Chronic illness imposes a significant workload on patients, and applying a task-technology framework for evaluation of a patient portal helped improve the portal's fit to patient needs. However, it also revealed that patients often lack a clear understanding of tasks that would help them accomplish personal health information management. Portal developers may need to educate patients about types of patient work involving medical centers, in a way that developers of clinical information systems do not need to do. An approach to doing this might be to provide narratives about hypothetical patients.
BackgroundDrug shortages are caused by many factors, therefore medicines errors are reported. It is necessary to know how much health quality is a concern of clinical practice and how patient safety is involved.PurposeTo check out the drug supply problems; analyse the characteristics of drug shortages and assess their impact on a medium-sized hospital.Material and methodsA retrospective study of drug supply issues was conducted from September 2012 to September 2014. Variables analysed: type of drug, expected duration of the shortage and strategies. All data were exported from the National Drug Agency website. Drug purchases were gathered from a drug management application.Results172 drugs were affected by shortages. 19.77% of the drugs belonged to the digestive and metabolic group (mainly mineral supplements); 18.02% to the nervous system (mostly psycholeptics); 16.86% to the anti-infective group (primarily antibacterials); 11.05% to the cardiovascular system (predominantly beta blockers); 11.05% to the hormones group (mostly systemic corticosteroids). The expected length of the shortage was 235 days, although in 29% of cases, planned end date was not prompted. In 63.37% of the cases, the same drug was marketed by another firm so it could be obtained. 21.51% could be requested through other brands under special conditions, and in 15.12% the option was to look for a therapeutic alternative.ConclusionThe increasing frequency of drug shortages raises many difficulties and has a profound impact on patient safety and clinicians. Although it is impossible to predict for every drug shortage, establishing clear procedures and guidelines for managing drug shortages can improve patient safety, help prevent medicines errors and improve quality of care.ReferenceLee Ventola C. The drug shortage crisis in the United States. PT 2011;36(11):740–2,749–57No conflict of interest.
BackgroundThe treatment of rare autoimmune diseases presents for patients the additional problem of limited therapeutic options, which are usually reduced to corticosteroids and immunosuppressants. The use of rituximab could be an effective alternative.PurposeTo determine the efficacy of treatment with rituximab in autoimmune diseases.Material and methodsRetrospective observational study of patients with autoimmune diseases who were treated with rituximab between January 2008–March 2014. Data was collected from electronic prescription records. Diagnosis, reason for prescribing, previous and concomitant treatments, dose, recurrence and treatment outcome were collected as study variables.Results11 patients (36% male), mean age 47 years were analysed. The diseases were lupus erythematosus (36%) autoimmune thrombocytopenia (9%) and a miscellaneous group: vasculitis, pemphigus, scleroderma, cryoglobulinaemia, Sjögren’s syndrome, antiphospholipid syndrome (55%). The reason for using rituximab was: treatment failure with pre-treatments in 81% of cases or first choice in the remaining 19%. 81% of administrations followed the pattern 375 mg/m²/week for 4 weeks while 19% followed the pattern of 1,000 mg on days 1 and 15 of each cycle. With respect to previous treatment, 81% of patients had received high doses of corticosteroids, 54% corticosteroids with immunosuppressant; 1 patient was on prior treatment with intravenous immunoglobulin. Rituximab was administered concomitantly with corticosteroids for the majority of patients (91%). Treatment efficacy was assessed according to the response as: complete response (27%), partial response (54%) and no response (18%). Of the 11 patients studied, 6 (54%) received only one cycle of rituximab, 3 (27%) currently remain in treatment and 2 patients (18%) died due to progression of their disease.ConclusionAlthough its efficacy is variable, rituximab may be a valid therapeutic option in autoimmune diseases. Randomised controlled studies are necessary to ensure the various indications of rituximab.ReferenceRosman Z, Shoenfeld Y, Zandman-Goddard G. Biologic therapy for autoimmune diseases: an update. BMC Medicine 2013;11:88No conflict of interest.
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