Buggemyers8200

No commercial re-use. See rights and permissions. Published by BMJ.Introduction The significant investments necessary to integrate a new technology or service often create a financial barrier. To convince a hospital board to invest, it is important to demonstrate a return on investment (ROI). As many pharmacists are not used to estimating an ROI, this short report proposes a simple methodology and a free practical tool to download. Methods Determining an ROI requires a calculation of all the expenses linked to the initial investments and the annual running costs of the equipment or service. When possible, real costs must be used in this calculation, but the costs of some parameters can only be estimated. The methodology involves three steps (A) calculation of the initial balance (on shot costs and savings), (B) calculation of the annual balance (valid in the years after the investment) and (C) final calculation of time to recovery (duration until the initial investments are reimbursed by the annual savings) and ROI (the net benefit in euros at the end of the amortisation period). Results This methodology was applied to the installation of automated dispensing cabinets in our hospital. The initial balance (€32 500±€4200) included equipment acquisition costs, installation costs and initial savings (stock-value reduction and non-investment in traditional ward pharmacy). The annual balance (€8622±3564) included amortisation and maintenance costs as well as human resources, medication, logistics and safety savings. We estimated a 3.8-year (min 2.7-max 6.4) time to recovery and an ROI of €36 476 (min €7964-max €64 988) after 8 years. Conclusions Large investments for innovative equipment or service will be harder and harder to obtain if no economic evaluation is provided. The method proposed here is simple and provides useful input for discussions with a hospital board. The case study highlights a positive ROI related to automated dispensing cabinets. © European Association of Hospital Pharmacists 2020. No commercial re-use. See rights and permissions. Published by BMJ.Objective To examine the comparative efficacy and safety of interventions for preventing chemotherapy-induced oral mucositis (OM) in adult cancer patients. Methods We searched PubMed, Embase and the Cochrane Central systematically for the randomised control trials (RCTs) of interventions for preventing OM. Network meta-analysis (NMA) was performed to estimate risk ratios (RR) and 95% confidence intervals (CI) from both direct and indirect evidence. The primary outcome was any grade of OM. Secondary outcomes were mild-moderate OM, severe OM and adverse events, such as taste disturbance and gastrointestinal adverse events. This study was registered with PROSPERO, number CRD42016052489. Results A total of 29 RCTs with 2348 patients (median age, 56.1 years; 57.5% male) were included. Cryotherapy was associated with a significantly lower risk of OM than control (RR 0.51, 95% CI 0.38 to 0.68), and zinc sulphate (RR 0.47, 95% CI 0.23 to 0.97), but not significantly lower than sucralfate and palifermin. No significant differences were observed between cryotherapy and control for taste disturbance and gastrointestinal adverse events. Palifermin was associated with the highest risk of taste disturbance. Conclusions This NMA suggests that cryotherapy was the most effective intervention for preventing chemotherapy-induced OM with a safety profile similar to control, but not significantly lower than sucralfate and palifermin. Large RCTs are needed to confirm these findings. © European Association of Hospital Pharmacists 2020. No commercial re-use. See rights and permissions. Published by BMJ.Objective Pulmonary arterial hypertension is a rare and progressive respiratory disease characterised by high blood pressure and vascular resistance producing right ventricular fatigue. In Italy, pulmonary hypertension can be treated with different drugs available on the market at different costs, and in the Marche region distributed exclusively by hospital pharmacies. The present study examined in an area of the Marche region the use of drugs specifically indicated for pulmonary hypertension, and evaluated how the introduction of the generic bosentan might lower pharmaceutical costs for the healthcare budget. Methods The study examined oral administration prescriptions and costs using data from the Apotheke Gold (Record Data) database from 1 January 2012 to 31 August 2017. Results Annually (from 1 January 2012 to 31 August 2017), an average of 4.83 patients were treated (prevalence of 102.35 cases per 1 million residents) with ambrisentan (Volibris), bosentan (Tracleer), macitentan (Opsumit), tadalafil (Adciher savings. © European Association of Hospital Pharmacists 2020. No commercial re-use. See rights and permissions. Published by BMJ.Objectives The objective of this study was to evaluate the physical and chemical stability of hydromorphone hydrochloride and bupivacaine hydrochloride in concentrations of 15 mg.ml-1 and 10 mg.mL-1 in 0.9% sodium chloride injection. Test samples of hydromorphone/bupivacaine mixtures were stored at 37°C, body temperature encounterd during continuous intrathecal infusion, for 90 days. The solutions were packaged in 20 ml plastic syringes. Evaluations for physical and chemical stability were performed initially and throughout the storage periods. Physical stability was assessed by visual observation. The chemical stability of the drug was evaluated by means of a stability-indicating high-performance liquid chromatographic (HPLC) analytical technique. In addition, pH and osmolarity were measured electronically. Methods This study determines the stability and compatibility of hydromorphone (15 mg.ml-1) and bupivacaine (10 mg.ml-1) mixture after 3 months at 37°C using a validated method by HPLC-UV. A simple, preci20. No commercial re-use. See rights and permissions. Published by BMJ.Objective According to current guidelines on atrial fibrillation (AF), the addition of an antiplatelet therapy to an anticoagulant for a stable vascular disease does not decrease the ischaemic hazard but increases the risk of bleeding. The aim of the study was to assess compliance of practices with existing clinical guidelines concerning the use of anticoagulant-antiplatelet combined therapy in patients 75 years and over with AF. Epigenetics inhibitor Methods This prospective observational study was carried out at the University Hospital of Strasbourg (France) between August 2016 and January 2017 with data collection on 1 day of every month. To be included, the patient had to be 75 years and over with AF and treated with anticoagulant-antiplatelet therapy. The population included all the patients admitted at the hospital excluding those from the Gynaecology-Obstetrics and Paediatrics departments. With regard to clinical ongoing guidelines (French, European, American and Canadian), the patients were sorted into three groups. Group 1 combined therapy in compliance with recommendations; Group 2 combined therapy debatable as to benefit-risk ratio; and Group 3 combined therapy not compliant with recommendations.