Perceived quality of life by patients with immune-mediated inflammatory diseases treated with biological therapies. SACVINFA study.

OBJECTIVES: To evaluate health-related quality of life perceived by patients with the most prevalent immune-mediated inflammatory diseases in Spain: inflammatory bowel disease (IBD), psoriasis (Ps), psoriatic arthritis (AP), rheumatoid arthritis (RA), and spondyloarthropathies (SpAs), and to determine the factors that influence patient quality of life. METHODS: The SACVINFA study (SA=satisfaction, CV=quality of life, IN=immune-mediated, FA=pharmacy) consisted of an observational study conducted in 4 hospitals in the Community of Madrid. A cross-sectional analysis was made for adult patients diagnosed with an immune-mediated inflammatory disease who attended the Pharmacy Service. Quality of life was assessed using the EQ-5D-5L questionnaire (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and specific questionnaires: SIBDQ-9, DLQI, PsAQoL, QoL-RA, and ASQoL. RESULTS: A total of 578 patients were analysed (inflammatory bowel disease=25.3%; psoriasis=19.7%; spondyloarthropathies=18.7%; rheumatoid arthritis=18.5%; psoriatic arthritis=17.8%). The mean age (standard deviation) was 49.8 (12.3) years and 50.7% were male. The average score (standard deviation) for the global EQ-5D-5L was 0.771 (0.2) and the mean (standard deviation) visual analogue scale score was 71.5 (20.0). Type of immune-mediated inflammatory diseases was associated with differences in quality of life showing psoriasis and inflammatory bowel disease higher values of EQ5D-5L than psoriatic arthritis, rheumatoid arthritis, and spondyloarthropathies, p<.05 in all comparisons. Patients with RA, IBD, and Ps achieved 70% of the maximum score, while patients with PsA and SpAs did not reach 50% of the maximum possible score. Female gender, a state of moderate/severe disease severity, an older age, and a higher number of previous treatments were correlated with worse quality of life. Conversely, persistence to current treatment correlated with better quality of life. CONCLUSIONS: Patients with immune-mediated inflammatory diseases have markedly affected quality of life, mainly in the pain/discomfort dimension, especially in those immune-mediated inflammatory diseases with a rheumatological component.

Remdesivir and SARS-CoV-2 monoclonal antibodies to prevent COVID-19 progression in hematological patients: an observational study.

BACKGROUND: Patients with hematological malignancies (HM) are at high risk of COVID-19 progression. Hence, early treatments to prevent progression are needed. The aim of our work was to evaluate the effectiveness and safety of remdesivir (RDV) and SARS-CoV-2 monoclonal antibodies (mAb) in patients with HM and mild-to-moderate disease in real clinical practice. METHODS: We conducted a prospective study in a tertiary hospital in 55 HM patients with mild-to-moderate SARS-CoV-2 disease diagnosed between August 2021 and July 2022 and who received RDV or mAb to prevent COVID-19 progression (related death or hospitalization). The primary endpoint was COVID-19 progression on day 28. Other outcomes were COVID-19 progression beyond day 28 and viral load evolution. RESULTS: RDV was administered to 44 (80.0%) patients and mAb to 11 (20.0%) patients. Death occurred in 1 (1.8%) patient and hospitalization in 9 (16.4%) patients by day 28, respectively; 3 patients (5.5%) required intensive care and 8 (14.5%), oxygen support. Of note, 5 additional patients [15, (27.3%) in total] died or required hospitalization after day 28. Two hazard Cox regression models yielded the absence of anti-SARS-CoV-2 antibodies, age over 65 years, and ECOG-performance status ≥ 2 as the main risk factors for COVID-19-related death or hospitalization. CONCLUSION: Our results from clinical practice suggest that RDV and SARS-CoV-2 mAb therapies elicit worse outcomes in hematological patients than those reported for high-risk population in clinical trials.

Evaluation of the hospital care quality perceived by patients with immune-mediated inflammatory diseases from the pharmacy service. SACVINFA study.

WHAT IS KNOWN AND OBJECTIVE: Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and highly disabling diseases. The objective is to evaluate the satisfaction with the health care received by patients with the most prevalent IMIDs in Spain: inflammatory bowel disease (IBD), psoriasis (Ps) psoriatic arthritis (PsA), rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and to determine the factors that influence patient satisfaction. METHODS: This was an observational, cross-sectional, multicentre study in a real-world evidence context conducted in the Pharmacy Service in four hospital centres of the Community of Madrid that belong to the National Health System. The study included adult patients diagnosed with an IMID who had attended the Pharmacy Service at least three times. The patients were grouped according to the main IMID. Health care satisfaction was evaluated using the chronic patient experience assessment (IEXPAC) questionnaire. The responses to IEXPAC are grouped into three factors: productive interactions, new relational model and patient self-management, with a total score from 0 (worst) to 10 (best experience). Health-related quality of life (HRQoL) was also evaluated using the EQ-5D-5L questionnaire, and pharmacological adherence was evaluated through the Morisky-Green test. RESULTS AND DISCUSSION: A total of 578 patients were analysed (IBD = 25.3%; Ps = 19.7%; SpAs = 18.7%; RA = 18.5%; PsA = 17.8%). The mean age (SD) was 49.8 (12.3) years and 50.7% were male. The average score (SD) for the total IEXPAC sample was 6.6 (1.9). RA was the IMID with the lowest score, at 5.83 (2.0), significantly lower than the scores of Ps (SD) [7.01 (1.7); p = 0.003], IBD [6.83 (1, 9); p = 0.012] and SpAs [6.80 (1.6); p = 0.001]. Productive interactions (SD) [8.5 (1.8)] and patient self-management (SD) [7.3 (2.3)] were the factors with the highest scores, and the new relational model had the lowest score (SD) [3.2 (2.7)]. Male gender, a longer time interval between medication administrations and a higher HRQoL were correlated with better patient satisfaction. Current biological therapy (according to the Anatomical Chemical classification system) also had a significant influence; patients treated with tumour necrosis factor inhibitors and interleukin inhibitors showed greater satisfaction than those treated with selective immunosuppressants. WHAT IS NEW AND CONCLUSION: The IEXPAC results show high general satisfaction with care quality reported by patients with IMIDs treated in the Pharmacy Service. However, there are areas of improvement in care quality specially health professional-patient communication, such as increasing access to information, and promoting and facilitating relationships with patients in similar conditions.

[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.

Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study.

BACKGROUND: Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. OBJECTIVE: The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. METHODS: We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. RESULTS: With regard to drug safety, 73% (37/51) of the patients in the control group and 70% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2%), doubts about contraindications and interactions with OAAs (70/283, 24.7%), and consultations for adverse reactions to treatment (39/283, 13.8%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. CONCLUSIONS: Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group.

Evolution of nutritional status and survival in patients with cancer on tyrosine kinase inhibitors treatment. / Evolución nutricional y de la supervivencia en un grupo de pacientes oncológicos en tratamiento con inhibidores de tirosina quinasa.

BACKGROUND AND OBJECTIVE: Treatment with oral antineoplastic agents known as tyrosine kinase inhibitors (TKIs) is new and, thus, little is known about their impact on nutritional status (NS), dietary intake, quality of life, and survival. The aim of this study was to provide information on these components in order to guide future nutritional recommendations. PATIENTS AND METHOD: A prospective, observational study in adults who start treatment with TKIs, in whom NS was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), anthropometric measures, biochemical parameters, and dietary intake (24-hour dietary recall). The EORTC QLQ-C30 was used to assess quality of life. Nonparametric tests were used in statistical analysis, and survival was analyzed using Kaplan-Meier and log-rank curves. RESULTS: Of the overall sample, 21.7% had moderate malnutrition according to PG-SGA, and 74.2% moderate weight loss at 6 months, but no patient had BMI<18.5kg/m2. Patients with moderate malnutrition had lower survival at four years of diagnosis (log-rank=0.015). Energy intake was lower than recommended by the ESPEN 2017 congress, and no patient covered the protein requirements (1.5g protein/kg weight) during follow-up. A worse score on the global health scale of the EORTC QLQ-C30 was related to worse NS. CONCLUSIONS: Treatment with TKIs does not appear to have a significant impact on NS and quality of life after 6 months of follow-up. Malnutrition should be prevented through individualized nutritional advice because it is related to shorter survival.

Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital-Compounded Bags.

BACKGROUND: Parenteral nutrition (PN) is associated with material and manpower costs and requires preparation time. The aim of this study was to evaluate the cost of PN using multichamber bags (MCBs) compared with hospital-compounded bags (COBs). The secondary aim of this study was to assess and compare preparation time and errors related to the production and preparation processes of PN bags. MATERIALS AND METHODS: A prospective, observational, cost-accounting study was conducted in 10 Spanish hospital pharmacy services. The cost assessments included components, raw materials, and hospital staff. Only PN bags with equivalent volume and nutrition value were included in the analyses. Assessment of errors related to PN was performed simultaneously with the cost and time comparison analyses. RESULTS: Among the 597 PN bags (295 MCBs, 302 COBs) evaluated, 392 PN bags (295 MCBs, 97 COBs) had an equivalent volume and nutrition value. The mean (standard deviation) total cost of the MCB was $62.11 ($12.34) per bag compared with $67.54 ($8.50) per bag for COBs, resulting in a significant cost savings of $5.71. On average, the time required to prepare an MCB was 38 minutes shorter (P < .001). Significantly fewer total number (percent) of errors was observed in the preparation of MCBs (3 [1.0%]) compared with COBs (15 [5.0%]); P < .01). CONCLUSION: The use of MCBs results in significant savings in cost and preparation time, which may have a beneficial effect on the economic burden associated with PN as well as a reduction in errors related to PN preparation.

Polypharmacy and enteral nutrition in patients with complex chronic diseases / La polifarmacia del paciente crónico complejo y la nutrición enteral.

Oral medications are often administered through enteral feeding tubes in patients with complex chronic diseases. It is important to consider possible interactions between drugs and enteral nutrition that might lead to unsuccessful treatment or tube occlusion. These patients become subjects for higher risk of problems and errors such as drug incompatibility with enteral nutrition and inappropriate dosage form selection. It is possible to minimize the risk of tube occlusion and incompatibilities problems by recognizing potential medication errors, selecting the most appropriate drug and dosage form and using appropriate administration techniques. In this context, high-alert medications for patients with chronic diseases deserve special attention. Furthermore, risk exposure should be considered among healthcare professionals and patient caregivers handling hazardous drugs. Therefore, main incompatibility problems between drugs and enteral nutrition have been reviewed, including general recommendations for administration of oral medications through enteral feeding tubes and safe handling of hazardous drugs. Specific recommendations for administration of high-alert medications for patients with chronic diseases are also included.

Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account.

OBJECTIVE: To review interactions between oral antineoplastic agents (OAAs) for the treatment of solid and hematological tumors and common food and medicinal plants. MATERIALS AND METHODS: All potential interactions between OAAs, medicinal plants and food were reviewed. OAAs were considered to be drugs for oral administration that have direct antitumor activity and were approved by the European Medicines Agency in April 2015. We performed the literature search in Pubmed(®) considering only medicinal plants and food. In addition, available data were analyzed from each OAA in secondary data sources taken from Thomson Micromedex(®) and Lexi-comp(®), as well as in the summary of product characteristics. RESULTS: Fifty-eight OAAs were analyzed. We found interactions in 60.3 % of OAAs. Those with most interactions described were: imatinib and procarbazine (4 interactions) and erlotinib, vemurafenib, pomalidomide, medroxyprogesterone and methotrexate (3 interactions). MEDICINAL PLANTS: We found 39 interactions (74.4 % important). St. John's wort was the medicinal plant with most interactions (92.6 % were considered important). The rest were: important (ginseng-imatinib, methotrexate-cola and tobacco-erlotinib and tobacco-pomalidomide) and moderate (caffeine-vemurafenib/medroxyprogesterone, medroxyprogesterone-ruxolitinib/St. John's wort, garlic-anagrelide and ginseng-procarbazine). FOODS: Twenty-six interactions (61.5 % important). Grapefruit had most interactions (82.4 % were considered important). The rest were: important (alcohol-procarbazine) and moderate (dairy-estramustine, methotrexate-ethanol, procarbazine-tyramine, vitamin A-tretinoin/bexarotene and grapefruit-bexarotene/etoposide/sunitinib). CONCLUSION: A review of interactions of medicinal plants and food should be taken into account in the management of OAAs, since more than half have interactions with MPs and food, of which 70.3 % are considered important. The most relevant are HSJ, grapefruit, ginseng and tobacco. This review is intended to serve as a support to all healthcare professionals at the time of prescribing or dispensing OAAs.

Guiding pharmacist clinical interviews: a safety tool to support the education of patients treated with oral antineoplastic agents.

OBJECTIVE: Oral antineoplastic agents (OAA) lead to new challenges in patient education, monitoring, medication errors, drug interactions, adverse events management, and adherence. The aim is to develop a structured guide supporting pharmacist interviews and onco-hematologic outpatients' education process and to identify the key points that a pharmacist should address in order to increase OAA safety and efficacy. METHODS: A literature review was performed and the recommended standards associated with OAA approved by ASCO and MASCC were analyzed. Additionally, a multidisciplinary team was formed to address the key points associated with OAA in clinical practice and to create a useful clinical guide. RESULTS: The multidisciplinary team defined the safety and efficacy key points during patient education and issued recommendations regarding the following items: dose, drug administration, interactions, adverse events, adherence, literacy, quality of life, storage, and handling. A guide was created as a check-list in support of the pharmacist clinical interview. Implications for clinical practice, including adverse events management, drug interactions management, and interventions on adherence were added. CONCLUSION: This article provides a consensus set of safety recommendations regarding OAA in clinical practice and a well-researched easily implementable support guide to standardize and guarantee quality pharmaceutical care of onco-hematologic outpatients.

Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction.

BACKGROUND: Self-administration of oral chemotherapy regimens in the home setting leading to new challenges in the health system. OBJECTIVE: To develop and evaluate a comprehensive pharmaceutical care program for cancer outpatients treated with oral antineoplastic agents. SETTING: A Spanish tertiary hospital. METHODS: During 2012, a comprehensive pharmaceutical care program was elaborated following the standards recommended by ASCO. It comprised a standard procedure focusing on: drug indication, dosing regimen, required laboratory tests, route of administration, interactions with other current medications and adverse events; a checklist and informational brochures. A pharmaceutical follow up was defined and structured into three clinical interviews over 6 months which focused on safety and efficiency outcomes. Patients starting treatment with oral antineoplastic agents during 2011 (control group) without pharmacist monitoring were compared to patients beginning treatment at some point in 2013 who were prospectively monitored by a pharmacist (intervention group). Statistical analysis was performed by the statistical program SPSS, 21.0 and p < 0.05 was considered significant. MAIN OUTCOME MEASURES: Patient demographics and clinical data were recorded. The primary endpoint was safety outcomes: detection of drug related problems, drug interactions, and adverse events. Adherence, permanence and patient satisfaction were also collected. RESULTS: A total of 249 patients were enrolled in the study. Two hundred and seventy-five medication errors were recorded [106 in the control group and 169 in the intervention group (p = 0.008)]. The pharmacist intervened in 362 occasions being accepted 88.8 % of the time, mainly to reinforce patient education and literacy and giving information on co-administration with other drugs and herbal medicines. Adherent patients increased at the 6th month of treatment in the intervention group by 20 % (p < 0.001). High satisfaction was reported. CONCLUSION: The program has been implemented and evaluated successfully. It ensures a high quality and standard of pharmaceutical care with high patient satisfaction rate and the key points to prioritize for improvement in terms of safety (interactions and administration errors) and efficiency (adherence and permanence) of oral antineoplastic agents.

[DIETARY INTAKE AND NUTRITIONAL STATUS IN ONCOLOGY PATIENTS WHO START TREATMENT WITH TYROSINE KINASE INHIBITORS]. / INGESTA DIETÉTICA Y ESTADO NUTRICIONAL DE PACIENTES ONCOLÓGICOS QUE INICIAN TRATAMIENTO CON INHIBIDORES TIROSINA QUINASA.

BACKGROUND: in recent years, researching about new oral antineoplastics has progressed while its impact on dietary intake and nutritional status (NS) hasn't developed enough yet. OBJECTIVES: dietary intake and NS assessment in patients who start treatment with tyrosine kinase inhibitors (TKI) and evaluate its impact on them. METHODS: an observational, prospective-six-months study, in which were included patients starting treatment with TKI. The intake was evaluated by a 24 h dietary record and a food frequency questionnaire. The NS was evaluated by anthropometric measurements and the patient-generated Global Subjective Assessment (PG-GSA); the results were compared with the Spanish references (SENC-semFYC, 2007 and O. Moreiras, 2013). Friedman test, χ2, Wilcoxon, Kruskal-Wallis and Mann-Whitney were used in the statistical analysis. Significance p < 0.05. RESULTS: 22 patients (54.5% male) were included. At baseline, NS was adequate in 73.9% of patients according PG-GSA. Weight loss was no significant, although a high percentage of the energy and protein requirements hadn't been reached. The caloric intake was positively related with the number of meals. Dietary habits did not change during treatment. CONCLUSION: dietary intake did not reach nutritional requirements at baseline. The TKI don't seem to affect the patient's intake and nutritional status. The research about these parameters before starting treatment could prevent future complications and it would guide the dietary advice.

Introducción: la investigación sobre nuevos antineoplásicos orales sigue avanzando en los últimos años mientras que su repercusión sobre la ingesta dietética y el estado nutricional (EN) no progresa de la misma forma. Objetivos: evaluar la ingesta dietética y EN de pacientes que inician tratamiento con inhibidores tirosina quinasa (ITK) y valorar el impacto que tienen sobre ellos. Métodos: estudio observacional y prospectivo de seis meses en el que se incluyeron pacientes que iniciaban tratamiento con ITK. La ingesta se evaluó con: recuerdo 24 h y cuestionario de frecuencia de consumo. El EN se valoró con: medidas antropométricas y cuestionario de valoración subjetiva global generada por el paciente (VSGGP); los resultados se compararon con las referencias SENC-semFYC, 2007 y Moreiras O., 2013. Para el análisis estadístico se utilizaron: Test de Friedman, 2, Wilcoxon, Kruskall-Wallis y Mann-Whitney. Significación p < 0,05. Resultados: se incluyeron 22 pacientes (54,5% hombres). Al inicio del tratamiento, el 73,9% tenía un EN adecuado según VSG-GP. No se produjeron pérdidas de peso significativas, pese a que un porcentaje elevado no cubrió los requerimientos energéticos y proteicos. El número de comidas se relacionó positivamente con la ingesta calórica. La ingesta y los patrones de frecuencia de consumo por grupos de alimentos tampoco variaron durante el tratamiento. Conclusión: la ingesta dietética al inicio del tratamiento no alcanza los requerimientos nutricionales. Los ITK no parecen afectar la ingesta ni el estado nutricional de los pacientes. El estudio de estos parámetros antes de comenzar el tratamiento evitaría futuras complicaciones y guiaría el consejo dietético.

Effectiveness of an electronic tool for medication reconciliation in a general surgery department.

BACKGROUND: Medication reconciliation is a key tool in the prevention of adverse drug events. OBJECTIVE: To assess the impact of an electronic reconciliation tool in decreasing unintended discrepancies between medications prescribed after surgery and the patient's usual treatment. SETTING: General Surgery Department of Gregorio Marañón's University General Hospital, Madrid. METHOD: A pre-post intervention study with no equivalent control group was carried out between June 2009 and December 2010. Patients hospitalized in the General Surgery Department for 24 h or more, and whose prescriptions prior to admission included three or more drugs were included in the study. Patients were interviewed to gather information about their usual treatment drugs. Discrepancies between the latter and the drugs prescribed after surgery were assessed before and after the medication reconciliation electronic tool was implemented. MAIN OUTCOME MEASURE: Proportion of patients with at least one unintended discrepancy. RESULTS: A total of 107 patients in the pre-intervention phase and 84 patients in the post-intervention phase were included. We detected 1,678 discrepancies, 167 were found to be unintended. The number of patients with at least one unintended discrepancy was 43 (40.2 %) in the pre-intervention phase, and 38 (38.1 %) in the post-intervention phase, p = 0.885. The percentage of unintended discrepancies over the total amount of drugs reconciled was lower in the post-intervention phase than in the pre-intervention phase (6.6 vs. 10.6 %), p = 0.002. Regarding unintended discrepancies 79.2 % were grade C severity (the error reached the patient but caused no harm), 13.6 % grade D (the error reached the patient and required monitoring or intervention to preclude harm) and 7.1 % grade E (the error may have contributed to or resulted in temporary harm to the patient and required intervention). CONCLUSION: Implementation of an electronic tool facilitated the process of medication reconciliation in a general surgery unit. The proportion of unintended discrepancies over the total amount of drugs reconciled was reduced after the implementation of the reconciliation programme. However, we could not demonstrate a more significant impact due to some methodological limitations.

[Nutritional assessment and quality of life of oncology outpatients initiating treatment with tyrosine­kinase inhibitors]. / Seguimiento del estado nutricional y calidad de vida de pacientes que inician tratamiento con inhibidores tirosin kinasa.

BACKGROUND AND OBJECTIVE: The consumption of oral antineoplastics -and more particularly of tyrosine-kinase inhibitors (TKI)- has increased in recent years. These therapies show a better tolerance but still, the nutritional alterations related to their daily and chronic clinical use are under investigation. This study assesses the effects of TKI on the intake, nutritional status and micronutrients as well as the patients quality of life. METHODS: A prospective longitudinal study was conducted including adult patients having started some TKI treatment from July 2012 to June 2013, and a 6 month follow-up period was established. Demographic pharmacotherapeutic, nutritional and biochemical variables were collected and also a EORTC-QLQ30 questionnaire at baseline, first, third and sixth month of treatment. RESULTS: 31 patients were included in the study. The percentage of weight loss at treatment baseline was statistically matched to the results on the patient-generated Global Subjective Assessment. Appetite decreased after one month of treatment, and so did the calorie consumption; 62.1% of the patients lost weight, 55.5% on the third month and 70.6% on the sixth month. 6-17% of the patients suffered from malnutrition to some degree during the follow-up period and a decrease of calcium, phosphate and magnesium plasma levels was detected. The emotional scale was the one with a lowest score in EORTC QLQ-30, and fatigue and lack of appetite were the most common symptoms at treatment baseline, progressively increasing those of nausea, vomits and diarrhea. DISCUSSION: Patients treated with TKI did not show a relevant malnutrition. Considering the results, it is important to take into account weight loss at treatment baseline; it is also important to control calcium and phosphate levels during treatment, to advise and counsel the patient on the GI effects (nausea, vomits and diarrhea) and emotionally reinforce the patient.

Introducción y objetivo: El consumo de antineoplásicos orales y concretamente de inhibidores tirosin kinasa (ITK) se ha incrementado en los últimos años. Son terapias mejor toleradas y, sin embargo, las alteraciones nutricionales relativas a su uso clínico diario y crónico están aún en estudio. El presente estudio valora la repercusión de los ITK sobre la ingesta, estado nutricional y micronutrientes y valora la calidad de vida de estos pacientes. Métodos: Se realizó un estudio prospectivo y longitudinal en el que se incluyeron aquellos pacientes adultos que iniciaron tratamiento con algún ITK de julio 2012 a junio 2013 con un periodo de seguimiento de 6 meses. Se recogieron variables demográficas, farmacoterapéuticas, nutricionales, bioquímicas y el cuestionario EORTC-QLQ30 al inicio, primer, tercer y sexto mes de tratamiento. Resultados: Se incluyeron 31 pacientes. El porcentaje de pérdida de peso al inicio del tratamiento se relacionó estadísticamente con la clasificación de la Valoración Subjetiva Global-generada por el paciente. Tras un mes de tratamiento descendió el apetito, las calorías consumidas y un 62,1% de los pacientes perdió peso, 55,5% al tercer mes y 70,6% al sexto mes. Entre un 6-17% de los pacientes sufría algún grado de desnutrición durante el seguimiento y se detectó una disminución de los niveles plasmáticos de calcio, fosfato y magnesio. En el EORTC QLQ-30, la escala emocional fue la peor puntuada y los síntomas más comunes al inicio de tratamiento fueron la fatiga y pérdida de apetito, aumentando progresivamente las náuseas, vómitos y la diarrea. Discusión: Los pacientes tratados con ITK no presentaron una desnutrición importante. A la vista de los resultados es importante valorar la pérdida de peso al inicio de tratamiento, monitorizar los niveles de calcio y el fosfato durante el tratamiento, aconsejar y prevenir al paciente sobre los efectos gastrointestinales (náuseas, vómitos y diarrea) y reforzar emocionalmente al paciente.

[Home parenteral nutrition; satisfaction of patients and their caregivers with nutrition unit and pharmacy service]. / Nutrición parenteral domiciliaria: satisfacción de los pacientes y sus cuidadores con la unidad de nutrición clínica y el servicio de farmacia.

INTRODUCTION: Home Parenteral Nutrition (HPN) is a practice in continually growing by the significant advantages involved for the patient and the healthcare system. Today, in the investigation of health outcomes is essential to assess the patient s opinion. Among the measures focused on patients with HPN, several studies about quality of life have been done, but the degree of satisfaction with this treatment modality has not been evaluated. OBJECTIVE: To evaluate the degree of satisfacion of patients and their caregivers receiving HPN with doctors, pharmacists and nurses in a hospital. MATERIAL AND METHODS: An anonymous survey was distributed, which consisted of 48 closed questions to patients and their caregivers receiving HPN who voluntarily answered. With survey responses a database in SPSS with the following variables was created: personal, sociocultural, clinical and related to HPN data and valoration of health personnel involved (nutrition area of the Pharmacy Service and Nursing and Medical Nutrition Units) and hospital facilities related to HPN. Also a section of open response suggestions was included. RESULTS: 24 surveys were distributed, 12 to patients and 12 to caregivers. Response rate was 91.7% in the case of patients and 58.3% in the caregivers. 63.6% of patients and 42.9% of caregivers were women. Mean age was, respectively, 46.1 years (SD: 13.7) and 47.0 years (SD: 3.6). Most of patients (55.6%) and caregivers (60.0%) had secondary studies and were pensoniers (72.7% and 71.4%, respectively). Underlying diseases of patients were: radiation enteritis (27.3%), intestinal obstruction (18.2%), intestinal carcinomatosis (45.5%) and Chron s disease (9.1%). With respect to items assessing satisfaction with physicians, nurses and pharmacists, in general both patients and caregivers were satisfied. Suggestions made were: greater amplitude of delivery schedule of HPN and inclusion of audiovisual information. CONCLUSIONS: The degree of satisfaction of patients receiving HPN and their caregivers with the care given by doctors, pharmacists and nurses is appropriate, but it s possible to make improvements to optimize the quality of the whole process.

Introducción: La Nutrición Parenteral Domiciliaria (NPD) es una práctica en continuo crecimiento por las importantes ventajas que presenta para el paciente y el sistema sanitario. En la investigación de los resultados en salud resulta hoy en día fundamental evaluar el punto de vista del paciente. Dentro de las medidas centradas en el paciente con NPD se han realizado varios estudios sobre la calidad de vida, pero no se ha evaluado el grado de satisfacción con esta modalidad de tratamiento. Objetivos: Evaluar el grado de satisfacción de los pacientes que reciben NPD y sus cuidadores con los médicos, farmacéuticos y enfermeros de hospital. Métodos: Se repartió una encuesta anónima y que constaba de 48 preguntas cerradas a los pacientes que recibían NPD y a sus cuidadores, los cuales contestaron de forma voluntaria. Con las respuestas recogidas se creó una base de datos en el programa SPSS con las siguientes variables: datos personales, socioculturales, clínicos y relacionados con la NPD y valoración del personal sanitario implicado (área de nutrición del Servicio de Farmacia y Unidades Médica y de Enfermería de Nutrición) y de las instalaciones del hospital relacionadas con la NPD. También se incluyó un apartado de sugerencias con respuesta abierta. Resultados: Se repartieron 24 encuestas, 12 a pacientes y 12 a cuidadores. La tasa de respuesta fue un 91,7% en el caso de los pacientes y un 58,3% en los cuidadores. El 63,6% de los pacientes y el 42,9% de los cuidadores eran mujeres. La media de edad fue, respectivamente, 46,1 años (DE: 13,7) y 47,0 años (DE: 3,6). La mayoría de los pacientes (54,5%) y de los cuidadores (42,9%) tenían estudios secundarios y eran pensionistas (72,7% y 71,4%, respectivamente). Las enfermedades de base de los pacientes fueron: enteritis rádica (27,3%), obstrucción intestinal (18,2%), carcinomatosis intestinal (45,5%) y enfermedad de Crohn (9,1%). Con respecto a los ítems que evaluaban la satisfacción con médicos, enfermeros y farmacéuticos, en general tanto pacientes como cuidadores estuvieron satisfechos. Las sugerencias recogidas fueron: mayor amplitud del horario de entrega de la NPD e inclusión de información audiovisual. Conclusiones: El grado de satisfacción de los pacientes que reciben NPD y sus cuidadores con el servicio dado por médicos, enfermeros y farmacéuticos es adecuado, aunque se pueden introducir mejoras para optimizar la calidad de todo el proceso.