[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.

Facial palsy after embolization with Squid® 12.

Endovascular procedures with liquid embolic agents such as ethylene-vinyl alcohol (EVOH) copolymers are indicated before surgical treatment of cervical paraganglioma. Consequently, these agents are now available as low viscosity formulations, one of which is Squid 12, which are demonstrating superior vascular penetration. Cases of facial paralysis secondary to embolization of cervical vascular lesions with classic embolic agents have been reported in the English literature, however, this complication has not been described with new generation options such as Squid 12.We describe the case of a 43-year-old patient with a left neck carotid paraganglioma. Embolization was performed under general anaesthesia before surgical excision. In the immediate postoperative period, the patient developed total left facial palsy. Since the imaging tests (Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)) and neurological examination showed no involvement of additional cranial nerves (CN), we hypothesise that the main cause of this complication is ischemia of the vasa nervorum of CN VII secondary to embolization. Almost six months later, the patient continues to present total facial paralysis (Grade VI House-Brackmann facial paralysis scale), and palsy of the left CN X and XII as a complication secondary to surgical resection of the paraganglioma.This case is relevant since it is the first clinical case of permanent facial paralysis secondary to embolization with Squid 12.

Real-world prevalence and consequences of potential drug-drug interactions in the first-wave COVID-19 treatments.

WHAT IS KNOWN AND OBJECTIVE: Initial treatment recommendations of COVID-19 were based on the use of antimicrobial drugs and immunomodulators. Although information on drug interactions was available for other pathologies, there was little evidence in the treatment of COVID-19. The objective of this study was to analyse the potential drug-drug interactions (pDDIs) derived from the medication used in COVID-19 patients in the first pandemic wave and to evaluate the real consequences of such interactions in clinical practice. METHODS: Cohort, retrospective and single-centre study carried out in a third-level hospital. Adult patients, admitted with suspected COVID-19, that received at least one dose of hydroxychloroquine, lopinavir/ritonavir, interferon beta 1-b or tocilizumab and with any pDDIs according to "Liverpool Drug Interaction Group" between March and May 2020 were included. The possible consequences of pDDIs at the QTc interval level or any other adverse event according to the patient's medical record were analysed. A descriptive analysis was carried out to assess possible factors that may affect the QTc interval prolongation. RESULTS AND DISCUSSION: Two hundred and eighteen (62.3%) patients of a total of 350 patients admitted with COVID-19 had at least one pDDI. There were 598 pDDIs. Thirty-eight pDDIs (6.3%) were categorized as not recommended or contraindicated. The mean value difference between baseline and pDDI posterior ECG was 412.3 ms ± 25.8 ms vs. 426.3 ms ± 26.7 ms; p < 0.001. Seven patients (5.7%) had a clinically significant alteration of QTc. A total of 44 non-cardiological events (7.3%) with a possible connection to a pDDI were detected. WHAT IS NEW AND CONCLUSION: The number of pDDIs in patients admitted for COVID-19 in the first pandemic wave was remarkably high. However, clinical consequences occurred in a low percentage of patients. Interactions involving medications that would be contraindicated for concomitant administration are rare. Knowledge of these pDDIs and their consequences could help to establish appropriate therapeutic strategies in patients with COVID-19 or other diseases with these treatments.

Evaluación de la satisfacción global de los pacientes connutrición enteral domiciliaria en la consulta de farmaciahospitalaria: estudio Satisfar-Ned / Evaluation of the global satisfaction of patients with home enteral nutritionat the hospital pharmacy consultation: study Satisfy-Ned

INTRODUCCIÓN: Conocer la opinión de los pacientes nos permite mejorar la calidad de los servicios prestados y los resultados en salud. OBJETIVOS: Evaluar la satisfacción de los pacientes que acuden a recoger nutrición enteral domiciliaria a la consulta del Servicio de Farmacia. Analizar los factores predictivos de una mayor satisfacción. MÉTODOS: Se realizó un estudio transversal en un hospital universitario (425 camas). Se diseñó un cuestionario autocumplimentable para medir la satisfacción de los pacientes ambulatorios con nutrición enteral domiciliaria en un servicio de farmacia del hospital. La satisfacción se midió mediante una escala de 1 a 10. Los índices de calidad percibida fueron analizados por un modelo de análisis de componentes utilizando la rotación de varimax. Para evaluar la relación entre la satisfacción global y los principales componente se realizó un análisis de regresión. RESULTADOS: Entre los meses de mayo-junio 2015, se realizaron 187 cuestionarios. La puntuación global de satisfacción fue de 7,3 (IC 95%: 5,1 a 9,4). El análisis de componentes puso de manifiesto que dos componentes explicaron el 64,4% de la varianza. El primero (CP1) contenía preguntas relacionadas con la adecuación de los recursos o servicios y el segundo (CP2), preguntas sobre la relación profesional-paciente. Se vio que una unidad adicional en CP2 está asociada con un aumento de 2,6 del riesgo de tener mayores puntuaciones de satisfacción. CONCLUSIONES: Nuestro estudio muestra que el grado de satisfacción de los pacientes es elevado. El factor que predice una mayor satisfacción de los pacientes con nutrición enteral domiciliaria es la atención ofrecida por los profesionales sanitarios

INTRODUCTION: The knowledge of the patients' opinions allows us to improve the quality of services provided, as well as health outcomes. OBJECTIVES: The objective of this study was to evaluate the factors leading to greater satisfaction among patients who come to pick up home enteral nutrition at the Pharmacy Service. METHODS: A cross-sectional study was conducted in a 425-bed university hospital. A self-fulfilling questionnaire was designed to measure patient satisfaction during may and june 2015. Global satisfaction was measured on a 1 to 10 scale. Indices of perceived quality were modelled through a principal component analysis using varimax rotation. The relationship between principal components and overall satisfaction was evaluated using regression analysis. RESULTS: A total of 187 questionnaires were collected. The overall satisfaction score was 7.3 (95% CI: 5.1 to 9.4). The analysis of components revealed two components that explained 64.4% of the variance. The first (CP1) contained questions related to the adequacy of resources and services and the second (CP2), questions about the professional-patient relationship. It was found that an additional unit in CP2 is associated with an increase of 2.6 in the risk of having higher satisfaction scores. CONCLUSIONS: Our study shows that the degree of patient satisfaction is high. The factor which predicts the satisfaction of patients on Enteral Nutricion is the care offered by health professionals

Medication list assessment in Spanish hospital emergency departments.

BACKGROUND: Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. OBJECTIVES: This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. METHODS: We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. RESULTS: We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. CONCLUSIONS: The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.

[Effect of pharmacologic treatment of the nutritional status of neurologic patients]. / Efecto del tratamiento farmacológico en el estado nutricional del paciente neurológico.

Clinical manifestations accompanying neurological diseases are diverse and affect multiple organs. Nutritional status of patients with certain neurological diseases such as stroke, Alzheimer's disease, Parkinson's disease, Epilepsy and Multiple Sclerosis can be altered because of symptoms associated with disease course, including certain micronutrient deficiency (folic acid, zinc, vitamin B6 and B12, vitamin D, vitamin E and vitamin C), changes in energy expenditure, intake decreased, gastrointestinal disorders and dysfunction of the bone mass. Also, we have to take in account other factors as: advanced age, multiple co morbidities, polypharmacy, the use of herbal products, social habits, diet and pharmacological treatments effect. An assessment of the factors related to neurological treatment that cause alterations in metabolic and nutritional status was performed: side effects of anti-Parkinson drugs, antiepileptic drugs, and multiple sclerosis drugs; drug-nutrient interactions; and nutrient-drug interactions.

Oclusión intestinal por fitobezoar recidivante: resolución con tratamiento no operatorio mediante celulasa / Intestinal obstruction caused by recurrent phytobezoar: resolved with non-surgical treatment with cellulose

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Efecto del tratamiento farmacológico en el estado nutricional del paciente neurológico / Effect of pharmacologic treatment of the nutritional status of neurologic patients

Las manifestaciones clínicas que acompañan a las enfermedades neurológicas son muy variadas, afectando a múltiples órganos. Los pacientes con ciertas patologías neurológicas como son el ictus, la enfermedad de Alzheimer, Parkinson, Epilepsia y Esclerosis Múltiple pueden ver su estado nutricional alterado a causa de determinados síntomas relacionados con el curso de la enfermedad, como el déficit de determinados micronutrientes (ácido fólico, zinc, vitaminas B6 y B12, vitamina D, vitaminas E y vitamina C), alteraciones del gasto energético, disminución de la ingesta, alteraciones gastrointestinales y disfunción de la masa ósea. A estas circunstancias, hay que añadir el efecto de otros factores: edad avanzada, múltiples comorbilidades, polifarmacia, la utilización de fitoterapia, hábitos sociales, la dieta y el efecto de los tratamientos farmacológicos (AU)

Clinical manifestations accompanying neurological diseases are diverse and affect multiple organs. Nutritional status of patients with certain neurological diseases such as stroke, Alzheimer’s disease, Parkinson’s disease, Epilepsy and Multiple Sclerosis can be altered because of symptoms associated with disease course, including certain micronutrient deficiency (folic acid, zinc, vitamin B6 and B12, vitamin D, vitamin E and vitamin C), changes in energy expenditure, intake decreased, gastrointestinal disorders and dysfunction of the bone mass. Also, we have to take in account other factors as: advanced age, multiple co morbidities, polypharmacy, the use of herbal products, social habits, diet and pharmacological treatments effect. An assessment of the factors related to neurological treatment that cause alterations in metabolic and nutritional status was performed: side effects of anti-Parkinson drugs, antiepileptic drugs, and multiple sclerosis drugs; drugnutrient interactions; and nutrient-drug interactions (AU)

[Pharmaceutical care strategies to prevent medication errors]. / Estrategias de atención farmacéutica para prevenir errores de medicación.

OBJECTIVE: To evaluate the impact of implementing new programs to improve the quality of the pharmaceutical care and unit-dose distribution system for in-patients. MATERIAL AND METHODS: An observational and prospective study was carried out in a general hospital during two different six-monthly period. Transcription and dispensation errors were evaluated in twelve wards during the first six months. Then, two new measures were introduced: the first- reference ward-pharmacist and the second-a new protocol for checking medication on the ward. Results were evaluated by SPSS v. 14 program. RESULTS: In the transcription evaluation, units without a ward pharmacist did not improve. Transcription errors significantly decreased in three units: gynaecology-urology (3.24% vs. 0.52%), orthopaedic (2% vs. 1.69%) and neurology-pneumology (2.81% vs. 2.02%). In dispensing, only units with the new protocol decreased their medication errors (1.77% vs. 1.24%). CONCLUSIONS: The participation of pharmacists in multidisciplinary teams and exhaustive protocols for dispensing medication were effective in detecting and decreasing medication errors in patients.

Estrategias de atención farmacéutica para prevenir errores de medicación / Pharmaceutical care strategies to prevent medication errors

Objetivo: Evaluar el impacto de medidas que mejoren la calidad de la atención farmacéutica y la distribución de medicamentos en pacientes hospitalizados. Material y métodos: Estudio observacional prospectivo en un hospital general. En 12 unidades de hospitalización, durante 2 semestres se recogieron los errores de medicación cometidos en los procesos de transcripción de prescripciones médicas y la dispensación de medicamentos en dosis unitarias. Tras 6 meses, se implantaron las medidas a evaluar: asignación de farmacéuticos de referencia y un nuevo protocolo de preparación/revisión de la medicación. Se realizaron análisis descriptivos y estadísticos (pruebas de la t de Student y ANOVA) de los resultados obtenidos mediante el programa SPSS versión 14. Resultados: En transcripción, ninguna unidad mejoró sin un farmacéutico de referencia. Los errores descendieron en 3 unidades de manera significativa: ginecología-urología (el3,24 frente al 0,52%), traumatología (el 2 frente al 1,69) y neurología-neumología (el2,81 frente al 2,02%). En dispensación, sólo disminuyeron de manera significativa en las unidades con nuevo protocolo (el 1,77 frente al 1,24%).Conclusiones: La integración del farmacéutico en equipos multidisciplinarios y protocolos seguros para dispensar medicamentos fueron medidas eficaces para detectar y reducir errores de medicación en pacientes hospitalizados (AU)

Objective: To evaluate the impact of implementing new programs to improve the quality of the pharmaceutical care and unit-dose distribution system for in-patients.Material and methods: An observational and prospective study was carried out in a university hospital during two different six-monthly period. Transcription and dispensation errors were evaluated in twelve wards during the first six months. Then, two new measures were introduced: the first- reference ward-pharmacist and the second-a new protocol for checking medication on the ward. Results were evaluated by SPSS v. 14 program. Results: In the transcription evaluation, units without a ward pharmacist did not improve. Transcription errors significantly decreased in three units: gynaecology-urology (3.24% vs.0.52%), orthopaedic (2% vs. 1.69%) and neurology-pneumology (2.81% vs. 2.02%). In dispensing, only units with the new protocol decreased their medication errors (1.77% vs. 1.24%). Conclusions: The participation of pharmacists in multidisciplinary teams and exhaustive protocols for dispensing medication were effective in detecting and decreasing medication errors in patients (AU)