BackgroundRobotic dispensing has demonstrated improvements in patient safety and workflow. However, there are no data on staff satisfaction after implementation.PurposeQuantitative evaluation of staff satisfaction after implementation of a robotic dispensing system in an outpatient pharmacy (OP).Material and methodsSetting: OP of a 1300 bed tertiary teaching hospital in Madrid (Spain). The pharmacist’s role consists of continuous centralised order validation, and patient counselling and education. Dispensing and inventory management is performed entirely by nursing assistants, using a robotic dispensing system (Rowa Vmax) with a conveyor belt system.Design: This was a cross sectional study involving 8 pharmacists and 9 nursing assistants.Overall satisfaction index and specific aspects, such as the contribution of the robotic dispensing system to safety, ease of use and stability were evaluated. In addition, the quality of the inventory control, the quality of the integration with other information systems of the OP, and installation and technical support were evaluated by the pharmacy staff.The results (0–10 points) were expressed as mean (±SD). Comparison between staff category was made using the Mann-Whitney U test.ResultsOverall satisfaction index was 8.63 ± 0.744 for pharmacists and 7.78 ± 0.667 for nursing assistants (p = 0.046). The greatest satisfaction was achieved for the increase in safety during dispensing (9.75 ± 0.463 for pharmacists and 8.00 ± 0.707 for nursing assistants; p < 0.001), ease of replenishing the robot (9.25 ± 0.707 and 7.44 ± 0.527; p < 0.001) and ease of handling the new dispensing software (9.13 ± 0.641 and 8.22 ± 0.667; p = 0.027). The aspect that had the lowest score was dispensing speed (7.75 ± 0.886 for pharmacists and 6.33 ± 0.500 for nursing assistants; p = 0.002).Pharmacists’ satisfaction with the quality of the inventory control, quality of the integration and installation was higher than 8.5 points. Satisfaction with technical support was 7.75 ± 0.707.All staff members recommended their implementation to other OPs.ConclusionThe results of pharmacists’ and nursing assistants’ satisfaction surveys have provided useful information in evaluating the quality of implementation of the robotic dispensing system. For most of the issues, satisfaction was greater in pharmacists than in nursing assistants. The only aspect in need of improvement is the dispensing speed of the system of conveyor belts.References and/or AcknowledgementsBeard RJ, Smith P. Springerplus 2013;2:295No conflict of interest.
BackgroundLimited data are available regarding co-administration of acenocoumarol with direct acting antiviral agents.PurposeWe report a case of a patient who required a significant increase in the acenocoumarol weekly dose when co-administered with ombitasvir/paritaprevir/ritonavir.Material and methodsData on international normalised ratio (INR), acenocumarol dosing and concomitant medications were obtained from the general practitioner. Potential drug-drug interactions were checked using Lexi-Comp, SPC and ResultsA 61-year-old-male with treatment naïve genotype 1a chronic hepatitis C was examined in the gastroenterology department. His baseline viral load was 2 893 236 IU/mL and he had compensated liver cirrhosis.His medical record included rheumatic valvulopathy that required double valve replacement and anticoagulation with acenocoumarol 8 mg/week (target INR 2.5–3.5). His INR had been stable on a dose of 8–9.5 mg/week over the past 2 years. Concomitant medications included omeprazole 20 mg/24 h, lisinopril 5 mg/24 h, digoxin 0.125 mg/24 h, bisoprolol 2.5 mg/24 h and furosemide as needed. Omeprazole interacts with acenocoumarol but increases its effect. Concomitant medications had not been modified for several months.He started antiviral treatment in April 2015 with ombitasvir/paritaprevir/ritonavir 25 mg/150 mg/100 mg/24 h, dasabuvir 250 mg/12 h and ribavirin 400 mg/12 h for 24 weeks. His baseline INR was 3. After evaluating potential interactions, the gastroenterologist recommended close digoxin and INR monitoring.At week 4, the INR became subtherapeutic at 1.4. Therefore, the acenocoumarol dose was increased to 11 mg/week and enoxaparin 100 mg/24 h was started.At week 6, the INR was 1.6 and the dose was titrated to 13 mg/week. Enoxaparin was reduced to 60 mg/24 h.At week 9, the INR was 1.9 and the dose was increased to 16.5 mg/week.At week 12, the INR was 2.1 and the dose was increased to 19.5 mg/week. Enoxaparin was withheld.At week 16, the INR was 2.3 and the dose was titrated to 20.5 mg/week.At week 24,the INR was 3.8 and the dose was decreased to 19 mg/week.At the end of treatment, the acenocoumarol dose had been increased by 137.5%.During the 24 week period, the patient reported no compliance problems, treatment modifications or dietary changes. He did not experience any thrombotic or bleeding event.A causality assessment was conducted according to the Naranjo algorithm and the score obtained was 5 (adverse drug reaction classified as probable).ConclusionThere is a possibility of decreased INR after concomitant use of acenocoumarol and ombitasvir/paritaprevir/ritonavir.No conflict of interest.
BackgroundIn 2015, the development of well tolerated and highly effective direct acting antivirals (DAAs) for hepatitis C virus (HCV) dramatically changed the therapeutic landscape. However, data are lacking on the effectiveness and safety of these combinations in patients coinfected with human immunodeficiency virus type 1(HIV-1).PurposeTo provide preliminary data on the effectiveness and safety of DAAs for the treatment of hepatitis C infection in a HIV/HCV coinfected population, under routine clinical practice.Material and methodsDesign: observational, descriptive, prospective study.Inclusion criteria: coinfected patients who had finished their treatment with DAAs before 9 October 2015.Variables: demographic and baseline clinical data; HCV genotype; sex; prior response to HCV treatment; grade of fibrosis; presence or absence of decompensated cirrhosis; blood count; ALT; and AST.Effectiveness analysis: viral Load (VL) at the end of treatment or sustained virologic response at week 12 if available.Safety analysis: adverse drug events (ADEs), including laboratory abnormalities.ResultsOf the 95 patients enrolled, 72.6% had genotype 1 infection, 14.7% genotype 4 and 12.6% genotype 3. Overall, 70.5% were men, 54.7% had been previously treated for HCV and 65.3% had cirrhosis. 15 (15.8%) patients had developed decompensated cirrhosis.The most frequent treatments were: sofosbuvir/ledipasvir (41.0%), ombitasvir/paritaprevir/ritonavir and dasabuvir (20.0%) and sofosbuvir and daclatasir (20.0%). Ribavirin was part of the treatment in 51.6% of cases. Duration of treatment was 12 weeks in 56.8% of cases.At the end of treatment, no patient had confirmed HIV-1 virologic rebound. Undetectable HCV VL was achieved in 80/83 patients (2 patients died during treatment because of other causes and 1 patient decided to stop treatment). Serum transaminases were normalised in 79.6% of patients, and 7/8 patients achieved SVR (no data for SVR still available for the remaining patients).No patient discontinued treatment because of ADEs. Only 3 ADEs of grade III were identified (insomnia in 2 patients treated with sofosbuvir and daclatasvir and in 1 patient treated with sofosbuvir/ledipasvir). Common ADEs of grade I-II identified were: headache (30.5%), fatigue (28.4%), anaemia (17.9%) prurito (17.9%), insomnia (16.8%), dry skin (15.8%), irritability (14.7%), decreased appetite (14.7%) and nausea (11.6%).ConclusionPreliminary data corroborate the high effectiveness and good safety profile of DAA regimens in HIV/HCV coinfected populations.References and/or AcknowledgementsRev Esp Quimioter 2015;28(Suppl 1):4851No conflict of interest.
BackgroundDirect acting antivirals (DAAs) have become elective treatment for chronic hepatitis C virus (HCV) infection but final data regarding routine medical practice are still limited.PurposeThe objective of this study was to assess treatment effectiveness and safety of DAAs in real practice.Material and methodsDescriptive, retrospective, non-interventional study. Inclusion criteria: all HCV monoinfected patients who started treatment with DAAs from January 2014 to March 2015. Exclusion criteria: patients with liver transplant.The following variables were collected from the digital medical record: demographics, degree of fibrosis, clinical data (decompensated cirrhosis, hepatocellular carcinoma), response to previous HCV treatment and viral genotype, viral load and analytical data (at baseline and at the end of treatment) and adverse events.Primary effectiveness endpoint was SVR12 (sustained virologic response 12 weeks after the end of treatment). Secondary endpoint was virologic response (undetectable virus load) and normalisation of serum transaminases at the end of treatment.Safety was evaluated by laboratory abnormalities and adverse events (AEs).Results48 patients were included: 29 (60.4%) were male; average age 60 years (SD=8.1).Distribution of virus genotypes were: genotype 1a=8 (16.7%) patients; 1b=33 (68.7%); 2=1 (2.1%); 3=4 (8.3%); and 4=2 (4.2%).42 (87.5%) patients were cirrhotic, 17 (40.5%) of these were decompensated and 5 (10.4%) had a hepatocellular carcinoma.24 patients (50%) were treatment naïve, 20 (41.7%) had a failed prior therapy with peginterferon/ribavirin and 4 (8.3%) with a protease inhibitor.The prescribed DAAs were: SOF+SMV=27 (56.2%), SOF+DCV=10 (20.9%), OTP/PTV/r+DSV=5 (10.4%), SMV+P-INF=3 (6.2%), SOF/LDV=1 (2.1%), DCV+SMV=1 (2.1%) and SOF=1 (2.1%). Ribavirin was present in 33 (68.7%) treatments.Treatment duration was 12 weeks in 34 (70.8%) patients and 24 weeks in 14 (29.1%).SVR12 was achieved in 31 (88.6%) patients with available laboratory data (72.9%). At the end of the treatment, virologic response was achieved in 100% of patients with data available (89.6%), and 85% of patients with available laboratory data (83.3%) had normalised serum transaminases.Most frequent AEs were: asthenia 25 (52%), ribavirin associated anaemia 15 (45.5%), pruritus 16 (33.3%), dry skin 10 (20.8%) and insomnia 10 (20.8%).ConclusionData show a high percentage of SVR12 and a totally virologic response at the end of treatment. Moreover, AEs did not differ from those described in clinical trials. DDAs seemed to be efficacious and well tolerated in real clinical practice.References and/or AcknowledgementsRev Esp Quimioter 2015;28(Suppl 1):48-51No conflict of interest.
Material and methods First, QI were selected through a literature review and expert meetings within the network for healthcare institutions (Zorgnet-ICURO). Next, these QIs were assessed for content validity in two separate datasets. The first dataset was obtained from national RD (year 2017, collected from all Belgian health care insurers). The second dataset comprised facturation data (FD) from two test hospitals: one general hospital psychiatry ward (GHP) and one mental health hospital (MHH). Results Four QIs were selected allowing in-depth evaluation of BZD use (Table ). For the MHH, reimbursement data corresponded well with local facturation data (719 vs. 710 patients with !1 BZD use) but not in the GHP (161 vs. 206 patients). Upon analysis, it emerged that three-quarters of QIs could not be calculated as RD does not provide for a valid nominator at different times during hospitalisation. A subsequent survey among hospitals showed high variability in how RD are reported to insurers, explaining information loss.
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