Proyecto Trazam: aplicación móvil para la trazabilidad de preparaciones elaboradas en un servicio de farmacia / Trazam project: A mobile application for the tracking of compounded preparations in a Pharmacy Department

Introducción el objetivo principal es describir el diseño e implementación de una aplicación para dispositivos móviles para facilitar el seguimiento de las preparaciones elaboradas en el servicio de farmacia hospitalaria. Los objetivos secundarios fueron evaluar el tiempo dedicado a la resolución de incidencias relacionadas con la dispensación/distribución de las preparaciones pre y postimplantación de la aplicación, conocer el grado de satisfacción de los usuarios y disponer de información cualitativa y cuantitativa del proceso que permita establecer indicadores de seguimiento. Métodos se definieron los requisitos a cumplir por el aplicativo informático, los fármacos susceptibles de entrar en el sistema y los circuitos de entrega. Se procedió al desarrollo de la aplicación por parte del proveedor e integración con los programas informáticos de prescripción/validación. Se crearon y añadieron los códigos QR de identificación en los puntos de entrega de medicamentos en las unidades de destino. Se adquirieron los dispositivos móviles necesarios. Primera etapa de formación de usuarios en la aplicación y prueba piloto en una planta de hospitalización. Posteriormente se inició la fase de expansión y consolidación. Resultados el 86,9% de las preparaciones estériles elaboradas en el servicio de farmacia hospitalaria se han incorporado al sistema, incluyendo quimioterapia, nutriciones parenterales de adultos y otras preparaciones estériles no peligrosas. Se han incluido en la aplicación las salas de hospitalización, los hospitales de día y 2 sedes externas. La media de preparaciones trazadas mensualmente es de 5.403 (DE = 297,3) (AU)

Introduction The primary objective of this study is to describe the design and implementation of a mobile application (App) for tracking preparations compounded in the Pharmacy Department. Secondary objectives include evaluating the time spent on resolving incidents related to the distribution of preparations before and after implementation, assessing users satisfaction with the application, and establishing a panel of quality indicators based on the data extracted from the App. Methods Defining application requirements, identifying drugs to be included in the software and outlining different workflows. Developing the App in collaboration with the supplier and integrating it with the computer programs involved in prescription and validation. Additionally, QR codes were created to identify delivery points at destination units, and suitable mobile devices were acquired. The initial phase involved user training in the application and a pilot test conducted in a hospital ward. The subsequent phase focused on expansion and consolidation. Results The system includes 86.9% of all sterile preparations prepared in the Hospital Pharmacy, encompassing chemotherapy, adult parenteral nutrition, and other non-hazardous sterile preparations. Furthermore, the application has been implemented in all hospitalization wards, day care units and two external sites. On average, 5,403 preparations were tracked per month (SD = 297.3). The time required to address incidents related to the distribution of preparations has decreased by 83% (from 38.9 to 6.6 minutes per day). The App regularly provides valuable management data for optimizing workflow in the compounding area. Additionally, users have expressed satisfaction with the application (AU)

Benznidazole-induced drug reaction with eosinophilia and systemic symptoms syndrome in a patient with human leucocyte antigen (HLA)-A*68.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe drug hypersensitivity reaction with potentially life-threatening consequences. It is characterised by fever, extensive maculopapular exanthema, lymph node enlargement, abnormal blood cell counts, and organ-related complications. Diagnosis can be challenging due to incomplete or non-specific symptoms, and it can sometimes manifest as a purely systemic disease. Discontinuation of the causative drug is essential. Treatment may involve corticosteroids and supportive care. Genetic screening for specific markers, such as human leucocyte antigen (HLA)-A*68, A11:01, and A29:02, can help identify individuals at risk for severe reactions to benznidazole, a drug used to treat Chagas disease. This case report describes the rarity and severity of DRESS syndrome, underscoring the potential benefit of genetic screening to prevent adverse reactions in patients with Chagas disease.

Trazam project: A mobile application for the tracking of compounded preparations in a Pharmacy Department. / Proyecto Trazam: aplicación móvil para la trazabilidad de preparaciones elaboradas en un servicio de farmacia.

INTRODUCTION: The primary objective of this study is to describe the design and implementation of a mobile application (App) for tracking preparations compounded in the Pharmacy Department. Secondary objectives include evaluating the time spent on resolving incidents related to the distribution of preparations before and after implementation, assessing users satisfaction with the application, and establishing a panel of quality indicators based on the data extracted from the App. METHODS: Defining application requirements, identifying drugs to be included in the software and outlining different workflows. Developing the App in collaboration with the supplier and integrating it with the computer programs involved in prescription and validation. Additionally, QR codes were created to identify delivery points at destination units, and suitable mobile devices were acquired. The initial phase involved user training in the application and a pilot test conducted in a hospital ward. The subsequent phase focused on expansion and consolidation. RESULTS: The system includes 86.9% of all sterile preparations prepared in the Hospital Pharmacy, encompassing chemotherapy, adult parenteral nutrition, and other non-hazardous sterile preparations. Furthermore, the application has been implemented in all hospitalization wards, day care units and two external sites. On average, 5,403 preparations were tracked per month (SD = 297.3). The time required to address incidents related to the distribution of preparations has decreased by 83% (from 38.9 to 6.6 minutes per day). The App regularly provides valuable management data for optimizing workflow in the compounding area. Additionally, users have expressed satisfaction with the application. DISCUSION: The proposed application enables hospital staff to easily and intuitively track preparations compounded in the pharmacy, irrespective of the computer program used for prescription. It has significantly reduced the need for manual record-keeping and has mitigated incidents associated with the distribution of sterile preparations.

Assessment of the change of antiemetic prophylaxis from double to triple combination in patients with high dose carboplatin chemotherapy.

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) is one of the adverse events that most affects oncologic patients' quality of life. Carboplatin AUC ≥ 4 belongs to agents with high emetic risk (moderate risk in ASCO guidelines). We aimed to compare the effectiveness of netupitant/palonosetron and dexamethasone triple combination (TC) therapy versus ondansetron and dexamethasone double combination (DC) therapy as antiemetic prophylaxis in patients with carboplatin AUC ≥ 4. As a secondary endpoint, in TC group we evaluated the effectiveness of changing NEPA administration timing from 1 h to 15 min before chemotherapy. METHODS: Open-label prospective study conducted in a tertiary-care hospital in patients receiving carboplatin AUC ≥ 4. CINV was evaluated using MASCC antiemetic tool, in acute (<24 h) and delayed phase (24-120 h). Results were analyzed using χ2 test. RESULTS: Two-hundred four completed questionnaires (CQ) were analyzed (76 in DC and 128 in TC). The proportion of patients who remained emesis-free was superior for TC-treated group compared to DC, either in acute (99.2% vs 92.1%, p = 0.0115) and delayed phase (97.6% vs 90.7%, p = 0.043). Likewise, a higher proportion of TC-treated patients compared to DC remained nausea-free for the first 24 h after treatment (90.6% vs 71%, p = 0.0004) and between 24 and 120 h (82.3% vs 62.7%, p = 0.0025). The change of NEPA administration time showed similar effectiveness in terms of CINV control (81.6% vs 74.5%, p = 0.70). CONCLUSIONS: TC showed superiority in early and delayed CINV control in carboplatin AUC ≥ 4 regimens, with no significant differences among cancer types. Change in NEPA administration timing has beneficial implications; it allows NEPA to be administered at hospitals before chemotherapy session.

Predictive performance of glomerular filtration rate equations based on cystatin C, creatinine and their combination in critically ill patients.

OBJECTIVE: 24-hour urine creatinine clearance (ClCr 24 hours) remains the gold standard for estimating glomerular filtration rate (GFR) in critically ill patients; however, simpler methods are commonly used in clinical practice. Serum creatinine (SCr) is the most frequently used biomarker to estimate GFR; and cystatin C, another biomarker, has been shown to reflect GFR changes earlier than SCr. We assess the performance of equations based on SCr, cystatin C and their combination (SCr-Cyst C) for estimating GFR in critically ill patients. METHODS: Observational unicentric study in a tertiary care hospital. Patients with cystatin C, SCr and ClCr 24 hours measurements in ±2 days admitted to an intensive care unit were included. ClCr 24 hours was considered the reference method. GFR was estimated using SCr-based equations: Chronic Kidney Disease Epidemiology Collaboration based on creatinine (CKD-EPI-Cr) and Cockcroft-Gault (CG); cystatin C-based equations: CKD-EPI-CystC and CAPA; and Cr-CystC-based equations: CKD-EPI-Cr-CystC. Performance of each equation was assessed by calculating bias and precision, and Bland-Altman plots were built. Further analysis was performed with stratified data into CrCl 24 hours <60, 60-130 and ≥130 mL/min/1.73 m2. RESULTS: We included 275 measurements, corresponding to 186 patients. In the overall population, the CKD-EPI-Cr equation showed the lowest bias (2.6) and best precision (33.1). In patients with CrCl 24 hours <60 mL/min/1.73 m2, cystatin-C-based equations showed the lowest bias (<3.0) and CKD-EPI-Cr-CystC was the most accurate (13.6). In the subgroup of 60≤ CrCl 24 hours <130mL/min/1.73 m2, CKD-EPI-Cr-CystC was the most precise (20.9). However, in patients with CrCl 24 hours ≥130mL/min/1.73 m2, cystatin C-based equations underestimated GFR, while CG overestimated it (22.7). CONCLUSIONS: Our study showed no evidence of superiority of any equation over the others for all evaluated parameters: bias, precision and Lin's concordance correlation coefficient. Cystatin C-based equations were less biased in individuals with impaired renal function (GFR <60 mL/min/1.73 m2). CKD-EPI-Cr-CystC performed properly in patients with GFR from 60-130 mL/min/1.73 m2 and none of them were accurate enough in patients ≥130 mL/min/1.73 m2.

Review of Drug Storage Conditions, A Case Report.

High temperatures during the summer season are a very important factor to be considered due to their possible influence on drug stability and effectiveness. This is especially important in those patients included in clinical trials, polymedicated or with long-term pharmacological therapies.

Evaluation of desensitization protocols to betalactam antibiotics.

WHAT IS KNOWN AND OBJECTIVE: Betalactam antibiotics are the most frequent cause of hypersensitivity reactions. Rapid drug desensitization (RDD) is a technique that induces temporary tolerance to a drug allowing a patient to receive the optimal agent. The increased use of RDD and the lack of standardization among available protocols in terms of formulation, starting dose, number of steps and dosing frequency make it essential to determine the safety and appropriate management of these protocols, especially regarding reconstitution, diluents, stability and drug administration in order to guarantee reproducibility. We reviewed betalactam desensitization protocols in a tertiary hospital, in accordance with currently published practices and evaluated its use on patients over a period of three years. METHODS: (a) We performed a literature search in PubMed, MEDLINE and Google Scholar databases for case reports and/or systematic reviews describing desensitization protocols for betalactam antibiotics. Pharmacokinetic parameters and physicochemical stability were checked for each antibiotic. (b) We retrospectively reviewed inpatients undergoing our antibiotic desensitization protocols from February 2018 to January 2021. Data and outcomes of desensitization procedures were analysed. RESULTS: We developed nine RDD protocols: meropenem, ceftriaxone, ceftazidime, ampicillin, ceftolozane/tazobactam, cloxacillin, piperacillin/tazobactam, amoxicillin/clavulanate and penicillin G sodium. Five antibiotics have RDD protocols for two different doses, adjusted to patients with impaired renal function. Detailed data (diluent, total dose, volume, concentrations, duration and stability) of the protocol of each antibiotic used are provided. 28 desensitizations were performed in 17 patients, three of them with confirmed allergies by skin test. 26 out of 28 (92.9%) of them were successfully completed, including those three with positive skin results. The pathogens most frequently involved were E. faecalis and P. aeruginosa; both frequently associated with bacterial resistance. Meropenem, ceftriaxone and ceftazidime were the antibiotics most desensitized. 25 out of 26 (96.1%) procedures were successful in resolving the infection. WHAT IS NEW AND CONCLUSIONS: Detailed information about compounding, dilution and stability is crucial to ensure safe and successful desensitization processes, as well as good coordination between the Allergy and Pharmacy departments. The increase in bacterial resistance to many of the commercially available antibiotics limits the therapeutic options for treating multidrug-resistant infections; in those situations, antibiotic desensitization may be a key therapeutic option. Although there is a broad consensus in limiting the use of RDD to patients with confirmed allergy, in usual clinical practice its application in those strongly suspected of having type I hypersensitivity is still observed. Our betalactam desensitization protocols have shown themselves to be safe and effective, as evidenced by data from the 17 patients on whom they have been tested.

Mejora de calidad del área de pacientes externos mediante participación del paciente y metodología Lean

Objetivo: Mejorar la calidad del proceso de dispensación y atenciónfarmacéutica a pacientes externos mediante la participación del pacientey la aplicación de la metodología Lean y analizar los resultados obtenidos en cuanto a eficiencia e impacto en la satisfacción de los pacientes.Método: Estudio observacional, prospectivo y unicéntrico. Se creó ungrupo de trabajo con los diferentes profesionales implicados en la atención al paciente externo para aplicar la metodología Lean y detectaroportunidades de mejora. Para conocer la experiencia del paciente seutilizó la técnica del grupo focal. El impacto en la satisfacción de lospacientes se midió mediante encuestas de satisfacción que se enviaron através del correo electrónico en diciembre de 2019 (antes de implantarlas principales medidas) y en diciembre de 2020.Resultados: Teniendo en cuenta la perspectiva de los pacientes yde los profesionales sanitarios, se identificaron más de 30 acciones demejora de las que se priorizaron 9, relacionadas fundamentalmente concambios estructurales y de circuitos. Se consiguió mejorar significativamente los tiempos de espera (el 35% de los pacientes esperaban másde 30 minutos frente al 4,5% en el análisis realizado después de lasintervenciones). Los aspectos que mostraron diferencias estadísticamentesignificativas en las encuestas entre los dos periodos fueron el tiempo de espera y la satisfacción global, en ambos casos el grado de satisfacciónfue superior una vez implantadas las acciones de mejora. (AU)

Objective: To improve the quality of the dispensing process and pharmaceutical care in the Outpatient Pharmacy through patient participationand Lean methodology, and to analyse the results obtained in terms ofefficiency and patient satisfaction.Method: Prospective observational single-centre study. A working groupwas organized with the health care staff involved in outpatient care toapply Lean methodology and detect improvement opportunities. Weused a focus group technique to understand the patients’ experience. Theimpact on patient satisfaction was measured through a mass survey mailed out in December 2019 (before introducing the main measures) and inDecember 2020.Results: More than 30 improvement actions were identified after surveying the opinions of the patients and health care staff involved. Nineactions were prioritized, which were mainly related to structural andcircuit changes. Waiting times significantly improved (35% of patientswaited for more than 30 minutes before the improvement actions vs4.5% afterward). The results showed that waiting times and overall satisfaction significantly improved in the period between the two surveys. Inboth cases, the degree of satisfaction was higher after introducing theimprovement actions. (AU)

Stability of 5% vancomycin ophthalmic solution prepared using balanced salt solution after freezing for 90 days.

PURPOSE: To evaluate the stability of 5% vancomycin ophthalmic solution prepared using balanced salt solution (BSS) and stored at -20°C in polypropylene containers. METHODS: Six batches of vancomycin 50 mg/mL eyedrops were aseptically prepared. One bottle of each batch was analyzed immediately after preparation, and the rest were stored at -20°C and analyzed using high-performance liquid chromatography (HPLC) at 30, 60, and 90 days to test their physicochemical stability and sterility. Thereafter, bottles were removed from the freezer and stored at 5°C for 30 days, with HPLC and other analyses repeated 105 and 120 days after preparation. All samples were analyzed in triplicate. Stability was defined as the absence of particles, color variation, or changes in pH and a remaining vancomycin concentration of 90% to 110% of the initial concentration. The sterility of the ophthalmic solution was evaluated by using soybean-casein digest broth with resins; samples were incubated for 7 days and checked daily for signs of microbial growth. RESULTS: There was no particle formation or sign of precipitation in any of the solutions throughout the duration of the study, regardless of the storage conditions. No change in color or turbidity was observed. The pH and osmolarity remained unchanged during storage at -20°C and after thawing. The vancomycin concentration remained within 10% of the initial concentration during the 90-day period of storage at -20°C and the subsequent 30 days after thawing. Sterility was preserved in all samples. CONCLUSION: A 5% solution of vancomycin prepared using BSS was physicochemically and microbiologically stable when stored at -20°C for 90 days. After thawing, this extemporaneous formulation remained stable when refrigerated at 5°C for 30 days.

Dose banding of intravenous ganciclovir: Banding scheme proposal and audit of toxicity and efficiency.

WHAT IS KNOWN AND OBJECTIVE: Dose banding is a strategy to optimize processing without reducing patient safety. Prescribed doses are rounded up or down to predetermined standard doses. Although it has been mostly used in chemotherapy, other drugs are suitable for this strategy, such as the antiviral ganciclovir. The aim of this work is to assess the safety and efficiency of a dose-rounding system for intravenous ganciclovir. METHODS: Dose bands were established for a maximum of 10% variation from the individualized dose. The number of annual preparations that expired before use and the number of ganciclovir vials saved were documented as indicators of efficiency. Toxicity was assessed comparing haematological parameters before and after ganciclovir treatment in a sample of patients who received doses above the theoretical dose (n = 121) and in the rest of the cohort (n = 129). RESULTS AND DISCUSSION: Five ganciclovir standard doses were established. It was shown that the bulk of the preparations (83.7%) had a maximum variation between the exact dose prescribed and the adjusted dose of ±10%. Three years after its implementation, a mean of 2848 annual preparations were compounded. The average percentage of annual expired preparations was lower than 1% of the total compounded doses, and the dose-rounding system allowed for saving 699 manufactured ganciclovir vials annually. There was no significant difference between haemoglobin and leucocyte levels measured before and after ganciclovir treatment in both groups. WHAT IS NEW AND CONCLUSION: Ganciclovir dose banding allows for efficient management of preparations without an increased risk of acute haematological side effects.

Continuous learning through platforms.

The health crisis situation we have experienced caused by the SARSCoV-2 virus  has changed our daily life in numerous aspects, including those related to  training (undergraduate, postgraduate, and continuing education, etc). Training  activities, conferences, lectures, face-to-face workshops were suspended until  the Health Situation was over. Alternatives to face-to-face training were needed  to guarantee the continuity of these activities. Online training, teaching and  evaluation emerged as a relatively fast, simple, operational and flexible solution. Universities and faculties promoted online teaching through virtual  classes. The Spanish Society of Hospital Pharmacy supported this initiative by  signing an agreement with the Board of Deans and Chancellors of Pharmacy to  make it possible for undergraduate students to continue their studies and  supervised practices in hospital pharmacy departments. Specialized training was  affected. Pharmacy residency programs were significantly modified by hospital  pharmacies to be able to provide the new clinical and research activities  required, everyday, by the pandemic situation. Postgraduate and residency  training were also negatively affected. Again, online activities made up for  restrictions to face-to-face teaching and training. The Spanish Society of Hospital Pharmacy promoted continuing education and provided updated information on  the SARS-CoV-2 virus through its website. Thus, numerous virtual sessions,  lectures and webinars have been held, and high-quality material was offered to  provide up-todate knowledge, on the pharmacological management of patients  with COVID-19. Online teaching and education has demonstrated to be an  invaluable tool for hard times. During the lockdown, technology has kept us  closer and has emerged as an ally. Many of us have found a new means of  communication, information, and training. The Spanish Society of Hospital  Pharmacy has substantially contributed to make it possible.

La situación de crisis sanitaria que hemos vivido con motivo de la pandemia causada por el virus SARS-CoV-2 ha cambiado nuestro día a día en muchos aspectos, incluidos los relacionados con nuestra formación (de  pregrado, especializada, continuada, etc.). Se suspendieron las actividades docentes, congresos, charlas y talleres presenciales hasta la  resolución de la situación sanitaria. Era necesario buscar alternativas a la  presencialidad que garantizasen la continuidad de estas actividades. La  formación, docencia y evaluación en línea se presentaba como una solución  relativamente rápida, sencilla, operativa y flexible. Desde las universidades y  facultades se promovía la docencia en remoto con material docente y clases  virtuales. La Sociedad Española de Farmacia Hospitalaria ha facilitado esta  iniciativa al firmar un convenio con la Conferencia de Decanos de Farmacia para  que estudiantes matriculados en Prácticas tuteladas, y en formación en un  servicio de farmacia hospitalaria, pudieran seguir con sus estudios de pregrado. La formación especializada resultó afectada. Los planes de formación de los farmacéuticos internos residentes requirieron cambios  importantes por la necesidad de dar respuesta desde los servicios de farmacia a  las nuevas actividades asistenciales y de investigación que se producían, cada día de manera cambiante, en la situación de pandemia. La formación continuada de los especialistas (y residentes) quedó también alterada. De nuevo, las  actividades en línea permitieron salvar, en cierto grado, el déficit de actividades  docentes y formativas. A través de su página web, la Sociedad Española de  Farmacia Hospitalaria promovió la formación continuada y el seguimiento de la  actualidad sobre la pandemia por el virus SARS-CoV-2; organizó sesiones  virtuales, jornadas y talleres en formato webinar y proporcionó material de alta  calidad que facilitaba el conocimiento, en tiempo real, de la gestión del  tratamiento farmacológico en pacientes con COVID-19. La aplicación de la  docencia y formación en línea ha demostrado ser una herramienta  imprescindible en tiempos complicados, como los vividos. Durante el  confinamiento, la tecnología nos ha acercado y se ha convertido en la gran  aliada. También ha supuesto el descubrimiento, para muchos de nosotros, de  una nueva manera de comunicarnos, informarnos y formarnos. La Sociedad  Española de Farmacia Hospitalaria ha colaborado de manera importante a que  esto sea así.

Formación continuada a través de plataformas / Continuous learning through platforms

La situación de crisis sanitaria que hemos vivido con motivo de la pandemia causada por el virus SARS-CoV-2 ha cambiado nuestro día a día en muchos aspectos, incluidos los relacionados con nuestra formación (de pregrado, especializada, continuada, etc.). Se suspendieron las actividades docentes, congresos, charlas y talleres presenciales hasta la resolución de la situación sanitaria. Era necesario buscar alternativas a la presencialidad que garantizasen la continuidad de estas actividades. La formación, docencia y evaluación en línea se presentaba como una solución relativamente rápida, sencilla, operativa y flexible. Desde las universidades y facultades se promovía la docencia en remoto con material docente y clases virtuales. La Sociedad Española de Farmacia Hospitalaria ha facilitado esta iniciativa al firmar un convenio con la Conferencia de Decanos de Farmacia para que estudiantes matriculados en Prácticas tuteladas, y en formación en un servicio de farmacia hospitalaria, pudieran seguir con sus estudios de pregrado. La formación especializada resultó afectada. Los planes de formación de los farmacéuticos internos residentes requirieron cambios importantes por la necesidad de dar respuesta desde los servicios de farmacia a las nuevas actividades asistenciales y de investigación que se producían, cada día de manera cambiante, en la situación de pandemia. La formación continuada de los especialistas (y residentes) quedó también alterada. De nuevo, las actividades en línea permitieron salvar, en cierto grado, el déficit de actividades docentes y formativas. A través de su página web, la Sociedad Española de Farmacia Hospitalaria promovió la formación continuada y el seguimiento de la actualidad sobre la pandemia por el virus SARS-CoV-2; organizó sesiones virtuales, jornadas y talleres en formato webinar y proporcionó material de alta calidad que facilitaba el conocimiento, en tiempo real, de la gestión del tratamiento farmacológico en pacientes con COVID-19. La aplicación de la docencia y formación en línea ha demostrado ser una herramienta imprescindible en tiempos complicados, como los vividos. Durante el confinamiento, la tecnología nos ha acercado y se ha convertido en la gran aliada. También ha supuesto el descubrimiento, para muchos de nosotros, de una nueva manera de comunicarnos, informarnos y formarnos. La Sociedad Española de Farmacia Hospitalaria ha colaborado de manera importante a que esto sea así

The health crisis situation we have experienced caused by the SARS-CoV-2 virus has changed our daily life in numerous aspects, including those related to training (undergraduate, postgraduate, and continuing education, etc). Training activities, conferences, lectures, face-to-face workshops were suspended until the Health Situation was over. Alternatives to face-to-face training were needed to guarantee the continuity of these activities. Online training, teaching and evaluation emerged as a relatively fast, simple, operational and flexible solution. Universities and faculties promoted online teaching through virtual classes. The Spanish Society of Hospital Pharmacy supported this initiative by signing an agreement with the Board of Deans and Chancellors of Pharmacy to make it possible for undergraduate students to continue their studies and supervised practices in hospital pharmacy departments. Specialized training was affected. Pharmacy residency programs were significantly modified by hospital pharmacies to be able to provide the new clinical and research activities required, everyday, by the pandemic situation. Postgraduate and residency training were also negatively affected. Again, online activities made up for restrictions to face-to-face teaching and training. The Spanish Society of Hospital Pharmacy promoted continuing education and provided updated information on the SARS-CoV-2 virus through its website. Thus, numerous virtual sessions, lectures and webinars have been held, and high-quality material was offered to provide up-to-date knowledge, on the pharmacological management of patients with COV I D -19. Online teaching and education has demonstrated to be an invaluable tool for hard times. During the lockdown, technology has kept us closer and has emerged as an ally. Many of us have found a new means of communication, information, and training. The Spanish Society of Hospital Pharmacy has substantially contributed to make it posible

Situación actual del farmacéutico de hospital en las unidades de cuidados intensivos a nivel nacional / Nationwide current situation of hospital pharmacists in intensive care units

Objetivo: Describir la situación actual del farmacéutico de hospital en las unidades de cuidados intensivos, su actividad asistencial, docente e investigadora. Método: Estudio multicéntrico, prospectivo mediante encuesta difundida por la Sociedad Española de Farmacia Hospitalaria, la cual constaba de varios apartados: datos personales y del hospital, características del hospital, implicación del farmacéutico en la unidad de cuidados intensivos y docencia. Resultados: Se obtuvieron 58 encuestas completadas. El número de farmacéuticos implicados en unidades de cuidados intensivos era 1 en el 77,6% de los casos, atendiendo una media de 30,8 camas (5-70). La experiencia en la unidad de cuidados intensivos del farmacéutico fue de 5 años de mediana (2 meses-25 años). La asistencia al pase de visita o cambios de guardia fue entre "nunca" en un 36,2% a "diariamente" en un 22,4%. El 93,1% de los encuestados reportaron dedicación a tiempo parcial en la unidad de cuidados intensivos. Respecto a actividades desarrolladas, entre el 40-60% gestiona estupefacientes, docencia en unidad de cuidados intensivos, conciliación y seguridad; entre el 60-80% abarca nutrición clínica, protocolización, optimización de antibióticos y farmacocinética, y un 84,5% realizan seguimiento farmacoterapéutico. Un 77,6% cuenta con formación sanitaria especializada, rotando los residentes en la unidad de cuidados intensivos en un 86% de los casos. Conclusiones: La mayor parte de los hospitales encuestados cuenta con un solo farmacéutico a tiempo parcial en estas unidades. Con objeto de mejorar la calidad de la atención farmacéutica del paciente crítico sería necesario ampliar la dedicación en tiempo y personal respecto a la situación actual y que más centros incluyan al farmacéutico en las unidades de cuidados intensivos hospitalarias

Objective: To describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching and in research. Method: Multicenter and prospective study through a survey disseminated by the Spanish Society of Hospital Pharmacy, which consisted of several sections: personal and hospital's data, hospital's characteristics, pharmacist's involvement in intensive care units and teaching. Results: A number of 58 completed surveys were obtained. The number of pharmacists involved in intensive care units was 1 in 77.6% of cases, assisting an average of 30.8 beds (5-70). Experience of pharmacists in the intensive care unit was 5 years on average (2 months-25 years). Visitor's pass assistance and shift changes were between "never" by 36.2% to "daily" by 22.4%. Out of respondents, 93.1% reported a part-time intensive care unit involvement. Regarding activities undertaken, between 40-60% of pharmacists manage narcotics, teaching at intensive care unit, conciliation and safety. Between 60-80%, pharmacists cover clinical nutrition, notarization, optimization of pharmacokinetics and antibiotics; and 84.5% perform pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6% have specialized medical training, rotating intensive care unit residents in 86% of cases. Conclusions: Most of the surveyed hospitals have one part-time pharmacist in these units. In order to improve the quality of pharmaceutical care of critically ill patients, it would be necessary to extend the involvement in time and staff, regarding the current situation, and a greater number of hospitals should include pharmacists in hospital intensive care units

Nationwide current situation of hospital pharmacists in intensive care units.

OBJECTIVE: To describe the current situation of the hospital pharmacist in intensive care units and their activity in care, in teaching  and in research. METHOD: Multicenter and prospective study through a survey  disseminated by the Spanish Society of Hospital Pharmacy, which  consisted of several sections: personal and hospital's data, hospital's  characteristics, pharmacist's involvement in intensive care units and  teaching. RESULTS: A number of 58 completed surveys were obtained. The  number of pharmacists involved in intensive care units was 1 in 77.6%  of cases, assisting an average of 30.8 beds (5-70). Experience of  pharmacists in the intensive care unit was 5 years on average (2  months-25 years). Visitor's pass assistance and shift changes were  between "never" by 36.2% to "daily" by 22.4%. Out of respondents,  93.1% reported a part-time intensive care unit involvement. Regarding  activities undertaken, between 40-60% of pharmacists manage  narcotics, teaching at intensive care unit, conciliation and safety.  Between 60-80%, pharmacists cover clinical nutrition, notarization,  optimization of pharmacokinetics and antibiotics; and 84.5% perform  pharmacotherapy follow-up. Out of the surveyed pharmacists, 77.6%  have specialized medical training, rotating intensive care unit residents  in 86% of cases. CONCLUSIONS: Most of the surveyed hospitals have one part-time  pharmacist in these units. In order to improve the quality of  pharmaceutical care of critically ill patients, it would be necessary to  extend the involvement in time and staff, regarding the current  situation, and a greater number of hospitals should include pharmacists  in hospital intensive care units.

Objetivo: Describir la situación actual del farmacéutico de hospital en las unidades de cuidados intensivos, su actividad asistencial, docente  e investigadora.Método: Estudio multicéntrico, prospectivo mediante encuesta  difundida por la Sociedad Española de Farmacia Hospitalaria, la cual  constaba de varios apartados: datos personales y del hospital,  características del hospital, implicación del farmacéutico en la unidad de  cuidados intensivos y docencia.Resultados: Se obtuvieron 58 encuestas completadas. El número de farmacéuticos implicados en unidades de cuidados intensivos era 1  en el 77,6% de los casos, atendiendo una media de 30,8 camas (5-70).  La experiencia en la unidad de cuidados intensivos del farmacéutico fue  de 5 años de mediana (2 meses-25 años). La asistencia al pase de visita  o cambios de guardia fue entre "nunca" en un 36,2% a  "diariamente" en un 22,4%. El 93,1% de los encuestados reportaron  dedicación a tiempo parcial en la unidad de cuidados intensivos.  Respecto a actividades desarrolladas, entre el 40-60% gestiona  estupefacientes, docencia en unidad de cuidados intensivos, conciliación  y seguridad; entre el 60-80% abarca nutrición clínica,  protocolización, optimización de antibióticos y farmacocinética, y un  84,5% realizan seguimiento farmacoterapéutico. Un 77,6% cuenta con  formación sanitaria especializada, rotando los residentes en la unidad de  cuidados intensivos en un 86% de los casos.Conclusiones: La mayor parte de los hospitales encuestados cuenta con un solo farmacéutico a tiempo parcial en estas unidades. Con objeto de mejorar la calidad de la atención farmacéutica del paciente crítico sería necesario ampliar la dedicación en tiempo y personal respecto a la  situación actual y que más centros incluyan al farmacéutico en las unidades de cuidados intensivos hospitalarias.

Interstitial pneumonitis and myelosuppression associated to mitomycin C urinary tract instillations: A case report.

Mitomycin C as a treatment for superficial bladder carcinomas and upper urinary tract tumours has been linked to local adverse events. Systemic toxicity has been documented for just a very few cases. This report presents a case of interstitial pneumonitis accompanied by myelosuppression in a 74-year-old patient after receiving the fifth administration of mitomycin C through a ureteral catheter as a treatment for left kidney pyelocaliceal urothelial carcinoma. Therefore, suspecting mitomycin C toxicity, urinary tract instillations were discontinued, and intravenous filgrastim and methylprednisolone were initiated. Currently, after five months since the last mitomycin C urinary tract instillation, the patient is still receiving filgrastim and corticosteroids. A moderate effort dyspnoea persists despite interstitial pulmonary infiltrates have presented a very important reduction. Pancytopenia has also persisted. Blood count and lung function monitoring would be appropriate in patients undergoing mitomycin C instillations, especially in those with established prior lung disease.

Síndrome serotoninérgico asociado a la administración de duloxetina; a propósito de un caso / Serotonin syndrome associated with the administration of duloxetine; report of a case

No disponible

Stability of frozen 1% voriconazole ophthalmic solution.

PURPOSE: The physicochemical stability of frozen 1% voriconazole ophthalmic solution was evaluated. METHODS: Multiple batches of voriconazole 10-mg/mL eye drops were aseptically prepared in a laminar-airflow cabinet. One batch was analyzed immediately after preparation, and the rest were stored at -20 °C and analyzed using high-performance liquid chromatography at 30, 60, and 90 days to test their physicochemical stability and sterility. All samples were analyzed in triplicate. Additional analyses were performed to determine the solution's in vitro activity once thawed. The sterility of the 1% voriconazole solution was evaluated using blood-agar media and thioglycollate broth. Samples were incubated for 14 days and checked daily for signs of growth. Stability was defined as the absence of particles, color variation, or changes in pH and a remaining antifungal concentration of 90-110% of the initial concentration. RESULTS: All solutions remained clear and colorless throughout the study, and no precipitation or turbidity was observed in any of the batches, regardless of solution temperature. The pH and osmolarity of all batches remained essentially unchanged during storage at -20 °C and after thawing. No significant differences in concentration were observed during the storage at -20 or 5 °C. The voriconazole concentration remained within 10% of the initial concentration during the 90-day period of storage at -20 °C. The percentage of recovery was also optimal after thawing. CONCLUSION: Voriconazole 1% solution prepared for ophthalmic use was stable and retained antifungal activity when stored at -20 °C for 90 days. After thawing, this extemporaneously prepared formulation was stable at 5 °C for 14 days.

Neumonitis intersticial como reacción adversa a inhibidores de mTOR / Interstitial pneumonitis as an adverse reaction to mTOR inhibitors

Introducción: Los inhibidores de mTOR (del inglés mammalian target of rapamycin), sirolimus y everolimus, utilizados como tratamiento inmunosupresor en el trasplante de órganos sólidos, pueden producir efectos adversos graves, como la neumonitis intersticial. Incidencia y presentación clínica: La incidencia de neumonitis intersticial se ha estimado entre el 4 % y el 11 %, aunque podría ser mayor. La mayoría de los casos publicados se ha producido en pacientes trasplantados renales en tratamiento con sirolimus. La presentación clínica es heterogénea, lo que dificulta el diagnóstico. Se acostumbra a observar alteraciones en la tomografía axial computarizada torácica, como opacidades en vidrio deslustrado. La fisiopatología es poco conocida. Sin embargo, se ha observado una mayor incidencia en pacientes con función renal alterada y en pacientes que habían recibido inhibidores de calcineurina previamente. La relación entre aparición de neumonitis y concentraciones plasmáticas de inhibidores de mTOR no está bien definida. Tratamiento: La suspensión del fármaco y la administración de dosis altas de corticoides parecen ser efectivos. Otras alternativas terapéuticas, aunque más discutidas, son la reducción de la dosis del inhibidor de mTOR y el cambio de sirolimus a everolimus. Conclusión: Se debe sospechar de neumonitis iatrogénica en pacientes trasplantados en tratamiento con inhibidores de mTOR y con síntomas respiratorios. Faltan datos concluyentes en cuanto a estrategias de tratamiento. Parece que everolimus podría ser mejor tolerado que sirolimus (AU)

Introduction: mTOR (mammalian target of rapamycin) inhibitors sirolimus and everolimus, used as immunosuppressants in solid organ transplantation, may cause severe adverse effects, such as interstitial pneumonitis. Incidence and clinical presentation: The estimated incidence of interstitial pneumonitis is 4-11% although it may be higher. Most reported cases have occurred in renal transplant recipients treated with sirolimus. Clinical presentation is heterogeneous, which makes diagnosis difficult. Abnormalities, such as ground glass opacities, are often found in computerised axial tomography scans of the chest. Physiopathology is not well-known. However, patients with abnormal renal function and those with previous calcineurin inhibitor treatment display a higher incidence. The relationship between pneumonitis and mTOR inhibitor plasma concentrations is not well defined. Treatment: Drug discontinuation and administration of high doses of corticosteroids seems to be an effective treatment. mTOR inhibitor dose reduction and replacing sirolimus with everolimus are other alternatives, but they are still under discussion. Conclusion: Iatrogenic pneumonitis must be suspected when a transplant recipient being treated with mTOR inhibitors presents respiratory symptoms. There is lack of conclusive data on treatment strategies. It appears that everolimus may be tolerated better than sirolimus (AU)

Interstitial pneumonitis as an adverse reaction to mTOR inhibitors.

INTRODUCTION: mTOR (mammalian target of rapamycin) inhibitors sirolimus and everolimus, used as immunosuppressants in solid organ transplantation, may cause severe adverse effects, such as interstitial pneumonitis. INCIDENCE AND CLINICAL PRESENTATION: The estimated incidence of interstitial pneumonitis is 4-11% although it may be higher. Most reported cases have occurred in renal transplant recipients treated with sirolimus. Clinical presentation is heterogeneous, which makes diagnosis difficult. Abnormalities, such as ground glass opacities, are often found in computerised axial tomography scans of the chest. Physiopathology is not well-known. However, patients with abnormal renal function and those with previous calcineurin inhibitor treatment display a higher incidence. The relationship between pneumonitis and mTOR inhibitor plasma concentrations is not well defined. TREATMENT: Drug discontinuation and administration of high doses of corticosteroids seems to be an effective treatment. mTOR inhibitor dose reduction and replacing sirolimus with everolimus are other alternatives, but they are still under discussion. CONCLUSION: Iatrogenic pneumonitis must be suspected when a transplant recipient being treated with mTOR inhibitors presents respiratory symptoms. There is lack of conclusive data on treatment strategies. It appears that everolimus may be tolerated better than sirolimus.