{"id":116759,"date":"2014-04-12T00:00:00","date_gmt":"2014-04-12T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/acontecimientos-adversos-a-medicamentos-en-el-tratamiento-de-patologias-cardiovasculares-en-el-ambito-hospitalario\/"},"modified":"2014-04-12T00:00:00","modified_gmt":"2014-04-12T00:00:00","slug":"acontecimientos-adversos-a-medicamentos-en-el-tratamiento-de-patologias-cardiovasculares-en-el-ambito-hospitalario","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/accion-de-los-farmacos\/acontecimientos-adversos-a-medicamentos-en-el-tratamiento-de-patologias-cardiovasculares-en-el-ambito-hospitalario\/","title":{"rendered":"Acontecimientos adversos a medicamentos en el tratamiento de patolog\u00edas cardiovasculares en el \u00e1mbito hospitalario."},"content":{"rendered":"<h2>Tesis doctoral de <strong> M\u00aa Jose Rodriguez Tortosa <\/strong><\/h2>\n<p>Resumen objetivo analizar la incidencia de los acontecimientos adversos a medicamentos (aam) en general y la incidencia especifica de aam usados en el tratamiento de patolog\u00edas cardiovasculares (aamcv) en pacientes hospitalizados, determinar las caracter\u00edsticas de dichos pacientes, identificar los f\u00e1rmacos implicados, las manifestaciones cl\u00ednicas, evaluar la evitabilidad, gravedad y causalidad as\u00ed como verificar la calidad del sistema de codificaci\u00f3n.  material y m\u00e9todos estudio observacional retrospectivo perteneciente al periodo enero 2001- diciembre 2007 en el hospital cl\u00ednico universitario virgen de la arrixaca de murcia, en el que a partir del conjunto m\u00ednimo b\u00e1sico de datos (cmbd) se identificaron aquellos pacientes mayores de 14 a\u00f1os ingresados, al menos 24 horas, y en cuyo informe de alta inclu\u00edan los c\u00f3digos relativos a aam producidos por f\u00e1rmacos cardiovasculares.  resultados de 253.338 informes de alta la incidencia de aam en general, fue del 2,68% (n=6.786), siendo los f\u00e1rmacos cardiovasculares responsables  en el 17,47% de los casos (n=1.187). El estudio se centr\u00f3 en 593 casos,  seleccionados de forma aleatoria entre  los 1.187 casos en los que se hab\u00eda codificado un aamcv. En la muestra estudiada las mujeres contribuyeron en mayor proporci\u00f3n que los hombres 57,2%(339) y respecto a la edad la mediana fue de 76 a\u00f1os (rango intercuart\u00edlico 68 y 82 a\u00f1os). Tras la revisi\u00f3n pormenorizada de las historias cl\u00ednicas  se encontr\u00f3 una discrepancia con la codificaci\u00f3n de 63 casos en los que no se confirm\u00f3 la existencia real de aam, por lo que el estudio se restringi\u00f3 a 530 casos confirmados de aamcv. Los f\u00e1rmacos m\u00e1s frecuentemente implicados en aam fueron acenocumarol  23,9%, digoxina 20,4% y diur\u00e9ticos 13,7% y las manifestaciones de aam m\u00e1s frecuentes fueron las atribuibles a los efectos esperados del f\u00e1rmaco potencialmente responsable, hemorragia 32,1%, arritmias 21,6% y alteraciones hidroelectrol\u00edticas 10,5%. En cuanto a la evitabilidad la mayor\u00eda de los aam fueron considerados inevitables 91,9%. Respecto a la gravedad 56,7% fueron moderados, 16,9% leves, 14,2%graves y 1,7% mortales. En relaci\u00f3n a la causalidad en la mayor\u00eda de los casos fue considerada probable 84,4%, definitiva en el 8,1% de los casos y posible en el 6,2%.   conclusiones    la incidencia de amm codificados fue relativamente baja en nuestro medio hospitalario. Los f\u00e1rmacos m\u00e1s frecuentemente imputados en los aamcv fueron acenocumarol, digoxina y dirur\u00e9ticos. Los aamcv fueron principalmente inevitables, de gravedad moderada y causalidad probable. El estudio revela errores de codificaci\u00f3n por lo que ser\u00eda \u00fatil alguna actuaci\u00f3n de mejora.   abstract  objetive to analyze the incidence of total adverse drug events (ade) in hospitalized patients, particularly focus on those related to cardiovascular drugs (adecv), to determine patients&apos;s characteristic, drugs involved, associated clinical signs and symptoms, their potential avoidability, severity, causality and the reliability of the codification system.   method we retrospectively identified all clinical records of all consecutively more than 24-hour hospitalized patients and older than 14 years at the university hospital virgen de la arrixaca, murcia (spain) from january 2001 to january 2008. Using the minimum basic data set (mbds) we identified all ade codes related to cardiovascular drugs (adecvd) to carefully review the clinical records of a randomized sample.    results among 253,338 hospital discharge reports, the incidence of total coded ade was 2,68% (n=6.786), 1,178 (17,47%) of them related to any cardiovascular drug. Among these 1,178 patients we selected a randomized simple of 593 patients. Patients with adecv were more frequently women 57,2%(n 339) and median age was 76 years (interquartile range 65-83). After the review of all medical records we found 63 cases in which we could not identify the real occurrence of adecv due to the absence of signs and\/or symptoms related to the coded drug. Therefore the study was focus on  530 cases in which adecv was confirmed. Drugs most frequently involved were acenocumarol 23.9%, digoxin 20.4% and diuretics 13.7%. Clinical signs and symptoms more often described were hemorrhage 32.1%, arrhythmia 21.6% and electrolyte disturbances 10.5%. Most of the adecv were considered as unavoidable, 91.9%. As regard as the severity of adecv, 56.7% were moderate, 16.9% mild, 14.2% severe and 1.7% fatal. Causality of adecv was more often classified as probable, 84.4% , highly probable in 8.1% and possible in 6.2% of the cases.       conclusions the incidence of coded adecv during the study period was relatively low in our hospitalized patients. Drugs most commonly involved were acenocumarol, digoxin and diuretics. Adecvd were mostly unavoidable, moderate severity and probable causality. Our data study showed some discrepancies suggesting codification errors, mainly related to misinterpretation of the real existence of ade. Therefore, efforts should be made to improve the relationship between the responsible of written clinical records and the codification service.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Acontecimientos adversos a medicamentos en el tratamiento de patolog\u00edas cardiovasculares en el \u00e1mbito hospitalario.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Acontecimientos adversos a medicamentos en el tratamiento de patolog\u00edas cardiovasculares en el \u00e1mbito hospitalario. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 M\u00aa Jose Rodriguez Tortosa <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 04\/12\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jose Galcera Tomas<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: alfonso Carvajal Garc\u00eda-pando <\/li>\n<li>m. angeles Carlos chilleron (vocal)<\/li>\n<li>teodomiro Fuente jimenez (vocal)<\/li>\n<li>Mar\u00eda Jos\u00e9 Pe\u00f1alver jara (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de M\u00aa Jose Rodriguez Tortosa Resumen objetivo analizar la incidencia de los acontecimientos adversos a medicamentos (aam) en 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