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Diferencias de género en adolescentes con conducta suicida: Personalidad y psicopatología. Este estudio evalúa la relación entre el género, la personalidad, la psicopatología y la conducta suicida entre los adolescentes. Para ello, se diseñó un estudio transversal con adolescentes hospitalizados (N = 92) que presentaban conductas suicidas. Se recogieron características sociodemográficas y datos relacionados con la conducta suicida. Además, se evaluó la personalidad y la gravedad clínica mediante la administración del Inventario Clínico de Adolescentes de Millon (MACI). Los resultados revelaron que las dimensiones de personalidad más prevalentes para ambos géneros fueron Introversivo, Auto-punitivo, Pesimista, Oposicionista, Tendencia límite e Inhibido. Sin embargo, los hombres puntuaron más alto en Inhibido (p = 0,02, d de Cohen = 0,45) y las mujeres en Egocéntrica (p = 0,03, d de Cohen = 0,40). En cuanto a la gravedad clínica de los síndromes, las mujeres puntuaron más alto en Predisposición Delictiva (p = 0,04, d de Cohen = 0,45) y los hombres en Sentimientos Ansiosos (p = 0,02, d de Cohen = 0. 51), Afecto Depresivo (p = 0,04, d de Cohen = 0,41) y Tendencia Suicida (p = 0,03, d de Cohen = 0,37), y los hombres informaron con mayor frecuencia de Abuso en la Infancia (p < 0,001, d de Cohen = 0,70). Los resultados ponen de manifiesto la importancia de las intervenciones universales para promover un cambio de actitud hacia la búsqueda de ayuda psicológica, especialmente en los hombres, y la necesidad de diseñar tratamientos eficaces a medida para adquirir habilidades de gestión emocional para ambos géneros This study evaluates the relationship between gender, personality, psychopathology and suicidal behaviour among adolescents. For this purpose, a cross-sectional study with adolescent inpatients (N = 92) displaying suicidal behaviour was designed. Sociodemographic characteristics and data related to suicidal behaviour were collected. In addition, personality and clinical severity were assessed by administering the Millon Adolescent Clinical Inventory (MACI). Results revealed that the most prevalent personality dimensions for both genders were Introversive, Self-demeaning, Doleful, Oppositional, Borderline tendency and Inhibited. However, men scored higher in Inhibited (p = 0.02, Cohen’s d = 0.45) and women in Egotistic (p = 0.03, Cohen’s d = 0.40). Concerning clinical severity of syndromes, women scored higher in Delinquent Predisposition (p = 0.04, Cohen’s d = 0.45) and men in Anxious Feelings (p = 0.02, Cohen’s d = 0.51), Depressive Affect (p = 0.04, Cohen’s d = 0.41) and Suicidal Tendency (p = 0.03, Cohen’s d = 0.37), with men reporting more frequently Childhood Abuse (p < 0.001, Cohen’s d = 0.70). Results highlight the importance of universal interventions to promote a change in attitudes towards seeking psychological help, specially in men, and the need to design effective tailored treatments to acquire emotional management skills for both genders

Background Our Hospital Pharmacy Service (HPS) participates in the process of authorising off-label indications (OLIs) of drugs. Immunosuppressants are often used in OLIs. Purpose To analyse prescriptions for oral immunosuppressants dispensed as OLI in our HPS Outpatient Unit (HPSOU) to identify points in the system that could be improved. Material and methods Retrospective study of oral immunosuppressants dispensed at our centre between March 2012 and March 2014. Variables collected were age, sex, drug, prescribing service and indication; obtained from the HPSOU database and the electronic medical history. Results 269 patients (median age 52 years (5–92), 135 women (50%) and 134 men (50%)) were evaluated. 6 drugs were dispensed in 8 different medicinal products: tacrolimus 94 patients (35%), mycophenolate mofetil 78 (29%), mycophenolic acid 56 (21%), ciclosporin 34 (17%), everolimus 6 (2%) and sirolimus 1 (0.3%). 11 services were involved: Haematology (89 patients: 33%), Rheumatology (61: 23%), Nephrology (56: 21%), Ophthalmology (15: 6%), Digestive (14: 5%), Pneumology (10: 4%), Paediatrics (9: 3%), Neurology (8: 3%), Internal Medicine (4: 1%), Dermatology (2: 0.7%) and Oncology (1: 0.3%). Immunosuppressants were dispensed for 35 different indications. Main indications and their treatments were: Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) for 75 patients (28%), with tacrolimus (71%), mycophenolate mofetil (17%) and ciclosporin (12%); Systemic Lupus Erythematosus (SLE) for 46 (17%), with mycophenolate mofetil (62%), mycophenolic acid (30%) and tacrolimus (8%) and Membranous Glomerulonephritis (MGN) for 20 (7%), with mycophenolic acid (50%) and tacrolimus. Conclusion The use of oral immunosuppressants as OLI is an established treatment for various indications, specially, allo-HSCT, SLE and GMN. The creation of multidisciplinary groups to develop protocols for the management of these drugs is required. References and/or Acknowledgements Summaries of product characteristics of the evaluated medicinal products. No conflict of interest.

Background New oral anticoagulants are an alternative to acenocoumarol in the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation. Purpose To assess the suitability of prescriptions for new oral anticoagulants for those diagnoses, in accordance with criteria established by the health organisation and to analyse pharmaceutical interventions. Material and methods A prospective, observational and cross-sectional study of all patients admitted to our hospital who were prescribed dabigatran, rivaroxaban or apixaban from 01/02/2014 to 31/08/2014. Electronic medical records and electronic medical prescriptions were used as data sources. Demographics (age, gender), reason for admission, indication for anticoagulation, risk factors for complications such as renal and hepatic failure, concomitant drugs that increase the risk of bleeding (NSAIDs, platelet inhibitors, low molecular weight heparins) and adverse events were collected. In addition, adverse drug-related events avoided were also recorded. Results 64 patients (36 men) with mean age of 76 years (range 35–95) were included. 24 patients were treated with dabigatran, 38 with rivaroxaban and 2 with apixaban. 4 of these treatments were used as off-label treatments. 8 patients had renal failure and 23 had a risk of major bleeding due to concomitant treatments, mainly NSAIDs. Pharmaceutical interventions were performed in the 8 cases of renal failure because the doses needed adjustment. 14 patients with concomitant drugs that could increase the risk of bleeding were also monitored. 100% of recommendations were accepted by physicians. 2 severe adverse events were recorded: 2 bleeding episodes. Conclusion 94% of new oral anticoagulant prescriptions met the criteria established by the healthcare organisation. Pharmacists were involved in the optimisation of a third of the treatments, with total acceptance. It would be desirable to extend this activity, individualization of anticoagulant treatment, into primary medical care. Reference Agencia Espanola de Medicamentos y Productos Sanitarios. Informe de posicionamiento Terapeutico UT/V4/23122013 No conflict of interest.

Background Systemic Autoimmune Rheumatic Diseases (SARDs) are a group of syndromes caused by antibodies inflammation related. Rituximab is a biological drug that targets antigen CD-20 present on the surface of B-Lymphocytes and thus potentially active against SARDs refractories to conventional treatment: steroids and immunosuppressants. Purpose To describe and evaluate safety parameters of the risk management protocol for adults SARDs patients treated with off-label Rituximab. Materials and Methods Descriptive-observational study from January 2011 to July 2012 realised by the Pharmacy and Rheumatology Service. Data were obtained from electronical medical records. Three types of risk management protocol data were evaluated. A) Clinical parameters: infection (including Tuberculosis), cardiovascular disease, severe cytopenia, neoplasia or new neurologic symptoms. B) Complementary tests: hemogram and general biochemistry while on Rituximab. C) Others: adverse events related with Rituximab infusion. Results 21 patients were included (mean age 52.71 ± 16.11 years). Diagnoses were Sjogren’s Syndrome (10), Systemic Lupus Erythematosus (4), Mixed Connective Tissue Disease (3), inflammatory myopathy (2), Systemic Sclerosis (1) and Wegener’s Granulomatosis (1). Clinical parameters: infection was detected on 5 patients (23%), severe cytopenia in 1 patient (4,7%) and peripheral neurological symptomatology in another one. Nor cardiovascular disease or neoplasia were detected. Complementary tests: patient presented severe thrombocytopenia (platelets Adverse events infusion related: detected on 19% of patients. Conclusions Rituximab off-label use for SARDs has increased over the last years and pharmacovigilance strategies as well as risk management protocols have proved useful identifying risks, controlling adverse events, improving quality of care and integrating Pharmacist into direct patient care. No conflict of interest.

Background It is necessary to monitor the effect of erythropoietin (EPO) on haemoglobin (Hb) levels to check the efficacy and safety of the medicine. The desirable therapeutic range of Hb according to the product information is from 10 to 12 g/dl and higher or lower levels can damage health. The tolerance, clinical need and urgency required in the resolution of the anaemia varies among patients, however, Hb ≥13 g/dl is associated with cardiovascular events such as thromboembolism, requiring urgent care. Purpose To determine the proportion of patients with anaemia linked to chronic renal failure in predialysis treated with EPO, with a value of Hb within or outside (lower or higher than) the therapeutic range. Materials and methods A retrospective study was performed of 155 nephrology patients who collect erythropoietin at the outpatient unit of the hospital pharmacy; duration 1 month. All of them had anaemia associated with chronic renal failure in predialysis and were treated with subcutaneous erythropoietin for at least 4 weeks. The outpatient dispensing program compiles items dispensed per patient, with dates, age, sex, medical record number, diagnosis, amount collected, dosage, department/ward and prescribing physician The last Hb value was obtained for the computerised medical history records and the proportion of patients below and above the therapeutic range was estimated. Results 139 patients, 61 women (43.9%) and 78 men (56.1%), between 21 and 101 years (mean 68.6). 48.9% (68) of the patients had an Hb within the therapeutic range (mean 11). 22.3% (31) had Hb less than 10 g/dl (mean 9.2 and minimum 6) while in 28.8% (40) it was greater than 12 (mean 13.2 and maximum 15.4). Conclusions 71 patients (51%) had Hb outside the therapeutic range. It is necessary to monitor the haemoglobin levels to check the safety and efficacy of erythropoietin. It is essential to include all episodes and data in the computerised medical history.

Background Vitamin D is essential for strong bones because it helps the body use calcium from the diet. Because most people have low levels of vitamin D, correcting to the recommended ranges will bring added value to patient healthcare in hospital. Purpose To detect patients with low vitamin D levels in an Orthopedic ward. To evaluate the degree of acceptance of the pharmacist9s recommendations to correct vitamin D levels by the physicians. To devise an educational session for patients and evaluate the efficacy of the intervention. Materials and methods From 7/03/2011 to 9/03/2011, total serum 25-hydroxycholecalciferol ((25OH)D 3 ) was measured in patients on the Orthopedic ward. A lack of vitamin D was defined as ((25OH)D 3 ) ≤30 ng/mL. The individual recommendation for vitamin D supplementation was written in each patient9s medical record by the pharmacist. Patients presenting low vitamin D levels were randomised to enrol in the educational programme, consisting of a 15-min session about vitamin D, nutritional habits, and supplementation with vitamin D. All patients were given an appointment 2 months later for a vitamin D test to evaluate the efficacy of the intervention. Conclusions There was a significant vitamin D deficiency in the population studied. Pharmaceutical intervention has been proved useful when adjusting vitamin D levels.

Disease-modifying therapies; Multiple sclerosis; Predictors Terapias modificadoras de la enfermedad; Esclerosis múltiple; Predictores Teràpies modificadores de la malaltia; Esclerosi múltiple; Predictors Background and Aims: In multiple sclerosis (MS), non-adherence/non-persistence is related to suboptimal response to treatment, including disease relapses and the need for more expensive healthcare. The aim of this study was to identify predictors related to adherence to disease modifying therapies (DMTs) in a cohort of Argentinian MS patients. Methods: We conducted a cross-sectional study at the National Medical Care Program from Argentina. MS patients with at least one claim for a DMT from 1 January 2017 to 1 October 2017 were identified. A telephone survey was performed to assess clinical and demographic factors. The medication possession ratio (MPR) was used to estimate adherence; MPR