[Translated article] Deglufarm: Mobile application with recommendations for the safe administration of drugs in patients with dysphagia or swallowing disorders.

OBJECTIVE: Develop an App to use in healthcare practice, with updated and accurate information on the handling of medications in patients with dysphagia or deglution disorders, as well as their compatibility with food and thickeners. METHODS: The development of the Deglufarm® App was based on the CRONOS, Nutrition and Techno working groups of the Sociedad Española de Farmacia Hospitalaria. A group of specialist pharmacists was created from different care areas for patients with dysphagia. The creation of Deglufarm® consisted of several stages: selection of active drugs, literature review, content development, design (an expert company in App design was contacted), testing, launch, content update and follow-up. RESULTS: Deglufarm® is available for Android and IOS free of charge from July 2022. It has been tested among the members of the research group and collaborators, Currently, 540 monographs of active drugs have been reviewed and registered in Deglufarm. The first version is aimed at healthcare professionals. CONCLUSIONS: Deglufarm® is an easy tool to consult, with the most current evidence on handling the medicines it contains.

Deglufarm: Mobile application with recommendations for safety drug administration in patients with dysphagia or deglution disorders. / Deglufarm: aplicación móvil con recomendaciones para la administración segura de medicamentos en pacientes con disfagia o problemas de deglución.

OBJECTIVE: Develop an App to use in healthcare practice, with updated and accurate information on the handling of medications in patients with dysphagia or deglution disorders, as well as their compatibility with food and thickeners. METHODS: The development of the Deglufarm® App was based on the CRONOS, Nutrition and Techno working groups of the Sociedad Española de Farmacia Hospitalaria. A group of specialist pharmacists was created from different care areas for patients with dysphagia. The creation of Deglufarm® consisted of several stages: Selection of active drugs, literature review, content development, design (an expert company in App design was contacted), testing, launch, content update and follow-up. RESULTS: Deglufarm® is available for Android and IOS free of charge from July 2022. It has been tested among the members of the research group and collaborators, currently, 540 monographs of active drugs have been reviewed and registered in Deglufarm. The first version is aimed at healthcare professionals. CONCLUSIONS: Deglufarm® is an easy tool to consult, with the most current evidence on handling the medicines it contains.

[Controversy 2. Drugs and their impact on nutritional status]. / Controversia 2. Fármacos y su repercusión en la situación nutricional.

Introduction: Controversy 2. Drugs and their impact on nutritional status.

Introducción: Controversia 2. Fármacos y su repercusión en la situación nutricional.

Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity.

Older adults with oropharyngeal dysphagia (OD) are unable to swallow pills safely, so some of them use liquid-formulated drugs mixed with thickeners to ensure safety. The aim of this study was to analyze the physical compatibility of a group of drugs with a thickener formulated with modified starch (Thick & Easy®). A secondary goal was to evaluate the amount of thickener needed to obtain the thickness levels 2, 3, and 4 defined by IDDSI framework for each drug. For this purpose, the rheological properties of the mixtures obtained were determined. Samples of each drug were prepared and 7, 10, and 12 g of thickener were added. Physical compatibility of the mixtures was observed; the apparent viscosity of the samples was measured using a rotational viscometer, and the results obtained were compared with the reference drug-free sample. We analyzed 45 medicinal products (38 active substances). Three drugs (almagate, ibuprofen, and macrogol) were found to be physically incompatible with the thickener and should not be mixed. Viscosity measurements indicated that clarithromycin and plantago ovata increased the viscosity of the mixture and required lower amount to achieve the target textures (110 cP, 590 cP, and 2620 cP for 7 g, 10 g, and 12 g in drug-free samples, respectively), whereas another subset reduced viscosity and required more thickener. This proved very relevant for acetylcysteine, amoxicillin, calcifediol, ferrous gluconate, fosfomycin, lactitol, lactulose, mepifiline, paracetamol, rivastigmine, sertraline, and tramadol. Measurements were below 1750 cP. Awareness of how each drug behaves when combined with thickeners is essential to avoid potential complications in OD.

[Recommendations for using oral antineoplastic and immunomodulating agents in oncohematology by enteral tube administration]. / Recomendaciones para la administración de antineoplásicos e inmunomoduladores orales por sonda enteral en oncohematología.

INTRODUCTION: Introduction and objective: in recent years, the number of oral antineoplastic and immunomodulating drugs in oncohematology has increased enormously. Often, these drugs must be administered to patients with enteral tube feeding or swallowing disorders, which causes safety problems when handling these drugs (many of them are classified as hazardous drugs). In addition, it is important to note that the administration of these drugs can also interact with enteral nutrition (EN). The objective of this study was to review and update the recommendations for the administration and handling of oral antineoplastic and immunomodulating drugs. Methods: a Working Group made up of pharmacists from the Pharmacy Group of The Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Clinical Nutrition Group of The Spanish Society of Hospital Pharmacy (SEFH) was created. A bibliographic review was carried out between 2015 and 2020 on the administration and handling of oral antineoplastic and immunomodulating drugs in oncohematology. The information about pharmaceutical specialties, dosage, presentation, brand names, instructions for oral or enteral tube administration, interactions with EN, precautions, and remarks for handling and administration was analyzed. Results: a total of 77 active principles and 84 pharmaceutical forms were included. Recommendations and instructions for oral, nasogastric tube, and gastrostomy administration, handling of the antineoplastic and immunomodulating drugs, and interactions with EN were described. Conclusions: the handling and administration information about the oral antineoplastic and immunomodulating drugs currently used in oncohematology for people with enteral accesses or swallowing disorders is limited. It is important to perform post-marketing studies to ensure a safe and effective administration of these drugs.

INTRODUCCIÓN: Introducción y objetivo: en los últimos años, el número de fármacos antineoplásicos e inmunomoduladores orales (ANIO) ha crecido enormemente. Con frecuencia, estos fármacos deben administrarse por sonda enteral (SE) o a pacientes con problemas de deglución, planteando un problema respecto a su manipulación (muchos pertenecen al grupo de medicamentos peligrosos). Además, también pueden presentar interacciones cuando se administran con la nutrición enteral (NE). El objetivo ha sido analizar y actualizar las recomendaciones de administración y manipulación de los ANIO. Métodos: se creó un Grupo de Trabajo formado por farmacéuticos del Grupo de Farmacia de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y del Grupo de Nutrición Clínica de la Sociedad Española de Farmacia Hospitalaria (SEFH). Se realizó una revisión bibliográfica entre 2015 y 2020 de las condiciones de manipulación y administración de los ANIO en oncohematología, elaborando una tabla que recoge especialidades farmacéuticas, dosis, presentación, nombre comercial, instrucciones para la administración oral y por SE, interacciones con la NE, precauciones y observaciones para su manipulación y administración. Resultados: se elaboró una tabla con 77 principios activos y 84 formas farmacéuticas, recogiendo recomendaciones e instrucciones para su administración por vía oral, sonda nasogástrica y gastrostomía, para la correcta manipulación y para la administración junto a la NE. Conclusiones: la información sobre cómo administrar y manipular los ANIO en personas con accesos enterales o problemas de deglución es escasa. Consideramos importante incluir en los estudios poscomercialización una investigación dirigida a responder a estas cuestiones para garantizar una administración segura y eficaz de los medicamentos a estos pacientes.

[Catheter-related bloodstream infections in patients receiving central parenteral nutrition: prevalence, associated factors, and treatment]. / Bacteriemia en pacientes con nutrición parenteral central: prevalencia, factores asociados y tratamiento.

INTRODUCTION: Background: catheter-related infection is one of the complications of central parenteral nutrition treatment with the highest morbidity and mortality. Objectives: the primary endpoint of this study was to analyze the prevalence of bloodstream infection in patients with central parenteral nutrition. Secondary objectives included: a) an assessment of whether type of central catheter, duration of parenteral nutrition treatment, body mass index, or being admitted to the intensive care unit are factors associated with the development of bloodstream infection; b) an analysis of the therapeutic approach. Methods: this was a retrospective observational study. All patients who received central parenteral nutrition after surgery between July 2018 and March 2019 were included. The association between the different variables and the development of bloodstream infection was analyzed by logistic regression. Results: the prevalence of bloodstream infection was 7.3 % (95 % CI: 3.9-13.3) (n = 9/123 patients). The duration of central parenteral nutrition was the only variable associated with the development of bloodstream infection (OR = 1.12; 95 % CI:1.05-1.20; p = 0.001). Conclusions: the prevalence of catheter-related bloodstream infection in this study is low, and the duration of central parenteral nutrition seems to be related to its development. However, further studies are needed to identify risk factors that might help reduce this kind of complications.

INTRODUCCIÓN: Introducción: la infección relacionada con el catéter es una de las complicaciones del tratamiento con nutrición parenteral central (NPC) que generan una mayor morbimortalidad. Objetivos: el objetivo principal fue analizar la prevalencia de la bacteriemia asociada al catéter en pacientes con nutrición parenteral central. Los objetivos secundarios fueron: a) evaluar si el tipo de catéter central, la duración de la nutrición parenteral central, el índice de masa corporal o la estancia en la unidad de cuidados intensivos son factores asociados al desarrollo de bacteriemia; b) analizar el manejo terapéutico de la infección. Material y métodos: se trata de un estudio observacional retrospectivo. Se incluyeron los pacientes que recibieron nutrición parenteral central tras una intervención quirúrgica entre julio de 2018 y marzo de 2019. La asociación de las variables con el desarrollo de la bacteriemia se analizó mediante regresión logística. Resultados: el 7,3 % (IC 95 %: 3,9-13,3) (n = 9/123) de los pacientes desarrollaron bacteriemia relacionada con el catéter. El único factor asociado al desarrollo de la infección fue la duración de la nutrición parenteral central (OR = 1,12; IC 95 %: 1,05-1,20; p = 0,001). Conclusiones: la prevalencia de la bacteriemia relacionada con el catéter en este estudio es baja. La duración del tratamiento con nutrición parenteral central parece estar relacionada con el desarrollo de la bacteriemia. Sin embargo, se necesitan más estudios para identificar factores de riesgo que permitan minimizar este tipo de complicaciones.

Specialized pharmaceutical care in social health centers in the times of COVID-19.

The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care  area, mainly the fact of not being integrated into the health system. The  objective of this work is to describe the pharmaceutical care developed by a  hospital pharmacy service established in a nursing home and, from a more  global perspective, analyze the strengths and weaknesses found from the  various experiences of hospital pharmacy in all spanish autonomous  communities to deal with this pandemic. Specialized pharmaceutical care has  provided rigor in the validation and treatments review processes from a  comprehensive perspective, maximizing safety and collaborating in the  establishment of the therapeutic intensity degree most appropriate to the  individual situation, has ensured the availability of all necessary medications,  has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal  nursing homes sectorization and has facilitated the coordination between the  nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the  health system. And also, the contribution of specialized pharmaceutical care in  improving healthcare coverage and coordination with health services has  highlighted the urgency of developing the current legislation, prioritizing the  establishment of pharmacy services able to provid specialized and specific care  for this area, so that it meets healthcare needs and is integrated into the health  system.

La pandemia COVID-19 está teniendo un efecto devastador en las residencias de personas mayores dependientes. La dificultad de la gestión de la crisis se ve  agravada por la fragilidad de las personas atendidas y por las propias  características del ámbito asistencial, principalmente el hecho de no estar  integrado en el sistema de salud. El objetivo del presente trabajo es describir la  atención farmacéutica especializada desarrollada por un servicio de farmacia  hospitalario establecido en un centro sociosanitario y, desde una perspectiva  más global, analizar las fortalezas y debilidades encontradas desde las diversas experiencias de la farmacia hospitalaria en el conjunto de comunidades autónomas para hacer frente a esta pandemia. La atención  farmacéutica especializada ha aportado rigor en los procesos de validación y  revisión de los tratamientos desde una perspectiva integral, maximizando la  seguridad y colaborando en el establecimiento del grado de intensidad  terapéutica más adecuado a la situación individual de la persona afectada, ha  asegurado la disponibilidad de todos los medicamentos necesarios, ha  colaborado en la adquisición y gestión de los equipos de protección individual, ha  sido capaz de adaptar los procesos de dispensación a la sectorización interna de las residencias y ha facilitado la coordinación entre la residencia y el sistema  de salud. Resulta evidente que la crisis provocada por la COVID-19 ha puesto de relevancia la necesidad de integrar el ámbito sociosanitario en el sistema de  salud. Y asimismo, la contribución de la atención farmacéutica especializada en  la mejora de la cobertura asistencial y de la coordinación con los servicios  sanitarios ha puesto de manifiesto la urgencia de desarrollar la legislación  vigente, priorizando el establecimiento de servicios de farmacia capaces de  proporcionar una atención especializada y específica para este ámbito  asistencial, de forma que cubra las necesidades asistenciales y quede integrada  en la estructura sanitaria.

Deprescribing antipsychotics in long term care patients with dementia.

OBJECTIVE: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with  behavioral disturbances that includes prescribing and deprescribing criteria and to assess its  applicability in longterm care institutions. METHOD: The protocol was developed from an interdisciplinary perspective based on a literature  search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to  the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study  with a follow-up of 6 months after the intervention study. RESULTS: A protocol was developed that includes prescribing and deprescribing criteria. The  intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was  completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7  (20%). Treatment was  resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that  there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in  combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in  improving the use of these drugs in elderly dementia patients in long-term care institutions.

Objetivo: Elaborar un protocolo de uso de fármacos antipsicóticos en pacientes institucionalizados  que presenten alteraciones conductuales que incluya criterios de prescripción y deprescripción y  valorar su aplicabilidad en el ámbito de los centros sociosanitarios. Método: El protocolo de actuación se elaboró por consenso de un equipo interdisciplinar a partir de  una búsqueda bibliográfica de las propuestas publicadas sobre el uso de antipsicóticos en estos  pacientes. La valoración de su aplicabilidad en la desprescripción de antipsicóticos se realizó mediante un estudio prospectivo antes-después con un seguimiento de 6 meses tras la intervención  en una residencia para personas mayores dependientes. Resultados: Se elaboró un protocolo que incluye criterios de prescripción y desprescripción de  antipsicóticos. La intervención se realizó sobre 35 pacientes, 21 (60%) de las cuales eran mujeres. La  retirada del tratamiento antipsicótico fue completa en 28 pacientes (80%) y se redujo a la mínima  dosis eficaz en 7 (20%). El tratamiento se reinició en 2 pacientes por agravamiento de los  síntomas. Los resultados de la evaluación conductual previa y a los 6 meses indicaron que no se  produjeron modificaciones significativas en dichas alteraciones (12,91 ± 12,80 frente a 13,76 ±  16,68; p = 0,124). Conclusiones: El establecimiento de un protocolo que incluya criterios de prescripción y  desprescripción, unido a la incorporación del farmacéutico en el equipo interdisciplinar, puede ser una  herramienta eficaz para mejorar el uso de este tipo de medicamentos en los pacientes  institucionalizados con demencia.

Prevalence of sarcopenia and associated factors in institutionalised older adult patients.

BACKGROUND & AIMS: Sarcopenia is a syndrome characterised by a progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death. The main aim of the present study was to establish the prevalence of sarcopenia using EWGSOP-defined criteria in institutionalised older adult patients in long-term care institutions. A secondary purpose was to identify the risk factors that develop Sarcopenia in this population. METHODS: A Multicentre cross-sectional study was conducted in 334 institutionalised older adult patients, where the prevalence of sarcopenia and its relation with certain risk factors were measured. Physical performance was measured by gait speed, muscle strength measured by a handheld dynamometer and skeletal muscle mass measured using bioimpedance analysis. Different variables were collected: body mass index (BMI), diseases documented in the clinical record, the numbers of falls, the level of activity and functional ability. RESULTS: Two hundred eighty five individuals were included. According the EWGSOP algorithm and the cut-off points proposed by Masanes et al. for the Spanish population, 118 (41.4%) participants presented sarcopenia, of which 32 patients (27%) suffered from moderate sarcopenia, 78 patients (66%) were identified as severe sarcopenia patients and only 8 (7%) were classified as sarcopenic obesity. More female residents (96 females (81.4%) vs. 22 males (18.6%), p < 0.0001) tended to be sarcopenic. Patients diagnosed with sarcopenia tended to be more functionally impaired and had a more unfavourable BMI than those who were not sarcopenic (Barthel score 40.93 vs, 49.22, p = 0.0034 and BMI 23.57 vs, 27.61, p < 0.0001). Results from regression analysis indicated that those older than 85 years old (OR 2.495, 95% CI 1.401-4.441), the female gender, (OR 3.215, 95%CI 1.635-6.324) and whose BMI was lower than 22 (OR 5.973, 95% CI 2.932-12.165) appeared to be associated with sarcopenia, whereas the Barthel Index and other factors were not. CONCLUSION: The present study suggests that sarcopenia is highly prevalent in patients living in long-term care institutions, especially in female patients. Our findings support that the muscle mass was negatively associated with poor nutritional status and poor capacity to develop basic activities of daily living that indicates high dependency of these patients and high necessity of care.

Approach to the development of a frailty index based on comprehensive geriatric assessment in nursing home.

OBJECTIVE: To carry out an approach for the development of a frailty index in  nursing homes and to analize its potential use in order to individualize the  pharmacological treatment. METHOD: The frailty index was constructed from the information included in the  comprehensive geriatric assessment established in nursing homes. The index  has been retrospectively applied to the patients of two centers using the last  comprehensive geriatric assessment of each one. RESULTS: 17 variables that included 27 deficits were selected and classified in 4  domains. 269 patients (mean age 82.9 ± 8.8 years) were included in the  analysis. The frailty index indicated that 86% of patients should be considered  frail and 60% of these to moderate-advanced level. CONCLUSIONS: The frailty index is simple and quick to apply. It seems to have  discriminative capacity in terms of quantifying the degree of frailty and it could  be useful in prescribing the most appropriate therapeutic aggressiveness to each  patient.

Objetivo: Realizar una aproximación al desarrollo de un índice de fragilidad en  centros sociosanitarios y analizar su posible repercusión en el desarrollo de una  farmacoterapia adecuada a la situación del paciente.Método: El índice de fragilidad se elaboró a partir de la información incluida en  la valoración integral geriátrica y se aplicó de forma retrospectiva a los pacientes de dos centros a partir de la última valoración de cada uno de ellos.Resultados: Se seleccionaron 17 variables, que incluyeron 27 déficits. El  análisis se realizó a 269 pacientes (edad media, 82,9 ± 8,8 años). El índice de  fragilidad consideró frágiles al 86% de los pacientes, estando el 60% de estos en un nivel de fragilidad moderado-avanzado.Conclusiones: El índice de fragilidad resulta sencillo, rápido de aplicar y parece  tener capacidad discriminatoria en la cuantificación del grado de fragilidad,  pudiendo ser de ayuda para establecer la intensidad terapéutica más adecuada  para cada paciente.

Reflection on the pharmaceutical service in nursing homes; understanding reality to cover needs.

The increasing concern regarding chronic care, which is a consequence of the current demographic progression, and the need to decrease the costs associated with its care, places a focus on social care homes caring for highly dependent patients. Simultaneously, the residential facilities are progressing in order to care for fragile patients with increasingly complexity, even though, with some exceptions, it is in parallel with the healthcare system. Within this reality, pharmaceutical care is developing very differently in all the autonomic regions, and has become a reason for controversy. In this sense, diverse factors related with the patient care setting, but also linked to different pharmaceutical levels, make it difficult to implement a patient care model. Faced with this scenario, it seems reasonable to analyze the situation from the perspective of the healthcare requirements of the institutionalized persons in these facilities, and in terms of the patient care that we can and should provide; subsequently, and based on this, we should be able to propose the basic guidelines for developing an efficient model of pharmaceutical care integrated within this patient care setting.

La creciente preocupacion por la atencion a la cronicidad, consecuencia de la progresion demografica actual, y la necesidad de disminuir los costes asociados a su cuidado, situa uno de sus focos en los centros de asistencia social que atienden a personas de alta dependencia. A su vez, el ambito sociosanitario esta evolucionando para atender a un paciente fragil cada vez mas complejo aunque, salvo excepciones, lo hace de forma paralela al sistema de salud. Dentro de esta realidad, la prestacion farmaceutica se esta desarrollando de forma muy heterogenea entre las comunidades autonomas y es motivo de controversia. En este sentido, diversos factores relacionados con el ambito asistencial, pero tambien con los distintos estamentos farmaceuticos, dificultan el establecimiento de un modelo asistencial. Ante esta situacion, parece razonable realizar un analisis de la situacion desde la perspectiva de las necesidades sanitarias de las personas institucionalizadas en estos centros y de la atencion que podemos y debemos prestar para, posteriormente, ser capaces de proponer las lineas basicas sobre las que desarrollar un modelo de atencion farmaceutica eficiente e integrado para este ambito asistencial.