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Objective: To determine the percentage of new Specialist Healthcare prescriptions received and modified by Primary Healthcare physicians., Design: Descriptive, cross-sectional and multi-centre study with the participation of Primary Healthcare physicians from one Madrid Health Area during 2 months. A method was established for registering the origin of the new prescriptions in the Computerised Medical Record System. In order to register new prescriptions without any change from Specialist Healthcare, the «second level» option was marked when the prescription was issued. A protocol was prepared and was available on the Computerized Medical Record System, so for those cases where there was a new Specialist Healthcare prescription, the Primary Healthcare physician would not issue any prescription or issue a prescription with changes as regards the original one., Results: A total of 69 Primary Healthcare physicians from 15 Primary Healthcare centres registered 46,512 new prescriptions, 3,893 (8.4%) from Specialist Healthcare. From this number, 3,544 prescriptions (91.0% 95% CI: 90.1-91.9) were issued without changes, and 298 prescriptions were modified (7.7% 95% CI: 7.0-8.7). In 46 cases (1.2% 95% CI: 0.8-1.5) no prescription was issued. Some prescriptions were changed by 51% of Primary Healthcare physicians, and the median of prescriptions changed or not issued was 3. The main reason for the modification was replacement with generics., Conclusions: A high percentage of new Specialist Healthcare prescriptions are issued without any changes being made by Primary Healthcare physicians. Modifications are concentrated in half of the participating physicians. Therefore, these data suggest that this practice is not generally adopted by the professionals., (Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the results of a plan for improving pharmacy indicators in a Primary Care (PC) Health Area., Design: Quasi-experimental study with a control group. The differences between the pre-intervention (Jan-Dec 2007) and post-intervention (Jan-Dec 2008) periods were evaluated., Setting and Participants: Intervention group: Primary Care doctors from PC Area 7 of the Community of Madrid (n=397)., Control Group: the rest of PC doctors of the Community of Madrid (n=4428)., Method: A multi-focus plan in which the main activities were: sessions in the health centres with the worst results, involvement of those responsible for the Rational Use of Drugs, interviews with the doctors with the most improvable indicators, recognition of those with good indicators, and preparing short notes on drugs., Main Measurements: Prescription and notification indicators associated with the safety of drugs., Results: In relation to Madrid, the absolute improvements of Area 7 in the accumulated indicators, %Generic drugs, %Statins, %ARAII y %Omeprazole were 0.29; 1.17; 0.61 and 0.37 percentage points, respectively. DHD Osteoporosis equalled the improvement of Madrid. In Area 7, the increase in notifications of suspected serious ADRs was 180% and number of ADR notifications of ADRs was 233%, better than the Madrid data (48% and 21%). The notification of medication errors showed similar increases in both groups (PC Area 7 1567% vs. Madrid PC 1633%)., Conclusions: Implementing a multi-focus improvement plan with feasible and specific actions can be a useful tool for improving pharmacy indicators., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Following the appearance of Staphylococcus epidermidis positive hemocultures in four patients undergoing parenteral nutrition in different services, and after microbiological controls of the mixtures prepared by the Pharmacy Service in order to discard contamination during preparation, it was decided to assess the handling o catheters and central pathways by the Hospital Nursing Staff. A survey was carried out of 34 nurses, 17 each from the morning and evening shifts, from the floors with patients undergoing parenteral nutrition, representing 13.3% of all the nurses of those floors. There were five sections in the survey, with fifty-two questions referring to the introduction of catheters, change of dressing, care of the point of insertion, uses of the administrative pathway, change and handling of the parenteral nutrition bag, intravenous administration of medicines and parenteral nutrition, and withdrawal of the catheter. According to the results, 76% of central catheters are introduced in the operating theatre: once in place, the catheter is checked by X-ray to ensure that it is in the correct position, in all cases. There were major differences in the changing of dressings. The pathway for administration of the parenteral nutrition is used for a variety of functions. Medicines are administered in "Y" with the nutrient mixture, although their stability is not known. In changing the parenteral nutrition bag and the handling of the catheter, adequate sterilization measures were not taken.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this retrospective study is to ascertain the physiopathological characteristics of patients on parenteral nutrition (PN), the types of diet used and duration of treatment. Presentation of epidemiological results and evolution of 637 adults receiving PN after a five-year period of nutritional follow-up, conducted by a Nutrition Team (NT) in hospital. For the purpose of this study, we used the Follow-Up charts of all the patients treated with PN from 1986-1990. The results obtained lead us to affirm that most patients suffered a malignant gastrointestinal process, that the duration of the PN was reduced significantly during the five-year term, mainly using dietary protocols, and that there was a gradual increase in preparations of nutrient units subjected to controls compared to the total prepared by the Pharmacy Department.

The stability of folic acid (FA) in mixtures of Total Parenteral Nutrition has been and is a controversial subject, with discussion concerning the influence of factors such as temperature, light and storage time. As regards the stability of the vitamin B12, there are few studies in scientific literature. For all those reasons, we consider it necessary to make a proper study to evaluate the influence of different factors in the stability of both vitamins. The study was made on 3 liter TPN bags of the EVA type, the composition of which was as follows: AA (85g), glucosa (225g), fat (50g), Na (86mEq), K (60 mEq), Ca (15 mEq), Cl (90 mEq), P (17 mmol) acetate (149 mEq) and 10 ml of MVI-12 which contain 400 micrograms of PA and 5 micrograms of Vitamin B 12. Consideration was also given to the stability of these two vitamins in the same diet, to which were added 10 ml of a commercial preparation of oligo-elements. Six TPN bags were prepared (without oligo-elements); two of them were kept in a fridge and protected from the light, two were kept at room temperature and protected from the light and the other two at room temperature without protection from the light. Samples were taken from all the bags immediately after their preparation and after 24, 48, 72 and 96 hours. The same process was carried with other TPN bags which did contain oligo-elements. The method for determining FA and Vitamin B12 was by radioassay.(ABSTRACT TRUNCATED AT 250 WORDS)