Background The use of intracameral cefuroxime is becoming more widely accepted for endophthalmitis prophylaxis (EP) after cataract surgery. Recently, the European Medicines Agency approved a single, sterile, unit dose of intracameral cefuroxime in a few countries of Europe. Purpose To evaluate the cost saving resulting from the implementation of an optimisation protocol for the preparation of ready-to-use (RTU) intracameral cefuroxime syringes from 1500 mg vials of cefuroxime. Materials and methods A review of the literature was conducted when we planned to change the protocol. To evaluate the cost savings, the cost generated by the use of cefuroxime 1500 mg vials in the preparation of RTU syringes since the implementation of the protocol was compared to the costs if the marketed unit dose of intracameral cefuroxime had been used. Results A total of 200 RTU syringes are prepared from a single vial of cefuroxime 1500 mg in each batch at the Pharmacy. 40 syringes are sent weekly to the OR, the rest are stored frozen in Pharmacy (stability three months). Between January and July 2013 five vials of cefuroxime 1500 mg were used to prepare 1000 RTU cefuroxime syringes, with a cost of 14.56 € (PVP: 145.6 €/50 vials). If we had used the marketed unit dose, for the same treatment the cost would have been 12164 € (PVP: 121.64 €/10 vials); meaning a 99.8% reduction in costs. Conclusions The implementation of the optimisation protocol for the preparation of RTU intracameral cefuroxime syringes has led to a significant cost saving without compromising patient health. No conflict of interest.
Background As the result of Resolution SC 0403/10 of December 22, 2010 in the region of Andalucia (Spain) some medicines for outpatient treatment are no longer dispensed in community pharmacies but in hospital pharmacies, given that they require special surveillance, supervision and control. Purpose To determine the savings made by dispensing oral cytostatic drugs in a third-level hospital. Materials and methods Descriptive observational study of the oral cytostatics dispensed between December 2010 and March 2013. Data were collected from APD software. We determined: The total expenditure on dispensing cytostatics for out-patients, The percentage of this expenditure relative to the total expenditure on all oral medicines for outpatients, The cost savings, The most expensive active ingredients. Results The value of oral cytostatics totalled 6,731,547.87 € during the period of study. This meant 6.37% of the total amount of out-patient prescriptions for oral medicines for the same period. These prescriptions would have cost € 7,141,037.52 if they had been made at community pharmacies. Therefore, these results equate to a saving of € 409,489.64. The active ingredients that affected the cost most were imatinib and sunitinib. Conclusions Hospital dispensing of oral cytostatics led to a cost saving of 5.73% when compared to community pharmacy dispensing. Two factors explain this cost saving: The Avoidance of Any Commercial Expenditure Undertaken by Community Pharmacies The Optimisation of Resources Driven by Patients Taking the Exact Amount Needed of the Drug as They Are Required to Return Any Untaken Medicine When Completing or Changing Their Treatment No conflict of interest.
Background As cancer is often life-threatening, medicines reconciliation is particularly important as cancer patients transition between different levels of the health system. Purpose The primary objective was to determine the frequency and type of medicines reconciliation discrepancies upon admission to the oncology unit. Secondary objectives were to assess the effectiveness of pharmacist interventions on medicines reconciliation discrepancies and to identify factors that may affect the frequency of errors. Materials and methods This was a prospective, single-centre study of patients taking at least one medicine who were admitted to the oncology unit. Medicines reconciliation was conducted by a pharmacist who gathered information by checking the patients’ home medicines, patient and caregiver interviews and confirming the medicines list with community pharmacy records. The resultant list was compared against medicines documented in the electronic medical record to identify any discrepancies. The frequency, type, and reason for medicines discrepancies were assessed together with demographic variables. Results Fourteen patients were interviewed, 66.6% were men. The mean age was 66 years. The admission complications were: pulmonary (14.3%), digestive (14.3%), haematological (14.3%), pain (21.4%) and chemotherapy administration (35.7%). Of 14 patients interviewed, all had at least one discrepancy. The pharmacist performed 83 interventions (to correct 84.3% omission, 7.2% therapeutic duplications, 8.4% wrong route, frequency or dose). They were accepted by doctors in 44 cases (53%). Three patients did not have any medicines list recorded in the e-prescribing program during hospitalisation. The mean number of medicines the patients were taking before the process was 8. Patients taking three or more drugs were found to have the most discrepancies. Conclusions The most common medicines reconciliation discrepancies were omission errors. Omission errors and moderate acceptance of interventions were attributed to the oncologists not using the e-prescribing program when the length of hospital stay is short, for example when patients are admitted for administration of chemotherapy. No conflict of interest.
Background Chronic myeloid leukaemia (CML) is a myeloproliferative disorder associated with the Philadelphia chromosome resulting in the BCR-ABL fusion gene. This produces a continued proliferative signal resulting in the clinical manifestations of CML. Purpose To analyse the use of tyrosine kinase inhibitors (TKIs) in CML patients, and their safety profile. Materials and methods Descriptive observational study in a third level hospital. We included patients who were under treatment with TKIs at the time of the data collection (September 2013). Data was compiled through the electronic prescription program (APD Prisma). Variables included demographics (age, sex); clinical data (age at diagnosis, time since diagnosis, treatment) and adverse reactions (ADRs). Data were obtained from medical records. Results We analysed 54 patients who picked up TKIs in a pharmacy service at the time of data collection. Fifty percent (n = 27) were male, with a mean age of 58.0 (8.83). Mean time since diagnosis was 7.1 years (1.26). 67% of the patients (n = 37) received imatinib, 21.8% (n = 12) nilotinib, and 10.9% (n = 6) dasatinib. More than 66% of patients receiving second generation TKIs were on second-line treatment after imatinib, the remaining 33% were first-line. ADRs for imatinib included: 10 patients with oedema (8 relating to the eyelids), 8 musculoskeletal pain and cramps, 4 asthenia, 2 skin rash, 1 pleural effusion, and 4 other. ADRs for nilotinib: 2 patients with oedema, 2 irritability, and 5 other. ADRs for dasatinib: 1 fatigue and 1 muscle pain. ADRs were not reported in 34 patients. Conclusions Clinical practice in our hospital is consistent with the Summary of Product Characteristics. All the ADRs reported are included as very common (>1/10) in the above-mentioned summary. Only 11% of CML patients are initially treated with second generation TKIs. Although this approach has gradually increased in our hospital, there are not enough cases of CML patients treated with nilotinib and dasatinib to draw definitive conclusions. No conflict of interest.
Background Despite the expanding knowledge base, much remains to be understood about effective treatments to treat the many symptoms of anti-NMDA receptor encephalitis (anti-NMDA RE). Purpose To describe the treatment options for a case of refractory status epilepticus associated with non paraneoplastic anti-NMDA RE. Materials and MethodsRevised drug-treatment history of the patient. ResultsA 22-year-old woman with a family history of epilepsy and an arteriovenous malformation (AVM) of the brain, presented a generalised tonic-clonic without clear focal onset and post-critical confusion. She was in non-convulsive status epilepticus. Treatment was initiated with various intravenous drugs during the 50 days of the status: diazepam, phenytoin, valproic acid, levetiracetam, clonazepam, midazolam, propofol, lacosamide, ketamine, and lidocaine. It was decided to proceed with induction of barbiturate coma three times, requiring supratherapeutic doses in the second one. Oxcarbazepine was administered via feeding tube. With these treatments, momentary remission status was achieved although epileptiform activity reappeared when the pharmacological effect expired. Thirty days after admission, it was decided to repeat computed tomography for development of AVM and investigate again whether the cerebrospinal fluid was positive for anti-NMDA. This being the case, teatment was initiated with methylprednisolone and immunoglobulins. She continued with clinical status, but electrical brain activity began to fade at the same time that the patient was starting to tolerate enteral nutrition and so oxcarbazepine possibly began to be absorbed. After discontinuing sedation the patient awoke and opened her eyes. Electroencephalogram was repeated and epileptiform activity had disappeared completely. Facial dyskinesias were treated with clonazepam. Conclusions Whereas the best treatment approach for anti-NMDA RE encompasses a combination of immunotherapy, intensive care, and rehabilitation, there is a dearth of information regarding management of psychiatric and behavioural symptoms [1]. The possibility of resolving the status by oxcarbazepine gavage opens a window into the use of drugs by this route in the event of failure of standard treatment. Reference Sansing LH, Tüzün E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol. 2007 May;3(5):291–6. No conflict of interest.
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