Background Adjuvant chemotherapy trials provide little information on safety in elderly patients because they exclude them or pool their results with those of younger patients. PurposeTo describe the safety of the different adjuvant chemotherapy treatments used in elderly patients with colon cancer. Materials and MethodsRetrospective observational study of colon cancer patients (age >65) diagnosed in 2010 and treated with adjuvant chemotherapy. Each patient was followed from the beginning of the treatment until the end of it. Demographic data, disease stage, antineoplastic agents and treatment-related toxicities were collected from patients’ clinical histories. Results16 patients (5 women, 11 men) were included in the study with a mean age of 75.1 years. 87.5% and 12.5% of patients had stage III and stage II disease, respectively. 6 patients (37.5%) were treated with a combination of 5-fluorouracil and oxaliplatin regimen (FOLFOX), 4 patients (25%) with capecitabine in monotherapy and the remaining 6 patients (37.5%) with a combination of capecitabine and oxaliplatin regimen (XELOX). Adverse events were documented in 100% of patients. 57 adverse reactions were detected, the most frequent toxicities being: neurotoxicity (75% of patients), fatigue and anorexia (68.8%), diarrhoea (37.5%) and thrombocytopenia (37.5%). 54.5% of the undesirable effects were grade 1, 30.9% grade 2 and 14.6% grade 3 toxicities. There were no grade 4 adverse reactions. XELOX was associated with high rates of hand-foot-syndrome (75% of patients) and XELOX and FOLFOX with a high incidence of neurotoxicity (100% and 83.3% respectively). Oncologists had to delay the cycle or reduce the treatment doses in 11 patients (68.8%) and 5 patients (31.3%) had to discontinue the treatment due to the toxicity. Conclusions A high number of adverse reactions were detected, but majority were grade 1–2. The safety profile of drugs studied in our population is in line with that described in the literature in younger patients. No conflict of interest.

Background A previous albumin use study had shown that consumption was continually increasing. Purpose To evaluate the effect of an update in albumin use guidelines and recommendations in our hospital. Materials and methods We conducted a literature review to update our albumin use protocol and to establish alternative treatment options and doses for each approved indication. After Pharmacy and Therapeutics Committee approval of the update and dissemination of the recommendations an observational, descriptive, retrospective study was conducted to evaluate intervention effectiveness. We compared albumin consumption 6 months prior to implementation with consumption 4 months later, and extrapolated to 6 months so that results could be compared. The following variables were analysed: prescribing service, date, number of vials prescribed, treatment costs 6 months before implementation of new protocol and 4 months later. Results A total of 397 treatment lines were included, corresponding to 1090 prescribed albumin vials (732 vials prescribed during the 6 months prior to implementation of the new protocol and 358 vials prescribed during the following 4 months). After data extrapolation, a reduction of 26.43% albumin can be concluded. The General Surgery Department maintained consumption (pre-review consumption: 250 vials, post-review consumption: 250.5 vials). Services where consumption increased were Geriatrics (pre-review consumption: 24 vials, post-review consumption: 58.5 vials), Anaesthesia and Resuscitation (pre-review consumption: 9 vials, post-review consumption: 13.5 vials). Services where consumption decreased were Internal Medicine (pre-review consumption: 160 vials, post-review consumption: 148.5 vials), Intensive Care Unit (pre-review consumption: 70 vials, post-review consumption: 0 vials), Gynaecology (pre-review consumption: 61 vials, post-review consumption: 54 vials), Emergency (pre-review consumption: 45 vials, post-review consumption: 0 vials), Traumatology (pre-review consumption: 81 vials, post-review consumption: 10.5 vials). Consumption reduction was due to alternative recommendations diffusion and dose adjustments. Albumin consumption increased in the Anaesthesia and Resuscitation Service due to the new treatment indication for spontaneous bacterial peritonitis. The reduction in consumption in other services occurred due to, for example, the recommendation to use vasoconstrictors as first-line treatment for hepatorenal syndrome, to use crystalloids as first-line treatment for liver resection >40% and to use 6–8 g/l albumin in paracentesis evacuations >5 litres (by reducing albumin dose per litre evacuated and raising the threshold treatment indication to 5 litres). Conclusions The review, updating and distributing Therapeutic Protocols among physicians, improved prescription rates thus improving the use of drugs. This directly improved treatment, with positive clinical and financial outcomes. No conflict of interest.

BackgroundThe kind of patients we can find in a geriatric centre have various comorbidities, which implies that they usually have more than one medicine. It is common to have drug interactions.PurposeTo evaluate the rational use of proton pump inhibitors (PPIs) in a geriatric centre with 300 beds attached to a second-level hospital.Material and methodsWe performed a cross descriptive study in all patients of a geriatric centre with PPI treatment in July 2014. Medical histories were reviewed and a database was designed: PPI, drug dose, diagnosis and concomitant NSAID treatment.PPI criteria for use were based on the current evidence available. Esomeprazole was limited to patients with a nasogastric tube, as it´s the only one that can be administered in this way.ResultsPPIs were prescribed in 80% of patients.Omeprazole was prescribed in 197 patients: 39% (77/197) had a gastrointestinal diagnosis and 61% (120/197) had no indication recorded, of which 57.5% (69/120) were on chronic NSAID treatment. Drug dosages were: 52.3% (103/197) 20 mg/24 h, 20 mg/12 h in 46.7% (92/197) and 0.5% (1/197) with 20 mg/8 h or 40 mg/8 h.The 42.5% (51/120) of patients whose treatment indication was unknown were re-evaluated: In 19.6% (10/51) the drug was suspended, in 58.8% (30/51) doses were changed to 20 mg/24 h. The remaining 21.6 (11%) patients were not changed without a clear medical reason.Esomeprazole was prescribed in 45 patients: 24% (11/45) had digestive diseases and 76% (34/45) had no indication recorded, of whom 61.7% (21/34) were on chronic NSAID treatment. Drug doses were: 66.7% (30/45) 20 mg/24 h and 40 mg/24 h in 33.3% (15/45).The 38.2% (13/34) patients whose treatment indication was unknown were re-evaluated: in 69.2% (9/13) the drug was suspended, 30.8% (4/13) were switched to omeprazole 20 mg/24 h.Only 28.9% (13/45) were carriers of a nasogastric tube.ConclusionInappropriate use of PPIs was observed in terms of indication and drug dose.Prophylaxis of gastropathy in patients on NSAIDs was the most common correct indication.It is important to incorporate clinical pharmacists in geriatric centre teams to ensure and promote the rational use of medicines.Referencehttp://dx.doi.org/10.4321/S1130-01082008000200003No conflict of interest.