Pharmaceutical Service

Leon, Spain

Pharmaceutical Service

Leon, Spain
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Del Pozo-Ruiz J.J.,Pharmaceutical Service | Martin-Perez E.,Hospital San Juan Of Dios | Malafarina V.,Clinica Los Manzanos
European Geriatric Medicine | Year: 2016

Introduction Sequential antibiotic therapy (SAT) is an important phase of treatment and an attempt to bring the change to oral treatment forward. We assessed the impact of SAT on the costs of antibiotic treatment on hospitalized elderly patients. Methods This was a prospective study in which 204 patients were assessed. Duration and costs of IV and oral treatment were recorded, as well as the day for switching from IV to oral treatment, mean stay and readmissions, and the results were confronted between the two phases of the study: observational and interventional. Mean antibiotic intake was defined as defined daily dose per every 100 stays (DDD/100S). Results Fifty-two were included in the observational phase and 59 in the interventional phase, mean age 80.0 ± 7.4, 52.3% women. Changeover of treatment was brought forward an average of 1.7 and 1.3 days with ciprofloxacin and levofloxacin, respectively, during the intervention phase compared to the observational phase (P < 0.001). The mean cost per unit in the intervention phase was reduced by 28.64 € with levofloxacin and by 24.28 € with ciprofloxacin. Intravenous DDDs/100S were reduced from 0.069 ± 0.023 to 0.042 ± 0.006 (P < 0.001) for levofloxacin and from 0.068 ± 0.029 to 0.038 ± 0.012 (P < 0.001) for ciprofloxacin. Conclusions Pharmaceutical intervention based on a SAT achieved reduction of the length of treatment of antibiotic IV treatment and thus also achieved a reduction in treatment costs. The intervention was not associated to an increase in relapse and was therefore efficient and cost effective. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Carnovale C.,Scientific Institute IRCCS Eugenio Medea | Perrone V.,University of Milan | Borsadoli C.,Pharmaceutical Service | Mambrini A.,Physician | And 6 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2013

Summary What is known and Objective Rheumatoid arthritis is an autoimmune disorder characterized by persistent synovitis and systemic inflammation. Genetic factors account for approximately 50% of cases of rheumatoid arthritis and environmental factors include smoking. Urinary incontinence may occur as a medication adverse effect. We present the first report of a case of hydroxychloroquine-induced urinary incontinence in rheumatoid arthritis. Details of the case A 71-year-old female with a history of rheumatoid arthritis developed urinary incontinence as an adverse drug reaction to hydroxychloroquine administered at therapeutic doses. Urinary incontinence remitted with drug withdrawal and reappeared on rechallenge. The Naranjo's algorithm indicated that hydroxychloroquine was a probable cause of this adverse drug reaction. The likely mechanism of this adverse drug is a direct action of the quinolone on the urinary system. What is new and conclusion This is the first report of hydroxychloroquine-induced urinary incontinence. The absence of previous reports suggest that the drug rarely causes this adverse effect. Methotrexate is most often used as first-line treatment, and several other drugs are now available to act as Disease-Modifying Antirheumatic Drugs (DMARDs). These drugs may be used alone or combined with methotrexate, most often to increase efficacy and reduce toxicity. The introduction of new biological agents, such as abatacept, rituximab, tocilizumab and inhibitors of tumour necrosis factor, has opened new therapeutic perspectives but are restricted by high costs and risk of infections. Thus, antimalarial drugs, especially the quinolones chloroquine (CQ) and hydroxychloroquine (HCQ), are still in use, and the latter is very efficacious. An advantage of HCQ is its low toxicity compared with other antimalarial drugs. Common side-effects of HCQ and the other antimalarial drugs include gastrointestinal effects such as nausea and vomiting, as well as skin rashes and headache, whereas their most common and severe side-effect is retinopathy. No case of urinopathy has been reported previously with HCQ. © 2012 Blackwell Publishing Ltd.

Carnovale C.,University of Milan | Brusadelli T.,University of Milan | Zuccotti G.,University of Milan | Beretta S.,University of Milan | And 10 more authors.
Expert Opinion on Drug Safety | Year: 2014

Objective: To gain information on safety of drugs used in pediatrics through a 4-year post-marketing active pharmacovigilance program. The program sampled the Italian population and was termed 'Monitoring of the Adverse Effects in Pediatric population' (MEAP).Research design and methods: Adverse drug reactions (ADRs) were collected for individuals aged 0-17 years treated in hospitals and territorial health services in Lombardy, Tuscany, Apulia and Campania; located to gain an appropriate sampling of the population. ADRs were evaluated using the Adverse Drug Reaction Probability Scale (Naranjo) and analyzed with respect to time, age, sex, category of ADR, seriousness, suspected medicines, type of reporter and off-label use.Results: We collected and analyzed reports from 3539 ADRs. Vaccines, antineoplastic and psychotropic drugs were the most frequently pharmacotherapeutic subgroups involved. Seventeen percent of reported ADRs were serious; of them fever, vomiting and angioedema were the most frequently reported. Eight percent of ADRs were associated with off-label use, and 10% were unknown ADRs. Analysis of these revealed possible strategies of therapy optimization.Conclusions: The MEAP project demonstrated that active post-marketing pharmacovigilance programs are a valid strategy to increase awareness on pediatric pharmacology, reduce underreporting and provide information on drug actions in pediatrics. This information enhances drug therapy optimization in the pediatric patients. © Informa UK, Ltd.

Pallaver F.,Santa Chiara Hospital | Riviera A.P.,University of Verona | Piffer S.,Epidemiological Service | Ricciardi R.,University of Pisa | And 3 more authors.
Neuroepidemiology | Year: 2011

Background: The recent literature suggests that the incidence and prevalence of myasthenia gravis (MG) are changing. We performed a population-based study of MG in the province of Trentino (524,826 inhabitants) and compared the results with those collected 20 years ago. Methods: Multiple sources of information (discharge diagnosis, antibody tests and anticholinesterase drugs) were analyzed. Incidence was calculated from 2005 to 2009. Prevalence was calculated on December 31, 2009. Comparison was made with descriptive statistics for 1981-1990 for the identical region. Results: Incidence and prevalence greatly increased in comparison with 1981-1990 data. The prevalence rate increased from 82.9 (95% confidence interval, CI, 58.4-114.3) in 1990 to 129.6 (95% CI 100.6-164.3) per million population, whereas the average annual incidence increased from 7.4 (95% CI 5-10.4) per million person-years in 1981-1990 to 14.8 (95% CI 10.5-20.3) in 2005-2009. This increase was mainly due to male patients with late-onset MG. Conclusions: The study confirms the increase in incidence and prevalence of late-onset MG in the same region 20 years apart. So we should consider MG also as a disease of the elderly. © 2011 S. Karger AG, Basel.

Research and Markets has announced the addition of the "Global Healthcare BPO Market Analysis & Trends - Service (Customer Relationship Management (CRM), Finance and Accounting (F&A) and Human Resources (HR)), Provider Service, Payer Service, Pharmaceutical Service - Forecast to 2025" report to their offering. The Global Healthcare BPO Market is expected to reach approximately $441.3 billion by 2025. By payer service the market is divided into analytics and fraud management services, billing and accounts management services, integrated front-end services and back-office operations, member management services, provider management services and claims management services. Claims management services segment is further segmented into information management services, claims investigation services, claims settlement, claims indexing services, litigation management, claims adjudication services and claims repricing. Based on the pharmaceutical service, the healthcare BPO market is divided into manufacturing, research & development and non-clinical services. Non-Clinical Services segmented is further classified into sales and marketing services, supply chain management & logistics and other non-clinical functions. This industry report analyzes the global markets for Healthcare BPO across all the given segments on global as well as regional levels presented in the research scope. The study provides historical market data for 2013, 2014 revenue estimations are presented for 2015 and forecasts from 2016 till 2025. The study focuses on market trends, leading players, supply chain trends, technological innovations, key developments, and future strategies. With comprehensive market assessment across the major geographies such as North America, Europe, Asia Pacific, Middle East, Latin America and Rest of the world the report is a valuable asset for the existing players, new entrants and the future investors. The study presents detailed market analysis with inputs derived from industry professionals across the value chain. A special focus has been made on 23 countries such as U.S., Canada, Mexico, U.K., Germany, Spain, France, Italy, China, Brazil, Saudi Arabia, South Africa, etc. The market data is gathered from extensive primary interviews and secondary research. The market size is calculated based on the revenue generated through sales from all the given segments and sub segments in the research scope. The market sizing analysis includes both top-down and bottom-up approaches for data validation and accuracy measures. Report Structure: 1 Market Outline 2 Executive Summary 3 Market Overview 4 Healthcare BPO Market, By Service 5 Healthcare BPO Market, By Provider Service 6 Healthcare BPO Market, By Payer Service 7 Healthcare BPO Market, By Pharmaceutical Service 8 Healthcare BPO Market, By Geography 9 Key Player Activities 10 Leading Companies For more information about this report visit Research and Markets Laura Wood, Senior Manager For E.S.T Office Hours Call +1-917-300-0470 For U.S./CAN Toll Free Call +1-800-526-8630 For GMT Office Hours Call +353-1-416-8900 U.S. Fax: 646-607-1907 Fax (outside U.S.): +353-1-481-1716

Carnovale C.,University of Milan | Pellegrino P.,University of Milan | Perrone V.,University of Milan | Antoniazzi S.,University of Milan | And 5 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2013

What is known and objective: Chronic constipation is very frequent in the general population. Although usually considered banal, this disorder has considerable personal, social and healthcare impact. Several studies have shown that the psychological impact exceeds that caused by rheumatoid arthritis or haemodialysis. Recently, prucalopride, a highly selective 5-HT4 receptor agonist has been shown to improve the symptoms of chronic constipation and to have a beneficial effect on social and healthcare impact. The drug was approved by the European Medicine Agency, in 2009 at a dose of 2 mg/day, 'for symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief'. Neurological side effects or psychiatric disorders have not been reported previously with prucalopride. We present the case of a 61-year-old woman, who developed such adverse effects when given prucalopride for the treatment for chronic constipation. Case summary: A few hours after oral administration of this drug at therapeutic dose (2 mg/day), the patient experienced life-threatening neurological effects that included visual hallucination, loss of balance and memory, disorientation, exhaustion and suicidal ideation. Analysis with the Naranjo algorithm indicated a 'possible' relationship between prucalopride and these disorders. What is new and conclusion: This is the first report of prucalopride-induced neurological side effects and psychiatric disorders with prucalopride. The absence of other similar reports suggests that prucalopride rarely causes these adverse effects. © 2013 John Wiley & Sons Ltd.

Brusadelli T.,University of Milan | Carnovale C.,University of Milan | Gentili M.,University of Milan | Borsadoli C.,Pharmaceutical Service | And 8 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2015

Summary What is known and objectives To date, no case of headache has been reported with enoxaparin. We present the case of a 60-years-old man, who developed enoxaparin-induced throbbing headache and discuss the possible pharmacological mechanisms. We provide an analysis of enoxaparin-induced headache in three international databases. Case summary A few hours after the subcutaneous administration of this drug at therapeutic dose, the patient experienced throbbing headache. Rechallenge on two other separate occasions separated by several days produced the same effect although with reduced intensity when the dose was lowered. The Naranjo Algorithm indicated a 'certain' relationship. What is new and conclusion We report a case of throbbing headache associated with the use of enoxaparin; with the increasing use of enoxaparin, physicians who prescribe this drug should be aware of this potential ADR. We suggest that it is a heparin class-effect, and therefore, a more general caution is also appropriate. Enoxaparin is generally safe but side-effects related to pharmacological effect could occur, i.e haemorrhages and thrombocytopenia. We report a case of enoxaparin- induced throbbing headache, an unknown ADR, likely due to the stimulation of the release of nitric oxide (NO) and the increase of cyclic guanosine monophosphate (cGMP). © 2015 John Wiley & Sons Ltd.

DUBLIN--(BUSINESS WIRE)--Research and Markets has announced the addition of the "Global Healthcare BPO Market Analysis & Trends - Service (Customer Relationship Management (CRM), Finance and Accounting (F&A) and Human Resources (HR)), Provider Service, Payer Service, Pharmaceutical Service - Forecast to 2025" report to their offering. The Global Healthcare BPO Market is poised to grow at a CAGR of around 11.1% over the next decade to reach approximately $441.3 billion by 2025. Some of t

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