Optimización del circuito de medicación de Farmacia a Hospitalización a Domicilio en un hospital urbano / Optimization of the medication circuit from Pharmacy to Hospital at Home in a urban hospital

Introducción: Se detectaron severas ineficiencias en los circuitos entre el Servicio de Far-macia Hospitalaria (SFH) y el Servicio de Hospitalización a Domicilio (HAD), lo que motivó la realización de un análisis, con el soporte de Calidad, y la definición e implementación posterior de varias acciones de mejora. Método: Análisis del flujo de medicación entre los SFH y HAD del Hospital Dos de Maig. Los objetivos propuestos fueron reducir las interrupciones a los profesionales, aumentar la eficiencia de los circuitos, y garantizar la disponibilidad de la medicación. Se identificaron ineficiencias en el sistema de solicitud y dispensación de medicación, y desajustes en la dotación y revisión del stock. Se acordó un cambio de modelo de dispensación, se ajustó la dotación del stock, se agilizaron las revisiones del mismo, y se aplicó una nueva herramienta de solicitud vía informática de medicación. Resultados: El equipo de HAD consiguió mayor autonomía, se redujeron las interrupciones entre ambos servicios y la dispensación ganó en seguridad. La dispensación global de fármacos fuera de stock disminuyó en un 61%, y los técnicos del SFH ganaron casi media hora diaria. Conclusiones: El cambio en la logística entre el SFH y HAD ha sido muy positivo, obteniendo unos logros importantes, que repercuten positivamente en la organización y en la seguridad del paciente, con un flujo de medicación más fluido y eficiente, y el registro sistemático de las entregas que incrementa la seguridad en la dispensación. (AU)

Introduction: Severe inefficiencies were detected in the circuits between the Hospitalary Pharmacy Service (HPS) and the Home Hospital at Home Service (HaH), which led to an analysis, with the support of Quality, and the defini-tion and subsequent implementation of various improvement actions. Method: Analysis of the flow of medication between HPS and HaH at Hospital Dos de Maig. The proposed objectives were to reduce interruptions to professionals, increase the efficiency of circuits, and ensure the availability of medi-cation. Inefficiencies were identified in the sys-tem of requesting and dispensing medication, and mismatches in the supply and review of the stock. A change of dispensation model was agreed, the stock was adjusted, revisions of the same were expedited, and a new application tool was applied via computer medication. Results: The HaH team achieved greater au-tonomy, interruptions between both services were reduced and dispensing became safer. The overall dispensing of out-of-stock drugs de-creased by 61%, and HPS technicians gained almost half an hour a day.Conclusions: The change in logistics between HPS and HaH has been very positive, obtaining important achievements, which have a posi-tive impact on the organization and the safety of the patient, with a flow of medications more fluid and efficient, and the systematic recording of deliveries which increases the security of dispensing.

Malnutrition is associated with postoperative complications in elderly patients undergoing total hip arthroplasty.

INTRODUCTION: Malnutrition in elderly patients with hip fracture has been described as a factor associated with poor outcomes. This evidence for elderly patients undergoing elective total hip arthroplasty (THA) for osteoarthritis is not well-established. METHODS: We retrospectively studied a cohort of patients with an age ≥65 years admitted to the hospital for THA between January 2018 and December 2020. Demographic characteristics were collected. Albumin and total lymphocyte count were included in the pre-operative analysis and 24h postoperatively. Nutritional screening was carried out 24h postoperatively. GLIM criteria were applied for the diagnosis of malnutrition. RESULTS: 25 patients out of the total cohort of 65 (38.4%) were malnourished. Five out of six patients (83.3%) with postoperative complications presented malnutrition compared with 20 of 59 patients (33.8%) without postoperative complications (P=0.028). Mean length of stay (LOS) was 3.49±0.88 days. Five out of six (83.3%) patients with postoperative complications presented LOS >3 days compared with one out of six patients (16.6%) with LOS ≤3 days (P=0.009). 26 patients (40%) were referred to a community health centre, no differences in diagnosis of malnutrition were detected compared with patients who were discharged home. Patients with a diagnosis of malnutrition were significantly older, had a lower body mass index (BMI), a lower preoperative and postoperative albumin and worse anthropometric parameters. CONCLUSIONS: Malnutrition is associated with postoperative complications and longer LOS in elderly patients with elective THA. Risk factors for malnutrition are older age and low BMI.

Influence of free fatty acid content and degree of fat saturation on production performance, nutrient digestibility, and intestinal morphology of laying hens.

This study was conducted to evaluate the effects of dietary free fatty acid (FFA) content and degree of fat saturation on production performance, lipid and calcium digestibility, and intestinal function of laying hens. For a 15-week period, a total of 144 laying hens (19 weeks old) were randomly assigned to 8 dietary treatments, which were obtained by gradually replacing crude soybean oil with soybean acid oil (AO), or crude palm oil with palm fatty acid distillate (FAD). Thus, there were 4 soybean and 4 palm diets with 6% added fat varying in their FFA percentage (10%, 20%, 30%, and 45%), following a 2 × 4 factorial design. Each treatment included 6 replicates with 3 birds per replicate. Average daily feed intake and final body weight were significantly higher in palm diets (P < 0.001), while no differences were found in egg mass and feed conversion ratio. Higher levels of FFA in soybean diets resulted in lower egg production and higher egg weight (linear, P < 0.01). Regarding the degree of fat saturation, hens fed soybean diets presented higher digestibility of ether extract (EE), fatty acids, and calcium than palm diets (P < 0.001). The dietary FFA percentage negatively affected the digestibility of EE and calcium (P < 0.01), while having little effect on FA digestibility. There was a significant interaction in the AME; lower values were reported in soybean diets as the dietary FFA percentage increased (linear, P < 0.01), whereas palm diets remained unaffected. The experimental diets had little effect on gastrointestinal weight and length. However, the jejunum of soybean diets showed higher villus height and higher villus height-to-crypt depth ratio than palm diets (P < 0.05), and the dietary FFA percentage increased the crypt depth and decreased the villus height-to-crypt depth ratio (linear, P < 0.05). It was concluded that varying dietary FFA content did not affect fat utilization as much as the degree of saturation did, supporting the use of AO and FAD as alternative fat ingredients.

Effects of Orange Pulp Conservation Methods (Dehydrated or Ensiled Sun-Dried) on the Nutritional Value for Finishing Pigs and Implications on Potential Gaseous Emissions from Slurry.

The inclusion of orange pulp (OP) in pig diets may promote the circular economy, but drying procedures might influence its nutritional value and environmental impact. The purpose of this study was to determine the energy value and nutrient digestibility of dehydrated (DOP) and ensiled sun dried (ESDOP) orange pulp. The potential ammonia (NH3) and methane (CH4) emissions derived from slurry were also measured. Digestible energies of 14.2 and 13.2 MJ/kg DM for DOP and ESDOP, respectively, were estimated by difference after a 500 g/kg substitution of a basal diet with OPs. A high fiber digestion efficiency was observed for both OPs. Pigs fed the basal diet showed a higher intake and a greater excretion of urine N than pigs fed with OP, but fecal N excretion did not differ among diets. A higher benzoic and hippuric acid content in urine was observed in OP than in basal diet. Altogether, these findings explained a lower pH in slurry of OP diets and a reduction of potential NH3 emissions. The biochemical CH4 potential also decreased, especially with ESDOP. Overall, both OP are relevant sources of energy for pig diets. Their inclusion in feeds generate favorable changes of slurry characteristics that reduce potential NH3 and CH4 emissions.

Degree of Saturation and Free Fatty Acid Content of Fats Determine Dietary Preferences in Laying Hens.

Behavioural and genetic evidence shows that the taste system is intimately related to the sensing of nutrients with consequences for poultry nutrition practices. A better understanding of how chickens may sense fat could provide the background for selecting feedstuffs used in poultry feeds. Acid oils have the potential to be economical and sustainable feedstuffs. These fat by-products from the edible oil refining industry possess a similar fatty acid composition to the crude oils but are richer in free fatty acids (FFA). An experiment was conducted to study the effect of FFA content and the unsaturated:saturated ratio (U:S) on dietary preferences in hens. Four fat sources were added to a basal diet at an inclusion rate of 6%, determining the experimental diets: soybean oil (SO; high U:S, 5% FFA); soybean acid oil (SA; high U:S, 50% FFA); palm oil (PO; low U:S, 5% FFA); and palm fatty acid distillate (PFAD; low U:S, 50% FFA). The experimental diets were offered in a series of double-choice tests to forty-eight Lohmann Brown laying hens housed individually in cages. Each hen was offered the ten potential binary combinations of the four diets including each diet compared to itself (referred to as four control double-choices). Feed intake was measured for two hours twice a day after one hour of fasting. Consumption was analysed as a standard preference index (% of test diet intake in comparison with the total intake). Preference values were compared to the random choice value of 50% using the Student's t-test. None of the four control comparisons differ significantly from 50% (p > 0.05), indicating that the changes in preference values observed in the other binary comparisons were related to the dietary changes associated to fat ingredients. Hens showed a feed preference for palm oil added diets over soybean oil diets (p < 0.05), with PO and PFAD being equally preferred (p < 0.05). However, in this trial the hens demonstrated a preference for SO (low %FFA) when offered in choice with SA (high %FFA) (p < 0.05). These results suggest that the degree of saturation plays an important role in dietary fat preferences: hens prefer predominantly saturated oils even when these are rich in FFA. Furthermore, when presented with a choice between predominantly unsaturated oils, hens prefer feed with a low %FFA. In conclusion, %FFA and the U:S ratio affected feed preferences in hens. The use of oils with greater preference values may give rise to greater feed palatability, enhancing feed intake at critical stages.

Amino acid availability in ruminants of cereals and cereal co-products.

BACKGROUND: Microbial corrected in situ estimates of the ruminal undegraded fraction (RU) and intestinal effective digestibility (IED) of amino acids (AA), except tryptophan, of rye, wheat and corn grains, wheat bran, wheat and barley distilled dried grains and corn gluten feed were measured on three rumen- and duodenum-cannulated wethers using (15)N-labelling techniques and considering ruminal rates of particle comminution and outflow. RESULTS: The lack of microbial correction led to overestimations of the intestinal digested fraction that rose with the increase in ruminal degradability. Thus these overestimations varied widely among feeds (from 4.3 to 32.1% for total analysed AA) and among AA. Digestion led to large changes in the AA supply that were greater in the rumen than in the intestine. The impact of these changes on the protein value is conditioned by the magnitude of the undegraded protein fraction. CONCLUSION: Microbial contamination taking place in the rumen and changes in the AA supply with digestion should be considered to attain accurate estimates of AA digestion. Globally, digestion improved the AA supply in rye, wheat and wheat distilled dried grain and decreased it in corn and corn gluten feed by reducing the supply of valine and basic AA, especially lysine.

Effects of the comminution rate and microbial contamination of particles in the rumen on in situ estimates of protein and amino acid digestion of expeller palm kernel and rapeseed meal.

BACKGROUND: Microbial corrected effective in situ estimates of ruminal undegraded fraction (RU) and intestinal effective digestibility (IED) of dry matter (DM), crude protein (CP) and amino acids (AA) of expeller palm kernel (EPK) and rapeseed meal (RSM) were measured on three rumen- and duodenum-cannulated wethers using ¹5N labelling techniques and considering ruminal rates of comminution (k(c)) and outflow (k(p)) of particles. RESULTS: The lack of k(c) and microbial correction overestimated the RU of DM by 4.91% (EPK) and 9.88% (RSM). The lack of this correction also overestimated in both feeds the RU of CP, individual and total (TAA) AA as well as the IED of DM, CP, TAA and most AA. RU estimates were higher for CP than for TAA, but the opposite was observed for IED. The intestinal digested fraction was higher for CP than for TAA: 17.4% (EPK) and 13.8% (RSM). Digestion led to large changes in the essential AA profile in both feeds. CONCLUSION: The lack of k(c) and microbial correction as well as CP-based results leads to considerable overestimations in the protein use of both feeds. Digestion aggravates the lysine deficiency of EPK but has global positive effects in the absorbed profile of RSM.