Antiemetic prophylaxis regimens in haematologic malignancies patients undergoing a hematopoietic stem cell transplantation. Which is the best standard of care? A systematic review.

INTRODUCTION: This systematic review, adhering to PRISMA guidelines, aimed to evaluate the efficacy and safety of antiemetic prophylaxis in haematological patients undergoing high-dose chemotherapy as part of their hematopoietic stem cell transplantation (HSCT) conditioning regimens. METHODS: We performed a comprehensive search in PubMed, EMBASE, ClinicalTrials.gov and the Cochrane database to identify randomised controlled trials (RCTs) and systematic reviews of antiemetic prophylaxis. Studies in English, French, Italian or Spanish were included. This review is registered with PROSPERO, ID CRD42023406380. RESULTS: Eight RCTs were analysed. The antiemetic regimens evaluated ranged from monotherapy with 5-Hydroxytryptamine Receptor 3 antagonists (5-HT3RAs) to complex combinations including olanzapine, neurokinin-1 receptor antagonists, 5-HT3RAs and corticosteroids. Complete response rates for triplet or quadruple regimens varied between 23.5% and 81.9%. Although no significant adverse effects were observed, minor symptoms such as diarrhoea, constipation, sedation and headaches were reported. CONCLUSION: Existing evidence on HSCT antiemetic therapy highlights its benefits but fails to provide clear clinical directions. The choice between triplet and quadruplet therapies for different patient scenarios is still uncertain. Until more detailed research is available, healthcare providers must rely on the latest guidelines and their judgement to customise antiemetic care for each patient's specific needs and risks.

Antiemetic prophylaxis in hematologic malignancies patients receiving conditioning protocols for hematopoietic stem cell transplantation: A study protocol for a systematic review. / [Artículo traducido] Profilaxis antiemética en pacientes con neoplasias hematológicas que reciben protocolos de acondicionamiento para el trasplante de células madre hematopoyéticas: protocolo de estudio para una revisión sistemática.

OBJECTIVE: Chemotherapy-induced nausea and vomiting continue to pose a significant challenge for patients undergoing hematopoietic stem cell transplantation. This study aims to synthesize available evidence on antiemetic prophylaxis regimens in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation, in order to identify the best standard of care. METHODS: A systematic review will be conducted using MEDLINE via PubMed, EMBASE, ClinicalTrials.gov., and Cochrane databases. Studies written in English, French, Italian or Spanish will be considered. After screening the literature according to the inclusion and exclusion criteria, two independent reviewers will extract data and assess the risk of bias in eligible articles. This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. This protocol is registered in the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42023406380. DISCUSSION: Chemotherapy-induced nausea and vomiting is a debilitating side effect that presents a significant challenge for patients with hematologic malignancies. Despite the publication of various guidelines, none of them includes specific recommendations for each chemotherapy regimen. Therefore, analyzing the primary antiemetic prophylaxis regimens in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation would be valuable in enhancing patients' quality of life.

Combined or Sequential Treatment with Immune Checkpoint Inhibitors and Car-T Cell Therapies for the Management of Haematological Malignancies: A Systematic Review.

The aim of this paper was to review the available evidence on the efficacy and safety of combined or sequential use of PD-1/PD-L1 immune checkpoint inhibitors (ICI) and CAR-T cell therapies in relapsed/refractory (R/R) haematological malignancies. A systematic literature review was performed until 21 November 2022. Inclusion criteria: cohort studies/clinical trials aimed at evaluating the efficacy and/or safety of the combination of CAR-T cell therapy with PD-1/PD-L1 inhibitors in R/R haematological malignancies, which had reported results. Those focusing only on ICI or CAR-T separately or evaluating the combination in other non-hematological solid tumours were excluded. We used a specific checklist for quality assessment of the studies, and then we extracted data on efficacy or efficiency and safety. A total of 1867 articles were identified, and 9 articles were finally included (early phase studies, with small samples of patients and acceptable quality). The main pathologies were B-cell acute lymphoblastic leukaemia (B-ALL) and B-cell non-Hodgkin's lymphoma (B-NHL). The most studied combination was tisagenlecleucel with pembrolizumab. In terms of efficacy, there is great variability: the combination could be a promising option in B-ALL, with modest data, and in B-NHL, although hopeful responses were received, the combination does not appear better than CAR-T cell monotherapy. The safety profile could be considered comparable to that described for CAR-T cell monotherapy.

Antiemetic prophylaxis in hematologic malignancies patients receiving conditioning protocols for hematopoietic stem cell transplantation: A study protocol for a systematic review.

OBJECTIVE: Chemotherapy-induced nausea and vomiting continue to pose a significant challenge for patients undergoing hematopoietic stem cell transplantation. This study aims to synthesize available evidence on antiemetic prophylaxis regimens in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation, in order to identify the best standard of care. METHODS: A systematic review will be conducted using MEDLINE via PubMed, EMBASE, Clinical-Trials.gov., and Cochrane databases. Studies written in English, French, Italian, or Spanish will be considered. After screening the literature according to the inclusion and exclusion criteria, 2 independent reviewers will extract data and assess the risk of bias in eligible articles. This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. This protocol is registered in the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42023406380. DISCUSSION: Chemotherapy-induced nausea and vomiting is a debilitating side effect that presents a significant challenge for patients with hematologic malignancies. Despite the publication of various guidelines, none of them include specific recommendations for each chemotherapy regimen. Therefore, analyzing the primary antiemetic prophylaxis regimens in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation would be valuable in enhancing patients' quality of life.

Recommended doses of endovenous vancomycin are insufficient to achieve therapeutic concentrations in paediatric patients.

OBJECTIVES: Vancomycin therapeutic drug monitoring is challenging, especially in the paediatric population where evidence is scarce. The main objective of this study was to analyse the achievement of therapeutic concentrations of vancomycin in paediatric patients and to evaluate the current monitoring method (trough levels), doses used, and the time required to achieve target concentrations. METHODS: Paediatric patients on treatment and monitored with vancomycin from November 2019 to December 2021 were included. Those with only one determination of serum vancomycin concentration were excluded. Demographic variables, analytical and microbiological parameters and toxicity data were collected. Pharmacokinetic parameters were assessed at baseline and during treatment. RESULTS: 225 patients (40.9% female; 108 neonates, 49 infants and 68 children or adolescents) were included in the study. The main indications for vancomycin treatment were sepsis (33.9%) and fever of unknown origin (29.3%). Microbiological cultures were positive in 71.1%, mostly with Gram-positive bacteria (60.4%). Therapeutic levels of vancomycin were reached in only 20.1% of the participants in the first determination. After pharmacokinetic monitoring, 81.7% of patients reached therapeutic concentrations, requiring a 23% increase in the initial dose, a 2-day lag time and 1-2 dosage adjustments until the therapeutic concentration was reached. Of the total patients, 13 developed nephrotoxicity, nine neutropenia and one patient developed red man syndrome. CONCLUSIONS: In our sample of paediatric patients, the recommended doses of vancomycin were insufficient to achieve therapeutic concentrations. Revision of the recommendations and/or a change in the method of pharmacokinetic monitoring is crucial to optimise treatment in this population.

Prevalence of depression among medical students during the COVID-19 pandemic. A systematic review and meta-analysis / Frecuencia de depresión en estudiantes de medicina durante la pandemia COVID-19

ABSTRACT Background: Medical students frequently have depressive symptoms. Thus, the psychological impact of COVID-19 on them should be high. AIM: To conduct a systematic review and meta-analysis on the prevalence of depression in medical students during the COVID-19 pandemic. MATERIAL AND METHODS: MEDLINE via PubMed, Embase and Web of Science were searched for studies reporting the prevalence of depression in medical students, published from December 1, 2019 to December 27, 2020. RESULTS: Eleven studies were included, most of them from Asia. The estimated overall prevalence of depression in medical students was 31% (95% CI: 23%-40%), with lower prevalence rates reported in studies from Asia in general, and China in particular. CONCLUSIONS: Our findings indicate that the proportion of medical students with depression during the pandemic was high, and comparable with that reported in other university students.

ANTECEDENTES: Los estudiantes de medicina muestran altos niveles de síntomas depresivos. Por lo tanto, se espera que el impacto psicológico de COVID-19 en ellos sea alto. OBJETIVO: Realizar una revisión sistemática y metanálisis de la prevalencia de depresión en estudiantes de medicina durante la pandemia de COVID-19. MATERIAL Y MÉTODOS: Se realizaron búsquedas en MEDLINE a través de PubMed, Embase y Web of Science para obtener estudios que informaran sobre la prevalencia de la depresión en estudiantes de medicina, publicados del 1 de diciembre de 2019 al 27 de diciembre de 2020. RESULTADOS: Se incluyeron 11 estudios, la mayoría de Asia. La prevalencia general estimada de depresión en estudiantes de medicina fue del 31% (IC del 95%: 23% - 40%), con tasas de prevalencia más bajas informadas en estudios de Asia en general y China en particular. CONCLUSIONES: Nuestros hallazgos indican que la proporción de estudiantes de medicina con depresión durante la pandemia es considerablemente alta y comparable con la informada en otros estudiantes universitarios.

Influence of Performance Status on the Effectiveness of Pembrolizumab Monotherapy in First-Line for Advanced Non-Small-Cell Lung Cancer: Results in a Real-World Population.

The KEYNOTE-024 clinical trial showed promising results for pembrolizumab in the first-line of treatment of advanced non-small-cell lung cancer (NSCLC). However, the profile of patients in real-world practice differs from those included in this clinical trial. Here, an observational single-center retrospective study was performed through a comparative analysis of clinical outcomes after pembrolizumab therapy according to the Eastern Cooperative Oncology Group Stage Performance Status (ECOG PS). Moreover, univariate and multivariate analyses were carried out to detect prognostic factors. In our cohort, 63.7% of patients had an ECOG PS of 0-1. Regarding response rate, 31.8% of patients had a partial response (PR), 19.3% had stable disease (SD) and 23.9% had progression disease. On the other hand, patients with ECOG PS ≥ 2 showed a significantly lower rate of PR and SD to pembrolizumab than patients with a PS of 0-1. The rate of response, median overall survival (OS) and progression-free survival (PFS) were significantly higher in patients with ECOG PS 0-1 than in those with ECOG PS ≥ 2. In the current study, we found ECOG PS as the only independent predictor of OS and PFS. Due to the ECOG PS scale being a subjective parameter, other tools are needed to identify treatment effectiveness to each patient.

Prevalence of Anxiety, Depression, and Stress among Teachers during the COVID-19 Pandemic: A Rapid Systematic Review with Meta-Analysis.

BACKGROUND: Since the beginning of the COVID-19 pandemic, teachers have been accumulating adverse psychological symptoms due to the closure of educational centers and the need to adapt to different teaching modalities. METHODS: Medline and PubMed were searched for studies on the prevalence of depression, anxiety, stress, and burn-out in teachers, published from 1 December 2019 to 15 June 2021. RESULTS: In total, eight studies were included in this study. The results show that teachers report levels of anxiety (17%), depression (19%), and stress (30%). In Asia, there has been more anxiety compared to other continents. Overall, anxiety has been higher among teachers in schools compared to universities. However, stress levels have been higher among teachers in universities compared to schools. Statistically, there were no significant differences regarding gender and age in any of the symptoms. CONCLUSIONS: The results suggest that teachers at different educational levels are experiencing adverse psychological symptomatology during the COVID-19 pandemic, and that anxiety levels vary between different countries. However, more international studies are needed to fully understand the impact of the pandemic on teachers' mental health.

Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis.

BACKGROUND: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. METHODS: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. RESULTS: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20-28%), 25% for nurses (95% CI: 18-33%), 24% for medical doctors (95% CI: 16-31%), and 43% for frontline professionals (95% CI: 28-59%). CONCLUSIONS: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

Prevalence of anxiety in health care professionals during the COVID-19 pandemic: A rapid systematic review (on published articles in Medline) with meta-analysis.

During the COVID-19, healthcare workers are exposed to a higher risk of mental health problems, especially anxiety symptoms. The current work aims at contributing to an update of anxiety prevalence in this population by conducting a rapid systematic review and meta-analysis. Medline and Pubmed were searched for studies on the prevalence of anxiety in health care workers published from December 1, 2019 to September 15, 2020. In total, 71 studies were included in this study. The pooled prevalence of anxiety in healthcare workers was 25% (95% CI: 21%-29%), 27% in nurses (95% CI: 20%-34%), 17% in medical doctors (95% CI: 12%-22%) and 43% in frontline healthcare workers (95% CI: 25%-62%). Our results suggest that healthcare workers are experiencing significant levels of anxiety during the COVID-19 pandemic, especially those on the frontline and nurses. However, international longitudinal studies are needed to fully understand the impact of the pandemic on healthcare workers' mental health, especially those working at the frontline.

Prevalence of depression among medical students during the COVID-19 pandemic. A systematic review and meta-analysis.

BACKGROUND: Medical students frequently have depressive symptoms. Thus, the psychological impact of COVID-19 on them should be high. AIM: To conduct a systematic review and meta-analysis on the prevalence of depression in medical students during the COVID-19 pandemic. MATERIAL AND METHODS: MEDLINE via PubMed, Embase and Web of Science were searched for studies reporting the prevalence of depression in medical students, published from December 1, 2019 to December 27, 2020. RESULTS: Eleven studies were included, most of them from Asia. The estimated overall prevalence of depression in medical students was 31% (95% CI: 23%-40%), with lower prevalence rates reported in studies from Asia in general, and China in particular. CONCLUSIONS: Our findings indicate that the proportion of medical students with depression during the pandemic was high, and comparable with that reported in other university students.

Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies.

BACKGROUND: The unprecedented worldwide crisis caused by the rapid spread of COVID-19 and the restrictive public health measures enforced by some countries to slow down its transmission have severely threatened the physical and mental wellbeing of communities globally. METHODS: We conducted a systematic review and meta-analysis to determine the prevalence of anxiety in the general population during the COVID-19 pandemic. Two researchers independently searched for cross-sectional community-based studies published between December 1, 2019 and August 23, 2020, using PubMed, WoS, Embase, and other sources (e.g., grey literature, manual search). RESULTS: Of 3049 records retrieved, 43 studies were included. These studies yielded an estimated overall prevalence of anxiety of 25%, which varied significantly across the different tools used to measure anxiety. Consistently reported risk factors for the development of anxiety included initial or peak phase of the outbreak, female sex, younger age, marriage, social isolation, unemployment and student status, financial hardship, low educational level, insufficient knowledge of COVID-19, epidemiological or clinical risk of disease and some lifestyle and personality variables. CONCLUSIONS: As the overall global prevalence of anxiety disorders is estimated to be 7.3% normally, our results suggest that rates of anxiety in the general population could be more than 3 times higher during the COVID-19 pandemic. These findings suggest a substantial impact on mental health that should be targeted by individual and population-level strategies.

Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use.

OBJECTIVE: Few data exist regarding the impact of antimicrobial stewardship programs on antifungal use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial stewardship program (ASP) focused on antifungal use. METHODS: During a 9-year period, we quarterly assessed antifungal consumption, incidence density of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression analysis of interrupted time series. RESULTS: A significant change in trend was observed for antifungal consumption, with a sustained reduction of -0.87% per quarter (95% confidence interval [CI], -1.36 -0.38, p < 0.001), accounting for a final reduction of -38.4%. The main reduction was produced in fluconazole, with a sustained reduction of -1.37% per quarter (95%CI, -1.96 -0.68, p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change in slope of -5.06% cases per 1000 OBDs per year (95%CI, -8.23 -1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (-6.36% deaths per 1000 OBDs per year; 95%CI, -13.45 -1.31, p = 0.09). CONCLUSIONS: This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia.

Clinical impact of an educational antimicrobial stewardship program associated with infectious diseases consultation targeting patients with cancer: Results of a 9-year quasi-experimental study with an interrupted time-series analysis.

OBJECTIVES: Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. However, their effectiveness or safety in immunocompromised hosts needs to be proved. METHODS: An ecologic quasi-experimental study was performed from January 2009 to June 2017 in the Oncology department of a tertiary-care hospital. A stable program of Infectious Diseases consultation (IDC) already existed at this unit, and an educational ASP was added in 2011. Its main intervention consisted of face-to-face educational interviews. Antibiotic consumption was assessed through quarterly Defined Daily Doses (DDD) per 100 occupied bed-days. Mortality was evaluated in patients with bloodstream infections through the quarterly incidence density per 1000 admissions, and the annual mortality rates at 7 and 30-days. Time-trends were analysed through segmented-regression analysis, and the impact of the ASP was assessed through before-after interrupted time-series analysis. RESULTS: Mortality significantly decreased throughout the study period (-13.3% annual reduction for 7-day mortality rate, p < 0.01; -8.1% annual reduction for 30-day mortality, p = 0.03), parallel to a reduction in antibiotic consumption (quarterly reduction -0.4%, p = 0.01), especially for broader-spectrum antibiotics. The before-after study settled a significant inflexion point on the ASP implementation for the reduction of antibiotic consumption (change in level 0.95 DDD, p = 0.71; change in slope -1.98 DDD per quarter, p < 0.01). The decreasing trend for mortality before the ASP also continued after its implementation. CONCLUSIONS: The combination of an ASP with IDC improved antibiotic use among patients with cancer, and was accompanied by a reduction of mortality of bacteraemic infections. Implementation of the ASP was necessary to effectively change antibiotic use.

Evaluation of the impact of a nationwide massive online open course on the appropriate use of antimicrobials.

Objectives: To evaluate the impact of a massive online open course (MOOC) design on the appropriate use of antimicrobial agents, to determine specific study areas with better learning outcomes and to identify weak points. Methods: A pre- and post-intervention study in the context of a training course on infectious diseases aimed at health professionals. We designed a questionnaire with 30 questions related to the management of infectious diseases in different clinical situations. Participants had to answer the questions based on their competencies and training for these situations. We analysed the scores obtained before and after the course and the resulting progress. In addition, an open response section was provided to enable a qualitative evaluation. Results: Two thousand one hundred and forty-eight health professionals were enrolled in the course. The questionnaire was completed before and after the course by 606 participants, mainly physicians (81.2%) and pharmacists (15.4%). The mean overall scores for the pre- and post-course questionnaires were 6.2 (SD 1.38) and 7.9 (SD 0.88), respectively (overall score increase = 1.8, SD 1.21, P < 0.001). A significant increase in self-assessment was detected (P < 0.001) for all the questions. Qualitative assessments were provided by 218 participants with 225 comments, most of which were very positive. Conclusions: The course with a MOOC design showed a great teaching capacity in the infectious diseases area for all the clinical situations analysed, notably in the management of severe infections with higher mortality. For future editions of this training activity, the need to include other infectious diseases, especially infections in primary care, was highlighted.

Systematic review of the efficacy of statins for the treatment of Alzheimer's disease.

Alzheimer's disease (AD) is the most common type of dementia. Recent studies have assessed the possibility of using statins as treatment for AD. However, their efficacy is not clear. In this study, we collected the most relevant information about the efficacy of statins for the treatment of AD. We conducted a systematic literature search using MEDLINE, EMBASE and The Cochrane Library. We included clinical trials, meta-analyses and systematic reviews that analysed the efficacy of statins in AD. We also extracted the characteristics and efficacy results of the studies selected. Of the 304 articles identified, 13 complied with the inclusion criteria. The scientific quality of studies was high and their results indicated that there were no significant differences in the main efficacy variables between statins and placebo treatment for AD. Therefore, according to the available scientific evidence, statins have not shown an improvement in cognition and do not appear to offer significant benefits to patients with AD.

The role of clinical pharmacists in the optimisation of medication prescription and reconciliation on admission in an emergency department.

OBJECTIVES: To describe a clinical pharmacist's (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission. METHODS: A 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected. RESULTS: The CP reviewed medications and medical orders of 1048 patients. 816 patients had home medication: 440 patients (53.9%) were correctly reconciled by the physician; 136 (16.7%) were reconciled by the physician with unintentional discrepancies; and 240 (29.4%) by the CP, with a higher percentage in patients admitted to surgical departments (χ2:38.698; P<0.001). Following pharmaceutical validation, 434 pharmaceutical interventions were performed. CONCLUSIONS: The presence of a CP in an ED could increase the detection of reconciliation errors and help resolve medication errors.

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis.

BACKGROUND: The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. METHODS: We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). RESULTS: A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, -216.8 defined daily doses per 1000 OBDs; 95% confidence interval, -347.5 to -86.1), and was sustained during subsequent years (average reduction, -19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, -.003 to .039) reverted toward a decreasing trend of -0.130 per quarter (change in slope, -0.029; -.051 to -.008), and so did the mortality rate (change in slope, -0.015; -.021 to -.008). CONCLUSIONS: This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

Clinical relevance of pharmacist intervention in an emergency department.

OBJECTIVES: To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity. METHODS: A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient. RESULTS: During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/p<0.001). CONCLUSIONS: In this single centre study, the clinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services.