Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain.

OBJECTIVE: Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model. METHODS: One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty. RESULTS: A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results. CONCLUSIONS: Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Effectiveness of oxaliplatin desensitization protocols

INTRODUCTION: Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. MATERIALS AND METHODS: A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. RESULTS: A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. CONCLUSION: This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR (AU)

[Evaluation of drug administration through enteral feeding tubes in hospitalized patients]. / Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados.

OBJECTIVE: To describe the administration of drugs through nasogastric tubes by the nursing staff of a tertiary hospital and to identify the most common administration errors. METHODS: An observational study was carried out between November of 2010 and March of 2011. The study population was the nursing staff of the hospital. A questionnaire was created asking about the daily practice of drugs administration through the nasogastric tube; a score was assigned to each question. A document on correct administration techniques of drugs through the nasogastric tube was elaborated, which served for the comparison of the answers obtained. RESULTS: A total of 162 surveys were answered. Most of the staff (44.5%) had a deficient knowledge on the proper administration techniques. 69.7% of the staff stated to have grinded some time a tablet with enteric coverage, and 66.2% a tablet with modified release. A significant lower number of perceived obstructions per month was obtained in those nurses with higher degree of knowledge, in those consulting the Pharmacy Department when they had doubts, and in those never having grinded a tablet with enteric coverage of modified release. CONCLUSIONS: It is observed that the knowledge on proper administration of drugs through the nasogastric tube by the nursing staff is deficient; therefore, it would be convenient to carry out specific training courses as well as a closer collaboration between the Pharmacy department and the Nursing units.

Evaluación de las prácticas de administración de fármacos por sonda nasoentérica y enterostomía en pacientes hospitalizados / Evaluation of drug administration through enteral feeding tubes in hospitalized patients

Objetivos: Describir la administración de fármacos a través de sondas por parte del personal de enfermería de un Hospital terciario e identificar los errores más comunes de administración. Métodos: Se realizó un estudio observacional entre noviembre 2010 y marzo 2011. La población de estudio fue el personal de enfermería del Hospital. Se elaboró un cuestionario con preguntas acerca de su práctica habitual a la hora de administrar fármacos por sonda, a cada una de las cuales se asignó una puntuación. Se elaboró también un documento de prácticas correctas de administración de fármacos por sonda con el que se compararon las respuestas obtenidas en los cuestionarios. Resultados: Fueron cumplimentadas un total de 162 encuestas. La mayoría del personal (44,5%) obtuvo un grado de conocimiento deficiente de las prácticas adecuadas de administración de fármacos por sonda. El 69,7% del personal afirmó haber triturado en alguna ocasión un comprimido con cubierta entérica y el 66,2% algún comprimido de liberación modificada. Se observó un número percibido significativamente menor de obstrucciones al mes en aquellos encuestados con mayor grado de conocimiento, en aquellos que consultaron con el Servicio de Farmacia en caso de duda y en aquellos que nunca habían triturado un comprimido de cubierta entérica o liberación modificada. Conclusiones: Se observa que el conocimiento de las prácticas correctas de administración de fármacos por sonda por parte del personal de enfermería es deficiente, por lo que sería muy adecuado realizar cursos formativos específicos así como una colaboración más estrecha entre el Servicio de Farmacia y las Unidades de Enfermería (AU)

Objective: To describe the administration of drugs through nasogastric tubes by the nursing staff of a tertiary hospital and to identify the most common administration errors. Methods: An observational study was carried out between November of 2010 and March of 2011. The study population was the nursing staff of the hospital. A questionnaire was created asking about the daily practice of drugs administration through the nasogastric tube; a score was assigned to each question. A document on correct administration techniques of drugs through the nasogastric tube was elaborated, which served for the comparison of the answers obtained. Results: A total of 162 surveys were answered. Most of the staff (44.5%) had a deficient knowledge on the proper administration techniques. 69.7% of the staff stated to have grinded some time a tablet with enteric coverage, and 66.2% a tablet with modified release. A significant lower number of perceived obstructions per month was obtained in those nurses with higher degree of knowledge, in those consulting the Pharmacy Department when they had doubts, and in those never having grinded a tablet with enteric coverage of modified release. Conclusions: It is observed that the knowledge on proper administration of drugs through the nasogastric tube by the nursing staff is deficient; therefore, it would be convenient to carry out specific training courses as well as a closer collaboration between the Pharmacy department and the Nursing units (AU)

Revisión de las reacciones de hipersensibilidad a antineoplásicos / Review of hypersensitivity reactions to antineoplastic agents

Objetivo Revisar las características y el manejo de las reacciones de hipersensibilidad causadas por agentes antineoplásicos. Método Se realizó una búsqueda bibliográfica en las bases de datos Pubmed y EMBASE de los últimos 10 años. Resultados Casi todos los quimioterápicos tienen potencial para causar una reacción de hipersensibilidad, pero determinados grupos han sido asociados con un mayor riesgo, como los derivados del platino, los taxanos, las asparraginasas, los anticuerpos monoclonales y las epipodofilotoxinas. Las manifestaciones clínicas de estas reacciones son variables e impredecibles incluyendo síntomas cutáneos, respiratorios, cardiacos y gastrointestinales. El mecanismo asociado con su desarrollo aún no se conoce en su totalidad. El diagnóstico se basa en los signos y síntomas que desarrolle el paciente y en la realización de pruebas cutáneas. El manejo de los pacientes que sufran una reacción de hipersensibilidad a un quimioterápico variará según el grado de severidad de la reacción, de la necesidad de continuar con el tratamiento y de las alternativas terapéuticas disponibles. Conclusiones Al producirse un incremento progresivo en la utilización de los agentes quimioterápicos, se puede esperar un aumento de la incidencia de las reacciones de hipersensibilidad. Los protocolos de desensibilización destacan como una alternativa que nos van a permitir reintroducir en la terapia del paciente el agente causal de la reacción de hipersensibilidad. Su utilización debe valorarse individualmente sopesando los beneficios y los riesgos (AU)

Objective To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. Method We conducted a search in the Pubmed and EMBASE databases for the last 10 years. Results Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients’ signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. Conclusions Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients’ therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits (AU)

[Home parenteral nutrition in infants and children in a tertiary level hospital between 1993 and 2009]. / Nutrición parenteral domiciliaria en niños en un hospital terciario entre los años 1993 y 2009.

UNLABELLED: Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. PATIENTS AND METHODS: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. RESULTS: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. CONCLUSIONS: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for catheters.

Review of hypersensitivity reactions to antineoplastic agents.

OBJECTIVE: To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. METHOD: We conducted a search in the Pubmed and EMBASE databases for the last 10 years. RESULTS: Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients' signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. CONCLUSIONS: Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients' therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits.

Nutrición parenteral domiciliaria en niños en un hospital terciarioentre los años 1993 y 2009 / Home parenteral nutrition in infants and children in a tertiary level hospital between 1993 and 2009

La nutrición parenteral domiciliaria (NPD) constituye la piedra angular en el tratamiento del fracaso intestinal permanente o transitorio en pediatría. Su empleo no está exento de complicaciones. Revisamos la experiencia de nuestro programa desde su inicio en 1993. Pacientes y métodos: Estudio longitudinal retrospectivo de las historias clínicas de los 25 niños (11 niños, y 14 niñas) que recibieron NPD en ese periodo. Cuando un paciente recibió NPD en periodos separados más de 3 meses del anterior se consideró un episodio diferente, por lo que el número total de episodios fue de 32. Los datos cuantitativos se recogieron como media o mediana y los cualitativos como frecuencia. Se recogieron las tasas de complicaciones por cada 1.000 días de NPD. Resultados: 16 pacientes comenzaron NPD antes del año de edad. La duración total de la NPD fue de 9.986 días, con una mediana de duración de 174 días con un rango de 7 a 2.444 días. La indicación principal fue síndrome de intestino corto en 6 casos, trastornos de la motilidad en otros 6, diarrea crónica en 5 casos, malnutrición en 3 casos y 5 de los casos respondían a otras causas. Se utilizaron un total de 47 catéteres, con una duración media de 212,5 días, mediana de 120 días (rango: 7 a 930). Mayoritariamente el catéter venoso empleado fue un catéter tunelizado (n = 42), seguido de un reservorio en 3 casos y en 2 casos un catéter venoso central de abordaje periférico (PICC). La tasa de complicaciones para 1000 días de NPD fue la siguiente: 3,4 para las infecciones relacionadas con el catéter; de 0,1 para las obstrucciones; 0,9 para las roturas y 0,1 extracciones accidentales. Los gérmenes más frecuentes en las infecciones relacionadas con el catéter fueron los Staphylococcus coagulasa negativo (47%), seguido de las bacterias Gram negativas (21%), Staphylococcus aureus (15%), hongos (9%) y otros en un 9%. Presentaron afectación hepática importante 4 pacientes. En cuanto a la evolución: 21 pacientes pudieron prescindir de la NP por conseguir adaptación intestinal, 3 pacientes fallecieron mientras estaban en el programa a causa de su enfermedad de base, 2 recibieron un trasplante intestinal y 5 continúan actualmente con NPD. Conclusiones: Cada año se incorporan dos pacientes nuevos al programa de NPD. En el 65% de los casos se pudo suspender la NPD por adaptación intestinal. Las complicaciones infecciosas relacionadas con el catéter fueron las más frecuentes (3,4 infecciones por cada 1.000 días de NPD). La duración mediana de la NPD fue de 174 días, y algo menor para los catéteres (120 días) (AU)

Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. Patients and methods: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. Results: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. Conclusions: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for catheters (AU)

Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad / Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality

Objetivo. Evaluar el grado de satisfacción de pacientes atendidos y auxiliares de farmacia del área de pacientes externos del servicio de farmacia tras una reestructuración del espacio y del procedimiento de dispensación. Métodos. Tres meses después de la reestructuración del área (enero de 2009), se entregaron encuestas de satisfacción (anónimas y voluntarias) durante 2 semanas a una muestra de los 3.300 pacientes/mes atendidos y a los auxiliares que trabajaron en ella. Ambas constaban de ocho preguntas cerradas con formato tipo Likert referentes al espacio físico, la organización, la dispensación y la satisfacción global (variable principal) más una pregunta abierta para recoger sugerencias. Resultados. Recibieron la encuesta 265 pacientes (tasa de respuesta, 94%). El aspecto mejor valorado fue la confidencialidad (4,2±0,7) y el peor, la zona de espera (3,2±1). Se entregaron y se contestaron 26 encuestas por parte de los auxiliares. La mayor puntuación se obtuvo en la instalación del lector del código de barras (3,9±0,6) y la menor, en la organización del almacén (3,1±1,2). En la pregunta abierta se recogieron comentarios sobre falta de personal, dificultad del sistema informático, organización y poca claridad de las prescripciones. El grado de satisfacción global de los pacientes fue de 4,2±0,6 y el de los auxiliares, 3,7±0,7. Conclusiones. Los resultados nos han proporcionado una información útil para evaluar cambios y detectar puntos de mejora. En la mayoría de las cuestiones se ha detectado un mayor grado de satisfacción en los pacientes que en los trabajadores. Son necesarias nuevas acciones de mejora en el espacio físico y en la organización(AU)

Objectives. To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. Methods. Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. Results. A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2±0.7) and the worst was the waiting area (3.2±1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9±0.6) and the lowest for organization of the stores (3.1±1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2±0.6 and that of the auxiliaries was 3.7±0.7. Conclusions. The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization(AU)

Variación en el uso de nutrición parenteral en un hospital infantilen Madrid (España) a lo largo de 15 años / Evolution of paediatric parenteral nutrition over the last 15 years in a tertiary hospital in Madrid (Spain)

Objetivo: Analizar el empleo de la nutrición parenteral (NP) pediátrica en un hospital terciario en Madrid (1994-2008). Material y métodos: Se revisaron las historias clínicas de pacientes pediátricos hospitalizados con NP en 2008, comparándose con 2002 y 1994. Resultados: Recibieron NP 120, 78 y 71 niños, siendo el 1,6%, 1,3% y 1,0% respectivamente del total de ingresados (2008, 2002 y 1994). Hubo diferencias significativas en la composición en el primer día en kilocalorías y lípidos; pero no en volumen, carbohidratos ni aminoácidos. La cirugía gastrointestinal fue la indicación más frecuente. La duración media de la NP varió de 15,2 ± 14,8 (1994) a 11 ± 9,8 días (2008) (p < 0,05). Presentaron complicaciones el 24,8% (2008), 10,8% (2002) y 16,9% (1994) de los pacientes. Conclusiones: En número absoluto y relativo de NP ha aumentado durante los años evaluados, aunque la duración media se ha reducido significativamente. Las complicaciones, sin embargo, han aumentado (AU)

Objective: To analyze the use of paediatric parenteral nutrition (PN) in a tertiary level hospital in Spain (1994-2008). Materials and methods: The charts from infants and children receiving NP in 2008 were reviewed. Data were compared with those in 1994 and 2002. Results: 120 patients received PN, 78 and 71 corresponding to 1.6%, 1.3% and 1.0% of total admissions in 2008, 2002 and 1994 respectively. When composition of PN was compared in the first day we found significant differences in energy and lipids; but not in volume, carbohydrate, or amino acid composition. Gastrointestinal surgery was the most common indication. Mean length was 11.0 ± 9.8 days (2008) to 15.2 ± 14.8 (1994) (p < 0.05). Complications were present in 24.8 patients (2008), 10.8% (2002) and 16.9 (1994). Conclusions: PN use increased along the study period, although mean length decreased. There were more complications in 2008 than in previous years (AU)

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation.

UNLABELLED: The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. MATERIAL AND METHODS: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 +/- 294 kcal/day and 98.6 +/- 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 +/- 307 kcal/day) and isonitrogenated (92 +/- 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. RESULTS: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. CONCLUSIONS: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified.

Continuidad del seguimiento farmacoterapéutico en los pacientes polimedicados después del alta hospitalaria / Continuity of pharmacotherapy follow-up in polymedicated patients after hospital discharge

Objetivo: Dar continuidad al seguimiento farmacoterapéutico delos pacientes polimedicados, después del alta hospitalaria, mediante la coordinación de los médicos y farmacéuticos del hospital con los médicos de atención primaria y los farmacéuticos comunitarios. Métodos: Estudio prospectivo, comparativo, realizado en la unidad de pluripatologías de nuestro hospital, en los centros de salud y en las oficinas de farmacia que atienden a los pacientes. Durante 6 meses se entrevistó a los pacientes ingresados (≥65 años, con ≥5 medicamentos al alta y autosuficientes para adquirir y tomar su medicación) a fin de conocer su adherencia y quién les informaba habitualmente sobre su tratamiento. Al alta, recibieron información verbal y escrita sobre sus medicamentos y se evaluaron sus conocimientos al respecto. Los pacientes de los centros de salud participantes fueron asignados al grupo de intervención y recibieron información estandarizada por parte de su médico de cabecera y su farmacéutico comunitario. El resto (grupo control) recibieron la atención habitual. Un mes después del alta, se entrevistó telefónicamente a los pacientes para conocer quién les había proporcionado información y si habían mejorado sus conocimientos y su cumplimiento. Resultados: Se incluyeron 108 pacientes, de los que 53 se asignaron al grupo de intervención (77,8 ± 6,4 años) y 55 al grupo control (77,5 ± 8,8 años), con 8,4 ± 2,1 y 8,9 ± 3,7 medicamentos prescritos alta, respectivamente. Participaron 11 centros de salud y 43 oficinas de farmacia. Un mes después del alta, el porcentaje de pacientes informados por el farmacéutico comunitario aumentó del 11 al 54% en el grupo de intervención, mientras que en el grupo control no se incrementó. El 35% de los pacientes del grupo de intervención habían mejorado sus conocimientos sobre los medicamentos, frente al 8% del grupo control. El incremento de los pacientes adherentes fue mayor en el grupo de intervención (25%) que en el grupo control (10%). Conclusiones: La coordinación entre hospital, centro de salud y oficina de farmacia ha permitido que el paciente reciba una información sobre medicamentos estandarizada y continuada en el tiempo, que estimamos que ha contribuido a mejorar el uso de los medicamentos y a aumentar la adherencia al tratamiento (AU)

Objective: To give continuity of pharmacotherapy follow-up inpolymedicated patients after hospital discharge based on coordination of the hospital physicians and pharmacists with the primary care physicians and the community pharmacists. Methods: A prospective, comparative study was made in the Pluripathology Unit of the Hospital, in the Health Centers and in the patients Community Pharmacies. During 6 months, the admitted patients (≥ 65 years, with≥ 5 drugs at discharge and self-sufficiency to acquire and take their medication) were interviewed to determine their adherence and who had informed them usually of their treatment. At discharge, the patients received verbal and written drug information and their knowledge about them was evaluated. The patients of the participating Health Centers were assigned to the intervention group and received standardized information from their primary care physician and community pharmacist. The rest (control group) received the usual care. One month after discharge, the patients were interviewed by telephone to determine who provided them with information and whether their knowledge and adherence had improved. Results: A total of 108 patients were included: 53 were assigned to the intervention group (77.8 ± 6.4 years) and 55 to the control group (77.5 ± 8.8 years). With 8.4 ± 2.1 and 8.9 ± 3.7 drugs prescribed at the time of discharge. Eleven Health Centers and 43 Community Pharmacies participated in this study. One month after discharge, the percentage of patients informed by the community pharmacist increased from 11% to 54% in the intervention group, while no increase was recorded in the control group. In turn, 35% of the patients in the intervention group had improved their knowledge of the medication, versus8% in the control group. Conclusions: The coordination among the Hospital, Health Center and Community Pharmacy has allowed the patients to receive standardized and continued information on their medications. We consider that this in turn has contributed to improve drug use and adherence to therapy (AU)

¿Es útil conocer las características de la nutrición parenteral en un hospital terciario pediátrico? / Is it worth knowing the characteristics of inpatient paediatric parenteral nutrition?

Objetivo: Estudiar la nutrición parenteral (NP) pediátrica en 2008 en un hospital terciario. Conocer su adecuación con las guías de práctica clínica actuales. Material y métodos: Estudio longitudinal, descriptivo y retrospectivo de las historias clínicas de pacientes menores de 16 años (excluidos los ingresados en las unidades neonatales) que recibieron NP en 2008. Recogimos datos demográficos y datos de la NP: indicación, composición en el primer día, lípidos, aminoácidos, micronutrientes, tipo de mezcla, estandarización, adición de medicamentos, duración, acceso venoso, causa de interrupción y complicaciones. Resultados: Recibieron NP 120 niños: 63 menores de 2 años, 30 preescolares y 27 mayores de 7 años. Constituyeron el 1,6% de los niños hospitalizados en ese período. Las indicaciones más frecuentes fueron cirugía gastrointestinal (35,5%) y enfermedades gastrointestinales (19,8%). La composición media del primer día fue de 63,1±21,3kcal/kg/día, volumen de 76,6±28,4ml/kg/día, hidratos de carbono de 9,6±3,2g/kg/día, aminoácidos de 2,1±0,6g/kg/día y lípidos de 1,9±1g/kg/día. La duración media fue de 10,5±9,8días. Los accesos venosos más frecuentes fueron la vena yugular (34,7%) y la vena femoral (26,5%). La causa principal de interrupción fue la tolerancia oral, seguida de NP domiciliaria. El 27,3% tuvo complicaciones asociadas a la NP. Conclusiones: La mitad de las NP se prescribió en lactantes, y la principal indicación fue la cirugía gastrointestinal. Todas las mezclas fueron ternarias con micronutrientes todos los días. La mayoría se estandarizó parcialmente, lo que ayuda a disminuir los errores en la prescripción y preparación (AU)

Objective: To describe the characteristics of inpatient parenteral nutrition during 2008 in a tertiary level paediatric hospital. To compare this practice with recent standards. Material and methods: Longitudinal, descriptive, and retrospective study of patients under 16 years receiving parenteral nutrition in 2008. Demographic data as well as data of the nutritional support were recorded. Results: A total of 120 children received parenteral nutrition, of whom 63 were under 2 years, 30 between 3 and 7 years, and 27 older than 7 years. They accounted for 1.6% of all the inpatients during that period. Most frequent indication was gastrointestinal surgery (35.5%), followed by non-surgical gastrointestinal diseases (19.8%). The average composition in the first day of parenteral nutrition was: 63.1kcal/kg (SD: 21.3); volume, 76.6ml/kg (SD: 28.4); carbohydrates 9.6g/kg/d (SD: 3.2); amino acids 2.1g/kg/d (SD: 0.6), and lipids 1.9g/kg/d (SD: 1). The mean duration of parenteral support was 10.5 days (SD: 9.8). Internal jugular vein (34.7%) and femoral vein were the most common intravenous access. The main reason to discontinue parenteral nutrition was transition to oral/enteral feedings. The complication rate was 27.3%. Conclusions: There is an interest in evaluating standard practice in parenteral nutrition in order to develop improvement strategies. Infants and toddlers are the principal candidates for parenteral nutrition. Standardisation is one way to decrease errors in its preparation and prescription (AU)

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation / Nutrición parenteral suplementada con glutamina en pacientes sometido a trasplante de médula ósea

The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. Material and methods: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 ± 294 kcal/day and 98.6 ± 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 ± 307 kcal/day) and isonitrogenated (92 ± 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. Results: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. Conclusions: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified (AU)

El objetivo del estudio es determinar si la administración de glutamina en la solución de nutrición parenteral (NP) disminuye la necesidad de antibióticos, el riesgo de hepatopatía y la duración de la estancia hospitalaria en trasplante de células hematológicas. Material y método: Estudio observacional retrospectivo, con 68 pacientes adultos sometidos a trasplante de células hematológicas, que precisaron NP por mucositis. De ellos, 40 pacientes recibieron NP con 2.063 ± 294 kcal/día y 98,6 ± 13,9 g de aminoácidos/día, suplementada con L-glutamina (13,5-27 g/día) y 28 recibieron una NP isocalórica (1.966 ± 307 kcal/día) e isonitrogenada (92 ± 16,3 g de aminoácidos/día) con solución de aminoácidos estándar libre de glutamina. Se analizó el consumo de antibióticos y la duración de la estancia hospitalaria. De la cohorte total, en 50 pacientes sin hepatopatía al inicio de la NP se estudió el perfil hepático al inicio y en el día 7 de la NP. Resultados: No hubo diferencias entre ambos grupos respecto al número total y duración de antibióticos prescritos, ni en estancia hospitalaria. De los 50 pacientes sin alteraciones hepáticas al inicio de la NP, 2 pacientes en el grupo control y 5 en el grupo glutamina desarrollaron un perfil hepático compatible con hepatopatía secundaria a NP. Comparando ambos grupos no hubo diferencias en los valores de enzimas hepáticas. Conclusiones: La suplementación con glutamina de NP no mejora las variables estudiadas, pero se debe continuar investigando el uso clínico real de glutamina en este tratamiento hematológico, identificando sus potenciales ventajas (AU)

[Evolution of paediatric parenteral nutrition over the last 15 years in a tertiary hospital in Madrid (Spain)]. / Variación en el uso de nutrición parenteral en un hospital infantil en Madrid (España) a lo largo de 15 años.

OBJECTIVE: To analyze the use of paediatric parenteral nutrition (PN) in a tertiary level hospital in Spain (1994-2008). MATERIALS AND METHODS: The charts from infants and children receiving NP in 2008 were reviewed. Data were compared with those in 1994 and 2002. RESULTS: 120 patients received PN, 78 and 71 corresponding to 1.6%, 1.3% and 1.0% of total admissions in 2008, 2002 and 1994 respectively. When composition of PN was compared in the first day we found significant differences in energy and lipids; but not in volume, carbohydrate, or amino acid composition. Gastrointestinal surgery was the most common indication. Mean length was 11.0 ± 9.8 days (2008) to 15.2 ± 14.8 (1994) (p < 0.05). Complications were present in 24.8 patients (2008), 10.8% (2002) and 16.9 (1994). CONCLUSIONS: PN use increased along the study period, although mean length decreased. There were more complications in 2008 than in previous years.

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding.

OBJECTIVE: We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS: We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS: Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS: The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

[Vitamins stability in parenteral nutrition]. / Estabilidad de vitaminas en nutrición parenteral.

OBJECTIVE: Some decades ago, several studies were published describing vitamins degradation in parenteral nutrition (PN) and their catalysis by oligoelements such as copper. Thus, the practice of administering oligoelements and vitamins every other day and adding them the same day of PN was implemented. Today, in many Spanish hospitals these recommendations are still being followed although currently different products, type of containers, and ways of administration are used. The purpose of this review is to determine whether combined administration of vitamins and oligoelements with PN is recommended and how many days they remain stable while refrigerated under the current conditions of preparation and administration of PN. SETTING: We have reviewed the articles on vitamins stability in PN published after 1990. RESULTS: The results are controversial with vitamin A, although "all-in-one" administration and photo-protection remarkably decrease its degradation and there seems to be no difference between adding the vitamin before its administration and doing so previously. Vitamin E is stable with photo-protection for 3-7 days under refrigeration plus one additional day at room temperature if multilayered bags are used. Thiamine is stable if bisulfites-free amino acids solutions are used. CONCLUSIONS: We conclude that vitamins and oligoelements may be administered together and PN be prepared before use if "all-in-one" photo-protected multilayered bags and bisulfite-free amino acids solutions are used.

Estabilidad de vitaminas en nutrición parenteral / Vitamins stability in parenteral nutrition

Objetivo: Hace algunas décadas se publicaron varios estudios describiendo la degradación de vitaminas en nutrición parenteral (NP) y su catalización por oligoelementos tales como el cobre. Por ello se instauró la práctica de administrar oligoelementos y vitaminas a días alternos y aditivarlos el mismo día de la administración. Todavía muchos hospitales españoles siguen estas recomendaciones aunque actualmente se utilizan productos, tipo de material del envase y formas de administración distintas de las de entonces. El objetivo de esta revisión es determinar si en las condiciones actuales de preparación y administración de NP sería recomendable la administración conjunta de vitaminas y oligoelementos y cuantos días serían estables en refrigeración antes de su administración. Ámbito: Se han revisado los artículos sobre estabilidad de vitaminas en NP publicados posteriormente a 1990. Resultados: Con la vitamina A hay resultados contradictorios pero la administración "todo en uno" y la fotoprotección disminuyen considerablemente su degradación y parece que no existen diferencias entre añadir la vitamina antes de su administración o hacerlo con anterioridad. La vitamina E se muestra estable con fotoprotección durante 3-7 días en refrigeración más un día a temperatura ambiente. La vitamina C es estable junto a oligoelementos en bolsas multicapa por 2-7 días en refrigeración más un día a temperatura ambiente. La tiamina es estable si se utilizan soluciones de aminoácidos que no contengan bisulfitos. Conclusiones: Se concluye que se pueden administrar conjuntamente vitaminas y oligoelementos y preparar la NP con anterioridad a su administración cuando se utiliza NP "todo en uno", bolsas multicapa, soluciones de aminoácidos sin bisulfitos y fotoprotección (AU)

Objective: Some decades ago, several studies were published describing vitamins degradation in parenteral nutrition (PN) and their catalysis by oligoelements such as copper. Thus, the practice of administering oligoelements and vitamins every other day and adding them the same day of PN was implemented. Today, in many Spanish hospitals these recommendations are still being followed although currently different products, type of containers, and ways of administration are used. The purpose of this review is to determine whether combined administration of vitamins and oligoelements with PN is recommended and how many days they remain stable while refrigerated under the current conditions of preparation and administration of PN. Setting: We have reviewed the articles on vitamins stability in PN published after 1990. Results: The results are controversial with vitamin A, although "all-in-one" administration and photo-protection remarkably decrease its degradation and there seems to be no difference between adding the vitamin before its administration and doing so previously. Vitamin E is stable with photo-protection for 3-7 days under refrigeration plus one additional day at room temperature if multilayered bags are used. Thiamine is stable if bisulfites-free amino acids solutions are used. Conclusions: We conclude that vitamins and oligoelements may be administered together and PN be prepared before use if "all-in-one" photo-protected multilayered bags and bisulfite-free amino acids solutions are used (AU)

Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro / Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Objetivo: hemos analizado los hallazgos que la cápsula endoscópicaaportó de las zonas accesibles a una gastroscopia que podríanjustificar un sangrado digestivo oscuro, así como la evoluciónde estos enfermos tras la nueva gastroscopia recomendadapara determinar si una segunda gastroscopia previa a la cápsulapodría añadir beneficios en el manejo de esta patología.Métodos: estudiamos de forma retrospectiva 82 pacientes alos que se efectuó cápsula endoscópica como estudio de hemorragiaoscura que contaban con una única gastroscopia.Los hallazgos que la cápsula apreció en tramos altos se dividieronen normales, leves/conocidos y severos-desconocidos que recomendaronuna segunda gastroscopia. Estos últimos casos fueronseguidos.Resultados: la cápsula endoscópica no objetivó hallazgosesofágicos desconocidos. En un 63% no evidenció lesiones gastroduodenales,en un 20% estas eran leves o conocidas y en un17% se recomendó una nueva gastroscopia al encontrar patologíadesconocida y que podría motivar la hemorragia digestiva a estenivel. La información motivó cambios en el tratamiento en un85% de este grupo, con mejoría en el 78%. La cápsula endoscópicaencontró alteraciones intercurrentes llamativas en el intestinodelgado en sólo un 14%.Conclusiones: una segunda gastroscopia previa a una cápsulaendoscópica en el estudio de la hemorragia oscura ofrecería beneficiosen términos diagnósticos y a la hora de introducir cambiosterapéuticos que consiguen buenos resultados clínicos.El análisis detallado de los fotogramas del tracto digestivo altoes obligado, ya que puede aportar información relevante y conimportancia en el manejo de estos pacientes(AU)

Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients(AU)