A new rapid desensitization protocol for chemotherapy agents

Background: Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar effi cacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. Objective: To assess the effi cacy of a new desensitization protocol in patients allergic to chemotherapy drugs. Methods: We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. Results: We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease. Conclusion: Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents

Información de medicamentos a la población desde el Servicio de Farmacia a través de Internet

Objectives: To describe and discuss the work of a Pharmacy Department for the health-care portal www.viatusalud.com. Methods: Using a web portal, a Pharmacy Department develops and updates a vademecum on drugs, and answers enquiries by end-users. Results: On December 31, 2002 more than 750 records on drugs were available, and 3030 enquiries had been answered. Conclusions: With this drug information and online enquiry service, our Pharmacy Department helps meet the demand of health-care information posed by the community and by patients previously seen at Clínica Universitaria. In addition, it allows areas of improvement to be detected in the information to be offered to patients fron a Pharmacy Department, and represents a tertiary source of information for health-care professionals

Errores de medicación: evaluación de un sistema de notificación y análisis de los errores en un hospital universitario

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 tool and concordance between different evaluators. We evaluated user satisfaction through a questionnaire given to nurses and doctors. In addition, we used two multivariable logistic regression models to determine independent factors associated with errors reaching the patient and with errors causing harm, respectively. A total of 2,578 medication errors were reported from May 2004 to December 2014. Of these, 94.0% caused no harm, 2.7% caused harm and 1.7% were potential errors. Nurses reported 71.3% of errors, 24.8% were notified by pharmacists and 3.9% by doctors. Regarding the process involved, 44.6% were prescription errors, 33.5% were related to preparation/dispensing and 17.6% to preparation/administration. After the root cause analyses some improvement actions affecting different processes were proposed, 69% of them were implemented. At least one discrepancy between narrative text and options selected from pull-down menus on the reporting form was present in almost 50% of the analysed reports. In those medication errors followed in depth, some discrepancy with reality existed in 40% of the reports. Concordance between evaluators was lower in recurrence probability, severity and identification of causes or contributing factors. However, discrepancies were not critical and did not hindered medication errors classification. Professionals consider the tool easy to use but tend to underreport. Multivariable models indicated that medication errors with higher odds of reaching the patient were: incorrect dose or drug, omission of a dose or a drug, wrong patient, wrong administration technique, medication errors in preparation/manipulation/packaging, those with various persons involved, errors in preparation/administration, and those with anticancer or anti-infective drugs. Therefore, the medication errors reporting system was successfully implemented, in addition, improvement actions were also introduced. Simple medication error reporting tools, as the one presented and analysed here, are valid and useful. Adding more pull-down menus and helping tools will increase identification of medication error causes and contributing factors. Narrative section in the reporting form is useful. Increasing hospital personnel training and offering more feed-back information would motivate reporting. Additional safety measures are necessary to check the right drug, dose and administration technique

Errores de medicación: evaluación de un sistema de notificación y análisis de los errores en un hospital universitario

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 tool and concordance between different evaluators. We evaluated user satisfaction through a questionnaire given to nurses and doctors. In addition, we used two multivariable logistic regression models to determine independent factors associated with errors reaching the patient and with errors causing harm, respectively. A total of 2,578 medication errors were reported from May 2004 to December 2014. Of these, 94.0% caused no harm, 2.7% caused harm and 1.7% were potential errors. Nurses reported 71.3% of errors, 24.8% were notified by pharmacists and 3.9% by doctors. Regarding the process involved, 44.6% were prescription errors, 33.5% were related to preparation/dispensing and 17.6% to preparation/administration. After the root cause analyses some improvement actions affecting different processes were proposed, 69% of them were implemented. At least one discrepancy between narrative text and options selected from pull-down menus on the reporting form was present in almost 50% of the analysed reports. In those medication errors followed in depth, some discrepancy with reality existed in 40% of the reports. Concordance between evaluators was lower in recurrence probability, severity and identification of causes or contributing factors. However, discrepancies were not critical and did not hindered medication errors classification. Professionals consider the tool easy to use but tend to underreport. Multivariable models indicated that medication errors with higher odds of reaching the patient were: incorrect dose or drug, omission of a dose or a drug, wrong patient, wrong administration technique, medication errors in preparation/manipulation/packaging, those with various persons involved, errors in preparation/administration, and those with anticancer or anti-infective drugs. Therefore, the medication errors reporting system was successfully implemented, in addition, improvement actions were also introduced. Simple medication error reporting tools, as the one presented and analysed here, are valid and useful. Adding more pull-down menus and helping tools will increase identification of medication error causes and contributing factors. Narrative section in the reporting form is useful. Increasing hospital personnel training and offering more feed-back information would motivate reporting. Additional safety measures are necessary to check the right drug, dose and administration technique

Removal of methylene blue from aqueous solutions using an Fe2+ catalyst and in-situ H2O2 generated at gas diffusion cathodes

Textile industries generate large volumes of wastewater containing organic dyes, which may be hazardous to the environment and human health. In this work, the oxidation of 100 mg dm-3 of methylene blue (MB) in aqueous solutions was studied using H2O2 (formed in-situ) at gas diffusion electrodes (GDEs) in the presence of 1 × 10-3 mol dm-3 Fe2+ catalyst, to create hydroxyl radicals to facilitate Fenton oxidation. The influence of applied potential (-0.5 to -1.3 V vs. Ag/AgCl) at different oxygen flow rates to the GDE (0.15 – 0.45 cm3 min-1) and different counter electrode materials (Pt mesh, Ni mesh, RVC) was investigated. MB was completely degraded to a residual concentration below the detection limit of 0.5 mg dm-3. The rate and degree of mineralisation were significantly influenced by the applied potential. A maximum mineralisation of 88.2% was achieved at -1.0 V vs. Ag/AgCl. The oxygen flow rate to the GDE did not influence the degradation of MB under the experimental conditions. The counter electrode material affected the degree of mineralisation in the order Pt mesh > reticulated vitreous carbon (RVC) > Ni mesh. The apparent first order rate decay constant for MB degradation and MB mineralisation was calculated to have a maximum value of 0.0182 min-1 for MB mineralisation at a potential of -1.0 V vs. Ag/AgCl

Phase I trial of intratumoral injection of an adenovirus encoding interleukin-12 for advanced digestive tumors

PURPOSE: To evaluate the feasibility and safety of intratumoral injection of an adenoviral vector encoding human interleukin-12 genes (Ad.IL-12) and secondarily, its biologic effect for the treatment of advanced digestive tumors. PATIENTS AND METHODS: Ad.IL-12 was administered in doses ranging from 2.5 x 10(10) to 3 x 10(12) viral particles, to seven cohorts of patients with advanced pancreatic, colorectal, or primary liver malignancies. Patients were thoroughly assessed for toxicity, and antitumor response was evaluated by imaging techniques, tumor biopsy, and hypersensitivity skin tests. Patients with stable disease and no serious adverse reactions were allowed to receive up to 3 monthly doses of Ad.IL-12. RESULTS: Twenty-one patients (nine with primary liver, five with colorectal, and seven with pancreatic cancers) received a total of 44 injections. Ad.IL-12 was well tolerated, and dose-limiting toxicity was not reached. Frequent but transient adverse reactions, including fever, malaise, sweating, and lymphopenia, seemed to be related to vector injection rather than to transgene expression. No cumulative toxicity was observed. In four of 10 assessable patients, a significant increase in tumor infiltration by effector immune cells was apparent. A partial objective remission of the injected tumor mass was observed in a patient with hepatocellular carcinoma. Stable disease was observed in 29% of patients, mainly those with primary liver cancer. CONCLUSION: Intratumoral injection of up to 3 x 10(12) viral particles of Ad.IL-12 to patients with advanced digestive malignancies is a feasible and well-tolerated procedure that exerts only mild antitumor effects

A new rapid desensitization protocol for chemotherapy agents

Background: Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar effi cacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. Objective: To assess the effi cacy of a new desensitization protocol in patients allergic to chemotherapy drugs. Methods: We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. Results: We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease. Conclusion: Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents

Información de medicamentos a la población desde el Servicio de Farmacia a través de Internet

Objectives: To describe and discuss the work of a Pharmacy Department for the health-care portal www.viatusalud.com. Methods: Using a web portal, a Pharmacy Department develops and updates a vademecum on drugs, and answers enquiries by end-users. Results: On December 31, 2002 more than 750 records on drugs were available, and 3030 enquiries had been answered. Conclusions: With this drug information and online enquiry service, our Pharmacy Department helps meet the demand of health-care information posed by the community and by patients previously seen at Clínica Universitaria. In addition, it allows areas of improvement to be detected in the information to be offered to patients fron a Pharmacy Department, and represents a tertiary source of information for health-care professionals

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort : 2004-2013

To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. Of 7165 new HIV diagnoses, 46.9% (CI:45.7-48.0) were LP, 240 patients died.First-year mortality was the highest (aHR = 10.3[CI:5.5-19.3]); between 1 and 4 years post-diagnosis, aHR = 1.9(1.2-3.0); an