Background Medicines with anticholinergic activity have been linked to a variety of adverse drug reactions in the elderly. Purpose To determine the anticholinergic burden in revised profiles, and the level of risk. Materials and MethodsThe Prescription Quality Unit (PQU), which is staffed by a doctor, two pharmacists, a nurse and other technical-administrative staff, is integrated into the geriatric care team. The Unit provides care to 6800 residents in 163 centres.The PQU provides training and support to different care teams by reviewing procedures and holding conciliation meetings. The process of rationalisation consists of systematically reviewing medicines plans according to the criteria of efficacy, safety and efficiency. The team suggests modifications in medicines plans and reports to the health care professionals involved. Anticholinergic drugs were selected from the review. These medicines were classified into four groups, according to the anticholinergic potency. Results A prospective study was undertaken during the period June 2011-June 2012: 7,347 patients were reviewed (some in duplicate). 959 patients were identified, and those patients were prescribed 1,984 drugs with anticholinergic activity (mean age 85 years (52-111 years)).In 162 patients, strong anticholinergic activity drugs were found: 62% oral antimuscarinics for urinary incontinence, 33% tricyclic antidepressants, 4% antispasmodics with anticholinergic properties and 1% systemic H 1 antihistamines (dexchlorpheniramine); 252 patients with moderate anticholinergic activity drugs (70% paroxetine); 500 patients with mild anticholinergic drugs and 45 patients had drugs whose activity was concentration-dependent.Sixty-eight patients were simultaneously being prescribed more than one medicine with anticholinergic activity (17 patients on strong anticholinergic activity drugs simultaneously). Conclusions Due to the comorbidities and frailty of this population, medicines must be selected individually for each patient, selecting drugs with the lowest level of anticholinergic activity. We observed a group of patients at special risk who were being treated for pathologies related to the urinary tract.No conflict of interest. Background Dronedarone is a drug related to amiodarone, marketed in 2010. Soon after, there were several safety alerts that forced Health Authorities to reduce their use, and require hepatic and renal function cheques. The alert (reference SGMUH (FV), 16/2011) requires initial and then at least 6-monthly hepatic and renal function tests. Purpose To assess the degree of compliance with the analytical tests required by the Competent Authority in patients taking dronedarone (creatinine and liver enzymes) in a health area of 200,000 inhabitants. Monitoring Materials and MethodsWe selected patients who were prescribed dronedarone during the last half of 2011. These patients were identified by querying the electronic prescription billing system. The prescriptions were analysed in three groups of patients: those who started treatment af...

Background Alpha tumour necrosis factor inhibitors (TNF inhibitors) represent an important advance in immune-mediated inflammatory diseases. The first three drugs marketed and most used nowadays within this family are: infliximab, etanercept, and adalimumab. There is no apparent superiority between any of these drugs and it is known they often loss their efficacy over time. Therefore, it could be of interest to find out if any of them (under usual clinical conditions) has a longer period of time without loss of efficacy. Purpose To compare the different treatments with TNF inhibitors, in order to find out which has the longest average duration (in days) before loss of treatment response finally requires a change in the treatment. Materials and Methods All patients who began the treatment with TNF inhibitors between March 2007 and March 2012 and who had a change in treatment were analysed retrospectively with pharmacotherapy management software. Patients who had stopped the treatment after presenting immediate adverse reactions in the first administration were excluded. The mean durations of treatment were compared using the Student’s t-test for unpaired data Results In total 309 patients were analysed. The three TNF inhibitor drugs most used were etanercept (Average duration 574.47 ± 461.51, N = 125), infliximab (Average duration 470.82 ± 469.64, N = 95) and adalimumab (Average duration 454.92 ± 378.89, N = 95). We found a significant difference between etanercept versus adalimumab (P.value = 0.0412), but not in the case of etanercept versus infliximab (P.valour = 0.0997). These results are coincident with Dr. Hetland’s study in 8074 patients (1). They also agree with the study presented by J.A Markenson in 2418 patients (2). However our study results do not resemble those of G. Lapadula’s study (3). Conclusions The average duration of treatment before requiring a change of drug is higher with etanercept than infliximab and adalimumab, but only is statistically significant with adalimumab. These results should be considered in the design of TNF inhibitor prescribing guidelines. No conflict of interest.

Objectives: Diagnosis of urinary tract infection (UTI) in young children is difficult. Prompt treatment could alleviate short-term symptoms and prevent serious longterm sequelae, but over-treatment will increase antibiotic resistance. We evaluated the cost-effectiveness of a UTI risk score based on signs, symptoms and dipstick test findings compared to clinical judgement in guiding urine sampling and antibiotic treatment. MethOds: We developed a risk score based on urine samples collected (by clean catch or nappy pad) in a multicentre diagnostic cohort study (DUTY) of 7,163 children < 5 years presenting to primary care. The diagnostic value of symptoms, signs and dipstick test results were evaluated against a reference standard of urine culture results from a research laboratory. We constructed decision-analytical models comparing the cost-effectiveness of 3 DUTY risk score thresholds (high sensitivity, high specificity or intermediate) versus clinical judgement in younger (nappy pad) and older (clean catch) children. We explored the role of the dipstick in guiding diagnosis. We considered health service costs and patient utilities during the initial diagnosis, acute illness and long-term sequelae. Results: The 'high specificity' DUTY threshold resulted in fewer urine samples than clinical judgement (4.8% vs. 9.2%) with similar sensitivity (58.6% vs. 57.1%) and higher specificity (96.1% vs. 91.4%). The difference in short-term net benefits between DUTY thresholds was small (range £1088 'high sensitivity' to £1091 'high specificity'). In younger children (nappy pads) the distinction in cost-effectiveness between the DUTY risk score and clinical judgement was not clear-cut. Dipstick tests could potentially expedite therapy in higher risk children. cOnclusiOns: Clinicians can reduce prescriptions and provide more cost effective care by using the DUTY risk score. Clean catch samples should be obtained whenever practical. Low UTI prevalence, imperfect NHS laboratory tests and an uncertain link between UTI and long-term sequelae mean that conservative sampling strategies may be most appropriate. PUK3ComParisons of the CliniCal effeCtiveness of treatments for the symPtoms assoCiated with overaCtive Bladder (oaB)