Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Our results revealed that: (i) infliximab has antioxidative properties, (ii) chronic inflammatory joint patients show high levels of oxidative injury, and (iii) oxidative stress is more intense in active disease group than in the inactive disease group.

The present study evaluated the effect of infliximab on the myeloperoxidase (MPO) concentration in chronic inflammatory joint disease. Eighteen patients were divided into active and inactive groups. Erythrocyte sedimentation rate, C-reactive protein, white blood cell counts, MPO concentration, and biomarkers of oxidative stress were measured before and after the infusion of infliximab. Patients with active disease showed increases in concentrations of MPO and biomarkers of oxidation, but decreases in antioxidant parameters. After infliximab treatment, both inflammatory parameters and MPO concentrations were normalized. In conclusion: (1) the MPO concentration is related to inflammatory activity and could play an important role in the maintenance and outbreak of oxidative stress present in these diseases, and (2) infliximab inhibits MPO concentration.

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Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.

BackgroundRilpivirine is a recently authorised antiretroviral. Adherence is essential in this kind of drug.PurposeTo evaluate treatment adherence with rilpivirine/emtricitabine/tenofovir (RPV/FTC/TDF) using the SMAQ questionnaire and pharmacy dispensing records (FDR) and the correlation between these in HIV/AIDS mono-infected patients.Material and methodsProspective observational study. We included patients treated with RPV/FTC/TDF from September 2013 until September 2014 with adherence data available of at least 3 months. Demographics data and reason for treatment were collected.Adherence was calculated across the SMAQ questionnaire (qualitative and semi-quantitative) and FRD, considering the patient adherent when any of these parameters was ≥95%. The correlation between the methods was assessed using the kappa (k) index.Results33 patients started treatment with RPV/FTC/TDF during the above-mentioned period. 21 were included in the study. 71% were men (average age: 40 ± 10 years). 38% were treatment-naïve and the rest were changes of therapeutic strategy (33% adverse reactions and 29% simplification of treatment strategies).26% of patients were considered adherent from a qualitative point of view in the SMAQ questionnaire, 76% from a semi-quantitative perspective and 95% via the FRD. The results between the three analysis only coincided in 6 patients.As for the results of k index, we observed the following strength of agreement: fair between the SMAQ quantitative and qualitative questionnaires (k = 0.22) and slight between the SMAQ qualitative questionnaire and FRD (k = 0.04) and between semi-quantitative SMAQ and FRD questionnaire (k = 0.01).ConclusionOur study highlights a low adherence to treatment obtained with the SMAQ questionnaire (both qualitative and semi-quantitative). It may be due to both the inflexibility of the questions and because of the patient assessment. These results could be improved through a pharmacist intervention in the monthly clinical review.Correlation between the three methods was low, so their use in isolation may give erroneous results in predicting adherence. However, with this way, “hidden” non-adherent patients (adherent FRD and non-adherent SMAQ) and “masked” non-adherent patients (non-adherent FRD and adherent SMAQ) could be detected.References and/or acknowledgementsNo conflict of interest.

BackgroundIt has been demonstrated that assisted electronic prescription (AEP) is an effective measure of reducing medication errors. It is necessary to correct parameterisation of the system, adapting it to the peculiarities of each clinical unit.PurposeTo establish parameterisation requirements of an AEP tool, prior to implementation in a psychiatric service (PS).Material and methodsFrom the AEP (Mira) programme, we proceeded to make decisions for adaptation of the PS; 30 beds belonging to a reference hospital area acted as a pilot for the implementation of the AEP in all of the hospital. Firstly, we performed an analysis of service needs according to consumption of drugs during the previous year (class of drugs, routes and hours of administration). Later, we took parameterisation decisions: (1) to facilitate prescription/administration, such as regular dosing schedule, preconfigured protocols, information about restrictions drugs and administration instructions; (2) to provide safe prescriptions, such as, maximum dose alerts, drug interactions (DI), high alert medications (HAM) and narrow therapeutic margin (NTM).ResultsDuring the previous year, the PS had used 151 active substance, 487 products and 73 699 dispensation units. 85% of the prescribed drugs belonged to 3 therapeutic groups according to the ATC classification: N-nervous system (43%), C-cardiovascular system (23%) and A-digestive system (19%). 76.3% of drugs were administered orally, followed by intramuscularly (7%). It was possible to parameterise default regular dosing schedule in 59% of medicines. Most administration instructions were related to oral administration: 25.3% with food and 16.3% without food. Furthermore, 3 protocols for clinical condition were created: ‘if agitation’, that included haloperidol, biperiden and clonazepam. Finally, to improve safety, we selected 6 DI considered clinically relevant and established maximal doses in 70.2% of active substances according to the technical data sheets. We discarded incorporation of all alerts of HAM or NTM to reduce saturation and increase effectiveness of those selected.ConclusionWe consider that parameterisations can facilitate previous work on implementation in other units, adapting the tool to the peculiarities of each service. PS benefits from the existence of a regular dosing schedule for most drugs. However, their prescriptions are not easily protocolised. We have highlighted a large number of drugs with maximum established dose, which can be useful to the prescriber who caters for chronic patients, whose reason for hospitalisation is often therapeutic failure which could lead to an excessive increase in doses.No conflict of interest