QALY (one case) were also apparent. In contrast, the input parameters were quite different. Every analysis demonstrated cost-reduction and patient safety enhancement but methodological differences were present in terms of perspective, discounting, duration, inflation, sensitivity, inputs and definitions (e.g. definition of ADE). Conclusion The different outcome data types used in studies counter the intention to prove the cost-effectiveness of CPOE systems. It is clear that no generally accepted definition is present over which system can be called CPOE. On the other hand, it will only be possible to compare different CPOEs if common agreement is developed in terms of outcomes observed by studies. Clinical pharmacists can play an important role in the unification of the upcoming studies and collection of data. REFERENCES AND/OR ACKNOWLEDGEMENTSThanks to the help of my co-workers and the guidance of our leaders.No conflict of interest.
The Prospective Payment System had significant impact on home healthcare agencies throughout the nation. Virtua Home Care, located in Southern New Jersey, realized the need for process improvement in order to remain viable. Six Sigma was introduced to the agency and the Define, Measure, Analyze, Improve, and Control processes were initiated to achieve sustainable results, and within 9 months, Virtua Home Care improved regulatory compliance, experienced a deficiency-free survey, and recognized a 1.2 million dollars financial gain.
BackgroundIron is used like a medicine to treat or prevent haemolytic anaemia. When iron is administered concomitantly with certain drugs, it can change absorption of these drugs by complex reaction. Consequently, treatments become ineffective.PurposeTo study in vitro physicochemical behaviour of iron with different cytotoxic drugs used in oncology therapeutic protocols.Material and methodsWe prepared several mixtures of bivalent and trivalent iron solutions with 13 anticancer drugs after their reconstitution. We mixed 0.1 ml of 5% iron solution (Fe 2+or Fe3+) with 1 mL of diluted drugs in glass tubes, and we observed in the presence or absence of a precipitate.The formed precipitates were washed, dried and identified by infrared spectroscopy and UV-visible spectroscopy. Spectra obtained are compared with those of the anticancer drugs studied.ResultsResults are represented in the following table:Abstract 3PC-033 Table 1 Cytotoxic drug (1 ml ) Interaction with iron Cytotoxic drug (1 ml ) Interaction with iron Fe 2+ (0.1 ml) Fe3+ (0.1 ml) Fe2+ (0.1 ml) Fe3+ (0.1 ml) Etoposide + Red Doxorubicin/Epirubicin black + Carboplatin – Yellow Vincristine – – Cyclophosphamide – Yellow Ifosfamid – Yellow Cytarabine + Red Cisplatin – Yellow Vinblastine – Yellow Methotrexate + + Dacarbazine – Yellow Bleomycin – – +: presence of precipitate –: no precipitateSpectra obtained by UV-visible and IR spectroscopy of the precipitates correspond to the spectra of cytotoxic drugs. We can deduce that the iron complex is incompatible with etoposide, cytarabin, doxorubicin, epirubicin and methotrexate.ConclusionThe findings suggest that iron (Fe3 +and Fe2+) is not compatible with etoposide, cytarabine doxorubicin, epirubicin, and methotrexate. We can deduce that intravenous iron should preferably be taken at least 2 hours before or 2 hours after taking these anticancer drugs to limit the risk of developing complications. For oral formulae like etoposide and methotrexate, concomitant administration of oral iron should be avoided in order to ensure good absorption.References and/or Acknowledgements1. Arlet J-B, et al. Iron therapy: indications, limitations and modality. Rev Méd Int2012;34:26–31.2. Dan L Longo MD. Iron-deficiency anaemia. N Engl J Med2015;372:1832–43.No conflict of interest
BackgroundThe development of oral anticancer drugs generates some risks related to the use of oral chemotherapy in the ambulatory treatment for cancer patients. For secure administration of these drugs, the patient needs to have knowledge of the use of the drug and the management of side effects. Therapeutic education of patients is considered one of the tools that allows good use of the drugs.PurposeThe aim of our study was to evaluate the knowledge of patients treated with oral chemotherapy, regarding their treatment and side effects, after educational sessions performed by a pharmacist.Material and methodsThis was a prospective, descriptive study, conducted between March and July 2014. We organised educational sessions, lasting 30 min, for each patient, without charge, on good utilisation of the drugs and the manifested side effects. We elaborated the educational cards for patients and dispensing files for pharmacists. Two evaluations (T1 and T2) were performed after and before the educational sessions. Data were collected with a checklist and analysed by SPSS 13.0.ResultsThe study included 50 patients who benefited from these sessions; average age was 53 year old and the sex ratio (M/F) was 0.43Comparing patient medication knowledge between T1 and T2, we observed an increment on all levels, among others information about treatment (T1, 72%; T2, 100%), dosage (T1, 92%; T2, 98%), medication administration time (T1, 88%; T2, 98%) and administration modalities (T1, 82%; T2, 96%).Therapeutic patient education ensured the prevention of some side effects caused by antineoplastic drugs, by respecting the hygieno-dietetic rules and medications associated with cancer treatment. Hand-foot syndrome was the most common side effect (T1, 38%); it decreased by 12% in T2.ConclusionOur educational approach demonstrated the interesting role of the hospital pharmacist in the development of knowledge, especially on administration modalities and management of side effects.References and/or AcknowledgementsTourette-Turgis C, Isnard-Bagnis C. Education thérapeutique. Néphrologie et thérapeutique, NEPHRO-633; 2013, p. 6No conflict of interest.
BackgroundPhysicochemical incompatibilities of parenteral drugs cause several problems in hospital practice. These incompatibilities can be represented by precipitation, complexation or colour change before or during administration to patients. Understanding these incompatibilities allow pharmacists to avoid many problems during preparation and administration.PurposeTo determine physicochemical incompatibilities of a cytotoxic drug widely used in paediatric oncology (methotrexate) with certain trace elements existing in food and medicines, as well as in food supplements.Material and methodsWe performed several mixtures to study physicochemical reactions between methotrexate reconstituted in infusion bags (25 mg/ml) and five cations: calcium (Ca2+), copper (Cu2+), iron (bivalent and trivalent), magnesium (Mg2+) and zinc (Zn2+). An interaction was elucidated by formation of a precipitate visible to the naked eye. Infrared spectroscopy was the method of authentication of precipitates.ResultsPrecipitates were formed with the copper, zinc, bivalent and trivalent iron. On the other hand, there was no precipitate with calcium and magnesium. Functional analysis of infrared spectra of precipitates showed the presence of methotrexate.ConclusionThe study of the physicochemical incompatibilities of methotrexate can avoid possible interactions with medicines, food or nutritional supplements containing trace elements.Recording to the results, methotrexate precipitates in the presence of copper, zinc and iron ions. The absence of the precipitate or change of colour in the other mixtures does not exclude a possible complexation.Reference and/or Acknowledgements1. Benaji B, et al. Compatibility study of methotrexate with PVC bags after repackaging into two types of infusion admixtures. Int J Pharma1994;105(1):83–87.No conflict of interest
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