduction of p-ERK levels. Finally, we are evaluating the effects of putative therapeutic agents against Sur8 in human CRC cell lines. Concretely, we are testing Celastrol, which has been described that binds and blocks the action of Sur8 in vitro. We have observed that Celastrol treatment diminishes the cell tumor proliferation in this model. Altogether, our results indicate that Sur8 may have a determinant role in CRC progression and that Sur8 could be a potential molecular target for the design of novel strategies against CRC

Implementación del aprendizaje basado en problemas (ABP) en la enseñanza práctica de la fisiología del sistema digestivo

Sección Deptal. de Fisiología (Farmacia)Fac. de FarmaciaFALSEsubmitte