[Clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives]. / Relevancia clínica de las interacciones medicamentosas entre antiinflamatorios no esteroideos y antihipertensivos.

OBJECTIVE: To establish the clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives, based on the interaction severity and probability of occurrence. DESIGN: Systematic review. DATA SOURCES: A PubMed/Medline search was made using the MeSH terms: NSAIDs, Antihypertensive drugs, and Drug interactions. DATA EXTRACTION: Articles between 2002 and 2012, human studies, in Spanish and English and full text access were included. Found articles were included and some of the references used in this works. Studies with in vitro methods, effects on ocular hypertension and those who do not consider the interaction NSAIDs, antihypertensives were excluded. For the selection of the papers included three independent reviewers were involved. We used a tool for data extraction and for assess of the interaction clinical relevance. RESULTS: Nineteen of 50 papers found were included. There were identified 21 interactions with pharmacodynamic mechanism, classified by their clinical relevance in level-2 high risk (76.2%) and level-3 medium risk (23.8%). In addition, evidence of 16 combinations of no interaction were found. CONCLUSIONS: Some NSAIDs may attenuate the effectiveness of antihypertensive drugs when used concurrently, especially with angiotensin converting enzyme inhibitors, diuretics, beta blockers and angiotensin receptorsii blockers. There was no evidence of effect modification of calcium channel antagonists, especially dihydropyridine, by concurrent use of NSAIDs.

Processes implemented and activities carried out by the pharmacists during the COVID­19 pandemic: A scoping review.

OBJECTIVE: To identify and summarize the processes implemented and the  activities performed by community and hospital-based pharmacists during the  COVID­19 pandemic. METHOD: A scoping review was carried out of the PubMed/Medline database  with the aim of identifying articles published until 30 June 2021. The PRISMA  recommendations for this type of review were followed. The articles included  were reviewed and classified according to their main characteristics and  outcomes, according to population, concept and context. The processes and  activities identified were grouped into three categories: those performed in  community and hospital pharmacies, those performed essentially in community  pharmacies, and those performed essentially in hospital  pharmacies. RESULTS: A total of 629 articles were identified, of which 454 were excluded  because they were unrelated to the object of the review and 81 due to meeting  the exclusion criteria. So, 94 articles were included in the analysis.  Most studies were conducted in Europe and the United States. During the  COVID­19 pandemic, the processes implemented and the activities carried out  in both community and hospital-based pharmacies included pharmaceutical  care, efficient and timely management of services, information and education,  psychological support, pharmacovigilance and telepharmacy. Processes  implemented and activities carried out essentially in community pharmacies  were those related to the detection recommendations, and drug indications.  Finally, processes and activities essentially occurring in hospital pharmacies  included those related to participation in drug treatment research, drug  evaluation and guidelines development, and to managing off-label drugs. CONCLUSIONS: During the COVID­19 crisis, pharmacists have led and implemented processes aimed at mitigating the impact of the pandemic on  the population´s health. Pharmaceutical care, efficient and  timely management of services, information and education, psychological  support, pharmacovigilance and telepharmacy, both in community and hospital pharmacies, are the main processes implemented by pharmacists  during the COVID­19 pandemic. These processes and activities, in addition to contributing to the control, prevention and effective and safe treatment of  COVID­19; have ensured the implementation of biosecurity measures, proper  dispensing of medication, the drug rational use, and the provision of evidence- based information and education.

OBJETIVO: Identificar y sintetizar los procesos y actividades realizados por el  farmacéutico en la farmacia comunitaria y hospitalaria durante la pandemia por  COVID-19.Método: Revisión sistemática exploratoria en PubMed/Medline de artículos publicados hasta el 30 de junio de 2021, siguiendo las  recomendaciones PRISMA para este tipo de revisiones. Los artículos incluidos  se clasificaron según sus principales características y resultados, acorde con la  estructura: población, concepto y contexto. Los procesos y las actividades  identificados se agruparon en tres categorías: realizados en farmacia  comunitaria y hospitalaria, llevados a cabo esencialmente en farmacia  comunitaria y realizados esencialmente en farmacia hospitalaria. RESULTADOS: Se identificaron 629 artículos, de los cuales se excluyeron 454  por no estar en relación con el objeto de la revisión y 81 por los criterios de  exclusión; por tanto, se incluyeron 94 en la revisión y análisis. La mayoría de  los estudios se desarrollaron en Europa y Estados Unidos. Entre los procesos y  actividades llevados a cabo por el farmacéutico durante la pandemia, tanto en  farmacia comunitaria como en hospitalaria, destacaron: atención farmacéutica,  gestión eficiente y oportuna de los servicios, información y  educación, apoyo psicológico, farmacovigilancia y telefarmacia. En farmacia  comunitaria destacaron también los relacionados con la detección de COVID-19  y derivación de pacientes, inmunización en farmacias, recomendaciones de  cuidados en el hogar e indicación farmacéutica. Entre los procesos  realizados esencialmente en farmacia hospitalaria destacaron los relacionados  con la participación en investigaciones de tratamientos farmacológicos,  desarrollo de guías de utilización de medicamentos basadas en evidencia y  manejo de medicamentos en indicaciones no aprobadas. CONCLUSIONES: Durante la pandemia por COVID-19, los farmacéuticos han  liderado e implantado procesos orientados a mitigar su impacto en la salud de  la población. Atención farmacéutica, gestión eficiente y oportuna de los  servicios, información y educación, apoyo psicológico, farmacovigilancia y  telefarmacia fueron los principales procesos y actividades realizados en  farmacia comunitaria y hospitalaria durante la pandemia por COVID-19. Dichos  procesos y actividades buscaron, además de contribuir al control,  prevención y tratamiento efectivo y seguro de la COVID-19, asegurar la  implantación de medidas de bioseguridad, la dispensación y uso adecuado de  los medicamentos y la información y educación basadas en la mejor evidencia  disponible.

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

BACKGROUND: Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. METHODS: We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. RESULTS: For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). CONCLUSIONS: Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined.

Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review.

BACKGROUND Recently, the US Food and Drug Administration requested that a "maximal use" trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers. OBJECTIVE To establish how frequently volunteers should be exposed to ABHR during a maximal use trial. DESIGN Retrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems. METHODS We reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour. RESULTS Of 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour. CONCLUSIONS Hand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial. Infect Control Hosp Epidemiol 2017;38:189-195.

Procesos y actividades realizados por el farmacéutico en la pandemia por COVID-19: Revisión sistemática exploratoria / Processes implemented and activities carried out by the pharmacists during the COVID-19 pandemic: A scoping review

Objetivo: Identificar y sintetizar los procesos y actividades realizadospor el farmacéutico en la farmacia comunitaria y hospitalaria durante lapandemia por COVID-19.Método: Revisión sistemática exploratoria en PubMed/Medline de artículospublicados hasta el 30 de junio de 2021, siguiendo las recomendacionesPRISMA para este tipo de revisiones. Los artículos incluidos se clasificaronsegún sus principales características y resultados, acorde con la estructura:población, concepto y contexto. Los procesos y las actividades identificados se agruparon en tres categorías: realizados en farmacia comunitariay hospitalaria, llevados a cabo esencialmente en farmacia comunitaria yrealizados esencialmente en farmacia hospitalaria.Resultados: Se identificaron 629 artículos, de los cuales se excluyeron454 por no estar en relación con el objeto de la revisión y 81 por loscriterios de exclusión; por tanto, se incluyeron 94 en la revisión y análisis.La mayoría de los estudios se desarrollaron en Europa y Estados Unidos.Entre los procesos y actividades llevados a cabo por el farmacéuticodurante la pandemia, tanto en farmacia comunitaria como en hospitalaria, destacaron: atención farmacéutica, gestión eficiente y oportuna delos servicios, información y educación, apoyo psicológico, farmacovigilancia y telefarmacia. En farmacia comunitaria destacaron también losrelacionados con la detección de COVID-19 y derivación de pacientes,inmunización en farmacias, recomendaciones de cuidados en el hogar e indicación farmacéutica. Entre los procesos realizados esencialmente enfarmacia hospitalaria destacaron los relacionados con la participaciónen investigaciones de tratamientos farmacológicos, desarrollo de guíasde utilización de medicamentos basadas en evidencia y manejo de medicamentos en indicaciones no aprobadas. (AU)

Objective: To identify and summarize the processes implemented andthe activities performed by community and hospital-based pharmacistsduring the COVID-19 pandemic.Method: A scoping review was carried out of the PubMed/Medlinedatabase with the aim of identifying articles published until 30 June 2021.The PRISMA recommendations for this type of review were followed. Thearticles included were reviewed and classified according to their maincharacteristics and outcomes, according to population, concept andcontext. The processes and activities identified were grouped into threecategories: those performed in community and hospital pharmacies, thoseperformed essentially in community pharmacies, and those performedessentially in hospital pharmacies.Results: A total of 629 articles were identified, of which 454 wereexcluded because they were unrelated to the object of the review and81 due to meeting the exclusion criteria. So, 94 articles were included inthe analysis. Most studies were conducted in Europe and the United States. During the COVID-19 pandemic, the processes implemented and theactivities carried out in both community and hospital-based pharmaciesincluded pharmaceutical care, efficient and timely management of services, information and education, psychological support, pharmacovigilance and telepharmacy. Processes implemented and activities carried outessentially in community pharmacies were those related to the detection and referral of COVID-19 patients, testing and immunization, home carerecommendations, and drug indications. Finally, processes and activitiesessentially occurring in hospital pharmacies included those related toparticipation in drug treatment research, drug evaluation and guidelinesdevelopment, and to managing off-label drugs. (AU)

Diseño y evaluación de un curso virtual para referenciar casos de COVID-19 desde farmacias-droguerías en Colombia / Design and evaluation of an online course to transfer suspected cases of COVID-19 from pharmacies-drugstores in Colombia

Introducción: es necesario diseñar, implementar y evaluar la aceptación, pertinencia y usabilidad de un curso virtual orientado a favorecer la identificación y referenciación de casos sospechosos de COVID-19 desde farmacias-droguerías en Colombia. Método: el diseño del curso se fundamentó en una ruta propuesta para la atención de usuarios sospechosos de COVID-19 que acuden a farmacias, complementada con información obtenida de una búsqueda en PubMed/Medline y en sitios Web de organizaciones referentes en el tema. La información se estructuró en un curso virtual, se elaboró y aplicó un instrumento para evaluar la cobertura, aceptabilidad y pertinencia del curso. Resultados: se diseñó el curso virtual ¿Cómo actuamos frente al COVID-19 desde las droguerías? organizado en 7 unidades con conceptos claves para identificar y referenciar casos sospechosos de COVID-19, desde farmacias-droguerías, disponible en https://udearroba.udea.edu.co/externos/my/. Entre abril/2020 y abril/2021 se registraron 863 personas, 382 (44,3%) finalizaron el curso y se les envió el instrumento de evaluación, y fue regresado por 240 (62,8%). En este grupo, la satisfacción con el curso y material didáctico fue del 95,8% y 97,1%, respectivamente. Además, el 97,9% manifestó que el curso contribuye a identificar y referenciar casos sospechosos de COVID-19; y el 93,3% que, el acceso y navegación por el curso, resultó sencillo. Conclusiones: se diseña, implementa y evalúa un curso virtual, abierto y usable, orientado a favorecer la identificación y referenciación de casos sospechosos de COVID-19, desde las farmacias-droguerías y, aunque los participantes declaran que contribuye con dicha finalidad, se requiere de un estudio diseñado para valorar esta aportación. (AU)

Introduction: it is needing to design, implement and evaluate the acceptance, relevance, and usability of an online course aimed at promoting the detection and referral of suspected cases of COVID-19 from pharmacies-drugstores. Method: the design of the course was based on a proposed route for the care of users suspected of COVID-19 attending pharmacies, complemented by information obtained through a search in PubMed/Medline and on Websites of leading organizations in the field. The information was structured in an online course, a formulary was developed and applied to assess the coverage, acceptability, and relevance of the course. Results: an online course (How do we act against COVID-19 from the drugstores?) was designed and organized in 7 units and with key concepts to identify and refer suspected cases of COVID-19 from pharmacies-drugstores, available in https://udearroba.udea.edu.co/externos/my/. From April/2020 to April/2021, 863 persons were registered, 382 (44.3%) finished and were sent the formulary for evaluation the course, which was returned by 240 (62.8%). In this group, the satisfaction with the course and education materials was 95.8% and 97.1%, respectively. Also, 97.9% people assert that the course contribute to identify and to refer suspected cases of COVID-19; and 93.3% that, the navigation through the course provides easy access of the contents. Conclusions: a virtual, open, and usable course is designed, implemented, and evaluated, and although the participants state that the course promoting the detection and referral of suspected cases of COVID-19, from pharmacies-drugstores, it is needing to conduct a study to assess this question. (AU)

Do peer effects improve hand hygiene adherence among healthcare workers?

OBJECTIVE: To determine whether hand hygiene adherence is influenced by peer effects and, specifically, whether the presence and proximity of other healthcare workers has a positive effect on hand hygiene adherence. DESIGN: An observational study using a sensor network. SETTING: A 20-bed medical intensive care unit at a large university hospital. PARTICIPANTS: Hospital staff assigned to the medical intensive care unit. METHODS: We deployed a custom-built, automated, hand hygiene monitoring system that can (1) detect whether a healthcare worker has practiced hand hygiene on entering and exiting a patient's room and (2) estimate the location of other healthcare workers with respect to each healthcare worker exiting or entering a room. RESULTS: We identified a total of 47,694 in-room and out-of-room hand hygiene opportunities during the 10-day study period. When a worker was alone (no recent healthcare worker contacts), the observed adherence rate was 20.85% (95% confidence interval [CI], 19.78%-21.92%). In contrast, when other healthcare workers were present, observed adherence was 27.90% (95% CI, 27.48%-28.33%). This absolute increase was statistically significant (P < .01). We also found that adherence increased with the number of nearby healthcare workers but at a decreasing rate. These results were consistent at different times of day, for different measures of social context, and after controlling for possible confounding factors. CONCLUSIONS: The presence and proximity of other healthcare workers is associated with higher hand hygiene rates. Furthermore, our results also indicate that rates increase as the social environment becomes more crowded, but with diminishing marginal returns.

Relevancia clínica de las interacciones medicamentosas entre antiinflamatorios no esteroideos y antihipertensivos / Clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives

OBJETIVO: Establecer la relevancia clínica de las interacciones medicamentosas reportadas entre antiinflamatorios no esteroideos (AINE) y antihipertensivos basándose en la gravedad y la probabilidad de ocurrencia de la interacción. DISEÑO: Revisión sistemática. Fuentes de datos: Se realizó una búsqueda en PubMed/Medline utilizando los términos Mesh: NSAIDs, Antihypertensive drugs y Drug interactions. Extracción de datos Se incluyeron publicaciones entre 2002 y 2012 de estudios en humanos, en español e inglés y con acceso a texto completo. Fueron incluidos los artículos que la búsqueda arrojó y algunas de las referencias usadas en dichos trabajos. Fueron excluidos los trabajos con métodos in vitro, con efectos sobre la hipertensión ocular y aquellos que no consideraran la interacción AINE-antihipertensivos. Para la selección de los trabajos incluidos participaron 3 revisores independientes. Se usó una herramienta especialmente diseñada para la extracción de datos y análisis de la relevancia clínica de la interacción. RESULTADOS: Se incluyeron 19 artículos de los 50 encontrados. Allí se identificaron 21 interacciones de mecanismo farmacodinámico, clasificadas por su relevancia clínica en nivel 2 (riesgo alto; 76,2%) y nivel 3 (riesgo medio; 23,8%). Adicionalmente se encontró evidencia de 16 combinaciones que no presentaron interacción. CONCLUSIONES: Algunos AINE pueden disminuir la efectividad del tratamiento antihipertensivo cuando se utilizan simultáneamente con antihipertensivos, en especial con inhibidores de la enzima conversora de angiotensina, diuréticos, bloqueadores beta y antagonistas de los receptores de angiotensina. No se encontró evidencia de la modificación del efecto de los antagonistas de los canales de calcio, especialmente dihidropiridínicos, por el uso simultáneo con AINE

OBJECTIVE: To establish the clinical relevance of drug interactions between nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives, based on the interaction severity and probability of occurrence. DESIGN: Systematic review. Data sources: A PubMed/Medline search was made using the MeSH terms: NSAIDs, Antihypertensive drugs, and Drug interactions. Data extraction: Articles between 2002 and 2012, human studies, in Spanish and English and full text access were included. Found articles were included and some of the references used in this works. Studies with in vitro methods, effects on ocular hypertension and those who do not consider the interaction NSAIDs, antihypertensives were excluded. For the selection of the papers included three independent reviewers were involved. We used a tool for data extraction and for assess of the interaction clinical relevance. RESULTS: Nineteen of 50 papers found were included. There were identified 21 interactions with pharmacodynamic mechanism, classified by their clinical relevance in level-2 high risk (76.2%) and level-3 medium risk (23.8%). In addition, evidence of 16 combinations of no interaction were found. CONCLUSIONS: Some NSAIDs may attenuate the effectiveness of antihypertensive drugs when used concurrently, especially with angiotensin converting enzyme inhibitors, diuretics, beta blockers and angiotensin receptors II blockers. There was no evidence of effect modification of calcium channel antagonists, especially dihydropyridine, by concurrent use of NSAID

Aspectos clínicos y farmacoterapéuticos de la infección del tracto urinario Revisión estructurada / Clinical and therapeutic aspects in the treatment of urinary tract infection Structured review

Objetivo: las infecciones del tracto urinario, después de las respiratorias, son las enfermedades infecciosas más frecuentes. Por ello es necesario disponer de información sistematizada y actualizada que contribuya a mejorar los resultados de la farmacoterapia y a disminuir la morbimortalidad asociada a esta infección. El objetivo de este trabajo fue realizar una revisión estructurada de los aspectos clínicos y farmacoterapéuticos de las infecciones del tracto urinario.Método: se realizó una revisión estructurada sobre lainfección del tracto urinario en humanos, en PubMed/MedLine, de artículos publicados en inglés y en español,entre el 2007 y el 2010, con acceso a texto completo, buscando, en el título o en el resumen los términos:“Urinary tract infections” y (classification, epidemiology,complications, physiology, physiopathology o drug therapy). La información se complementó conuna búsqueda específica de la base de datos Scielo Colombia,utilizando los términos: infecciones urinarias y urinary tract infection, al igual que con las referenciasde artículos considerados relevantes. La información se estructuró en los siguientes apartados: clasificación, indicadores epidemiológicos, factores de riesgo, etiología, presentación clínica, diagnóstico, farmacoterapia, profilaxis y resistencia. Resultados: se presentan aspectos relevantes y actuales de la infección del tracto urinario (ITU) relacionados consu clasificación, epidemiología, factores de riesgo, etiología,presentación clínica, diagnóstico, farmacoterapia, profilaxis y resistencia a antibióticos. Conclusiones: la revisión de problemas de salud frecuentesen la población, como las infecciones del tracto urinario, ofrece la posibilidad de actualizar y esbozar un enfoque farmacoterapéutico basado en el uso adecuado de los medicamentos, con el propósito de disminuir la probabilidadde fallo terapéutico y la resistencia de los microorganismos.

Objective: The urinary tract infections (UTI) are more frequent infection after respiratory infectiousdiseases. It is therefore considered necessary to have systematic and updated informationto help improve drug therapy outcomes and reduce morbidity and mortality associated with this infection. The aim of this study was to performa structured review of clinical and pharmacotherapeuticaspects of urinary tract infections.Methods: We conducted a structured review of urinary tract infection in PubMed/MedLine ofarticles published in English and Spanish, between2007and 2010, in humans, with accessto full text. Search terms were: “Urinary tract infections” AND (classification OR epidemiologyOR complications OR physiology OR physiopathology OR drug therapy) in title/abstract field. The information was complemented bothby a specific search of Colombia Scielo database,using the terms: urinary tract infections and urinary tract Infection, and by review of referencescited in relevant articles. The information is organized into the following sections: Classification,epidemiological, risk factors, etiology,clinical presentation, diagnosis, drug therapy, prophylaxis and resistance. Relevant aspectsare presented and current urinary tract infection (UTI) related to its classification, epidemiology,risk factors, etiology, clinical presentation, diagnosis, drug therapy, prophylaxis and antibioticresistance. Results: We present some relevant and currentaspects of the urinary tract infection related to its classification, epidemiology, risk factors, etiology,clinical presentation, diagnosis, drug therapy, prophylaxis, and antibiotic resistance.