Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon,Spain: The impact of a local calibration

Background  

In the financing of a national health system, where pharmaceutical spending is one of the main cost containment targets, predicting pharmacy costs for individuals and populations is essential for budget planning and care management. Although most efforts have focused on risk adjustment applying diagnostic data, the reliability of this information source has been questioned in the primary care setting. We sought to assess the usefulness of incorporating pharmacy data into claims-based predictive models (PMs). Developed primarily for the U.S. health care setting, a secondary objective was to evaluate the benefit of a local calibration in order to adapt the PMs to the Spanish health care system.     

Adverse reactions during transfusion of thawed haematopoietic progenitor cells from apheresis are closely related to the number of granulocyte cells in the leukapheresis product

Background and Objectives The infusion of thawed haematopoietic progenitor cells from apheresis (HPC‐A) is associated with minor but frequent adverse reactions (ARs), which has been mainly attributed to dimethyl sulphoxide (DMSO). Nevertheless, other factors may play a role in the pathogenesis of such toxicity. Materials and Methods The ARs on a cohort of 423 cryopreserved HPC‐A infusions for 398 patients in HPC transplantation program were analysed. Results ARs were reported in 105 graft infusions (24·8%) and most of them were graded as mild to moderate. The most frequently reported ARs were gastrointestinal and respiratory, and three patients presented epileptic seizure. The volume of DMSO/kg (P < 0·001), volume of red‐blood‐cells/kg (P = 0·02), number of nuclear cells (NCs)/kg (P < 0·001) and number of granulocytes/kg (P < 0·001) in the infused graft were significant in the univariate analysis for the occurrence of ARs. The amount of granulocytes/kg remained significant in the multivariate analysis (P < 0·001). The grade of ARs also correlated with the amount of cryopreserved granulocytes. Conclusion The incidence and grade of ARs during infusion of cryopreserved HPC‐A are related to the amount of granulocytes in the graft.     

Hardening and Fresh State Behaviour of Ternary Cement for Marine Environments: Modification through Nanoadditives

The use of nanomaterials to enhance the physical and mechanical properties and durability of cement materials in their hardened state has been studied for a long time in many investigations. In comparison, fewer studies focus on nanomaterials’ influence on the fresh state when the cement reaction starts. In addition, if we consider ternary blended cement (as those used for applications in marine environments), this has been rarely studied. Severe stresses in the marine environment require high durability, which is achieved by using pozzolanic additions, to the detriment of a rapid achievement of the properties. The addition of nanomaterials could contribute to increasing the durability and also accelerating the setting of the concrete. In this work, we performed a systematic and comparative study on the influence of adding graphene oxide (GO), nanosilica (NS), and microfibrillated cellulose (MFC) during the setting mechanisms of cement (CEM V/A suitable for concrete subjected to external attacks in marine environments) blended with fly ash and slag. Cement hardening was examined through setting time and rheology within mini-slump tests. The effect of nanoadditives on the cement hydration was analysed by heat flow calorimetry to evaluate the acceleration potential. Exploring the three nanoadditives on the same formulation, we could establish that the retention of mixing water significantly decreased workability for MFC. In contrast, NS increases the hydration of cement particles, acting as nucleation nodes and promoting supplementary cement hydrates (pozzolanic reactions) and accelerating setting time. Finally, GO showed a reduction in workability. We also investigated the dosage effects on mechanical behaviour at an early age and discovered an improvement even at low GO (0.006%) and NS (3%) dosages. We have also analysed the dosage effects on mechanical behaviour at an early age.     

Oferta de servicios de atención farmacéutica: clave para un nuevo modelo de servicios de salud

La colaboración interdisciplinar entre profesionales sanitarios es esencial para mejorar los resultados en salud de la población. Las capacidades que poseen los farmacéuticos les convierten en profesionales que pueden contribuir al control integral de la farmacoterapia en coordinación con otros profesionales de la salud. El Consejo de Europa aprobó la resolución CM/Res(2020)3 sobre implementación de la atención farmacéutica en el sistema sanitario para promover el uso apropiado y seguro de los medicamentos. Entre las actividades a realizar mediante el proceso de atención farmacéutica destaca la detección de problemas relacionados con la farmacoterapia como son las contraindicaciones, duplicidades, errores de prescripción, interacciones, etc. La intervención farmacéutica en ese ámbito requiere establecer un marco de colaboración interprofesional adecuado. En el presente artículo se comentan los aspectos a abordar para afrontar el cambio de modelo hacia una farmacia asistencial, con una mayor integración e implicación en el sistema, todo ello bajo el amparo del Consejo de Europa.Palabras clave: Atención farmacéutica, Servicios farmacéuticos asistenciales, Farmacéuticos, Farmacia comunitaria, Colaboración interprofesional, Atención primaria de salud     

Paracetamol-induced fulminant hepatic failure in a child after 5 days of therapeutic doses

We report the case of a two and a half year-old girl who developed fulminant hepatic failure following 5 days of regular oral ingestion of paracetamol, approximately 90 mg x kg-1 x day-1. She presented with the typical findings of hepatomegaly, encephalopathy, high ammonia levels, high transaminases, hypoglycaemia and lactic acidosis. After stabilization, she was transferred to a specialist paediatric liver failure unit and fortunately she made a full recovery with intensive medical management.     

Multicentre survey on compliance with growth hormone therapy: what can be improved?

A survey was undertaken to evaluate compliance in Spanish patients receiving growth hormone treatment. The 28-item structured questionnaire was designed to collect data on compliance, treatment schedule, device used and instruction received. In total, 473 questionnaires were completed in 17 paediatric endocrine units. Compliance was divided into four categories based on percentage of doses omitted, classified as excellent if 0%, good <5%, fair 5–10% and poor >10%. The level of compliance was excellent in 74.0%, good in 20.1%, fair in 3.4% and poor in 2.5%. Compliance was better in those who injected themselves (p < 0:01), were trained by hospital staff (p < 0:01) and used automatic pens (p < 0:05). Patients using conventional syringes were less likely to comply (p < 0:05). More information on growth hormone treatment was requested by 57.6% of patients. The results indicate that the specialist nurse should spend sufficient time with the patients and relatives to ensure a higher compliance rate.     

Validation of a prioritization tool for patients on the waiting list for total hip and knee replacements

Rationale and aims Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. Methods We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, among other questions, the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t‐test or one‐way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. Results The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47–0.69) between items measuring similar constructs than those measuring different constructs (0.27–0.49). These data are similar in both joints. Conclusions Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement.