Intervention by a clinical pharmacist carried out at discharge of elderly patients admitted to the internal medicine department: influence on readmissions and costs.

BACKGROUND: Patient education on pharmacological treatment could reduce readmissions. Our objective was to carry out a pharmacist intervention focused on providing information about high-risk medications to chronic patients and to analyse its influence on readmissions and costs. METHODS: A single-centre study with an intervention group and a retrospective control group was conducted. The intervention was carried out in all polymedicated patients ≥ 65 years who were admitted to internal medicine and signed the informed consent between June 2017 and February 2018. Patients discharged to nursing homes or long-term hospitals were excluded. The control group were all the patients who were admitted during the same months of 2014 who met the same inclusion criteria. The patients were classified according to the HOSPITAL score as having a low, intermediate, or high risk of potentially avoidable readmission. Outcome measures were 30-day readmission and cost data. To analyse the effect of the intervention on readmission, a logistic regression was performed. RESULTS: The study included 589 patients (286 intervention group; 303 control group). The readmission rate decreased from 20.13% to 16.43% in the intervention group [OR = 0.760 95% CI (0.495-1.166); p = 0.209)]. The incremental cost for the intervention to prevent one readmission was €3,091.19, and the net cost saving was €1,301.26. In the intermediate- and high-risk groups, readmissions were reduced 10.91% and 10.00%, and the net cost savings were €3,3143.15 and €3,248.71, respectively. CONCLUSIONS: The pharmacist intervention achieved savings in the number of readmissions, and the net cost savings were greater in patients with intermediate and high risks of potentially avoidable readmission according to the HOSPITAL score.

Subcutaneous versus intravenous administration of trastuzumab: preference of HER2+ breast cancer patients and financial impact of its use.

PURPOSE: To investigate the preference of HER2+ breast cancer patients and nursing professionals for subcutaneous (SC) versus intravenous (IV) trastuzumab and to evaluate the financial impact derived from the use of the SC formulation. METHODS: A cross-sectional questionnaire-based study was carried out to investigate preferences of all patients who started treatment with SC trastuzumab while they had received the IV formulation before. The preference of nursing staff in charge of preparation and administration was also analysed. The financial impact was evaluated considering the number of preparations of SC trastuzumab and the cost of IV and SC trastuzumab, the consumables used for preparation and administration and nursing staff time for preparation. RESULTS: 76 female patients were included, 84% completed the questionnaire. Of the patients, 94% declared to be satisfied with the SC route and 88% would prefer SC administration if they had to choose between IV and SC. Time saving was the main reason to justify satisfaction and preference (48 and 45% respectively). The most common adverse event related to SC trastuzumab was post-injection pain in the injection site, experienced by 77% of the patients. SC trastuzumab was preferred by 100% of the nursing staff. Total annual savings using SC formulation instead of the IV were 35.332€. CONCLUSIONS: SC trastuzumab is preferred by patients and the nursing staff versus the IV administration. The use of SC trastuzumab reduced the cost derived from trastuzumab administration.

Design of mobile and website health application devices for drug tolerability in hereditary fructose intolerance.

BACKGROUND: Hereditary fructose intolerance (HFI) is a rare metabolic disease caused by aldolase B deficiency. The aim of our study was to analyse excipient tolerability in patients with HFI and other related diseases and to design mobile and website health applications to facilitate the search for drugs according to their tolerance. RESULTS: A total of 555 excipients listed in the Spanish Medicines Agency database (July 2023) were classified as suitable for HFI patients, suitable with considerations ((glucose and glucose syrup, intravenous sucrose, oral mannitol, polydextrose, gums and carrageenans, ethanol, sulfite caramel and vanilla), not recommended (intravenous mannitol) and contraindicated (fructose, oral sucrose, invert sugar, sorbitol, maltitol, lactitol, isomaltitol, fruit syrups, honey, sucrose esters and sorbitol esters). Glucose and glucose syrup were classified as suitable with considerations due to its possible fructose content and their potential endogenous fructose production. For other related intolerances, wheat starch was contraindicated and oatmeal was not recommended in celiac disease; oral lactose and lactose-based coprocessed excipient (Cellactose®) were not recommended in lactose intolerance; and glucose, invert sugar and oral sucrose were not recommended in diabetes mellitus. The applications were named IntoMed®. Results are listed in order of tolerability (suitable drugs appear first and contraindicated drugs at the end), and they are accompanied by a note detailing their classified excipients. If a drug contains excipients within different categories, the overall classification will be the most restrictive. The apps are also able to classify substances with the same criteria if they act as active ingredients. The tools exhibited good usability (82.07 ± 13.46 points on the System Usability Scale [range: 0-100]) on a sample of HFI patients, their families and health care professionals. CONCLUSIONS: IntoMed® is a tool for finding information about the tolerability of drugs according to excipients for patients with HFI and other related intolerances, with good usability. It is a fast and reliable system that covers the current excipient legislation and expands on it with other specific information: HFI patients should be alert for excipients such as mannitol (especially in intravenous drugs), fruit syrups, honey, sulfite caramel or vanilla. Glucose might contain or produce fructose, and special precaution is needed because of potential errors in their composition.

Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study.

OBJECTIVES: To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital. DESIGN AND SETTING: Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain. PARTICIPANTS: All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020. RESULTS: A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0-81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51-71); 74.1% men; median length of stay 9 days (IQR 5-19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6-14). CONCLUSIONS: This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity.

[Precipitation limits in pediatric parenteral nutritions with organic sources of calcium and phosphate]. / Límites de precipitación en nutriciones parenterales pediátricas con fuentes de calcio y fosfato orgánicas.

OBJECTIVE: to determine if precipitation processes occur in parenteral nutrition solutions (PNs) with calcium gluconate and sodium glycerophosphate in the precipitation threshold limits of the Spanish SENPE/SEGHNP/SEFH 2008 consensus document of PN preparation. METHODS: seven PNs with different composition were prepared in triplicate: five 100 ml PNs with different concentrations of amino acids, calcium and phosphorus similar to consensus document maximum concentrations for precipitation, and two control PNs: one without calcium and phosphorus and other with high calcium and phosphorus content and low concentration of amino acids. All PNs did not contain lipids to allow correct detection of precipitates. The no lipid PNs were stored at room temperature for 20 hours, and at 35 °C for four hours. Subsequently, they filtered through a 0.2 µm filter, which was observed by electron microscopy. Because a large amount of not expected precipitates was observed, complementary studies were carried out. RESULTS: precipitates were observed in all PNs except in the control solution without calcium and phosphorus; many of them were greater than 10 µm. However, according to our studies, these crystals were produced after filtration and calcium was found in their composition, but not phosphorus. Particles from the preparation of parenteral nutrition were also observed. CONCLUSIONS: in our study we did not find calcium phosphate precipitates in the limits included in the consensus document SENPE/SEGHNP/ SEFH. However, it is possible that micro precipitates with calcium are formed. It is important to filter PNs prior to their administration.

OBJETIVO: conocer si hay precipitación en nutriciones parenterales (NP) con gluconato cálcico y glicerofosfato sódico en las cantidades límites del documento de consenso español de preparación de nutrición parenteral SENPE/SEGHNP/SEFH 2008. MÉTODOS: se prepararon por triplicado siete NP: cinco de 100 ml con concentraciones de aminoácidos, calcio y fósforo similares a las concentracionesmáximas de precipitación del documento consenso SENPE/SEGHNP/SEFH y dos controles, uno sin calcio y fósforo y otro con alto contenido de calcio y fósforo y baja concentración de aminoácidos. Las NP no contenían lípidos. Las NP se almacenaron 20 horas a temperatura ambiente y cuatro horas a 35 °C, y se filtraron con un filtro de 0,2 micras. Estos filtros se transportaron y observaron parcialmente por microscopía electrónica. Los cristales observados se analizaron por espectrometría por dispersión de rayos X a 1.000 aumentos. Al observarse gran cantidad de precipitados, que no se correspondían a los estudios publicados, se realizaron estudios complementarios para conocer su origen. RESULTADOS: en todos los casos, a excepción del control sin calcio y fósforo, se observaron precipitados. Sin embargo, estos cristales, según nuestros estudios, se produjeron después de la filtración y en su composición está el calcio, pero no el fósforo. También se observaron partículas provenientes de la preparación de nutrición parenteral. CONCLUSIONES: en nuestro estudio no encontramos precipitados de fosfato cálcico en los límites recogidos en el documento consenso SENPE/SEGHNP/SEFH. Sin embargo, es posible que se formen microprecipitados con calcio en su composición. Es importante fi ltrar las NP previamente a su administración.