Concomitant administration of seasonal influenza and COVID-19 mRNA vaccines.

Current clinical guidelines support the concomitant administration of seasonal influenza vaccines and COVID-19 mRNA boosters vaccine. Whether dual vaccination may impact vaccine immunogenicity due to an interference between influenza or SARS-CoV-2 antigens is unknown. We aimed to understand the impact of mRNA COVID-19 vaccines administered concomitantly on the immune response to influenza vaccines. For this, 128 volunteers were vaccinated during the 22-23 influenza season. Three groups of vaccination were assembled: FLU vaccine only (46, 35%) versus volunteers that received the mRNA bivalent COVID-19 vaccines concomitantly to seasonal influenza vaccines, FluCOVID vaccine in the same arm (42, 33%) or different arm (40, 31%), respectively. Sera and whole blood were obtained the day of vaccination, +7, and +28 days after for antibody and T cells response quantification. As expected, side effects were increased in individuals who received the FluCOVID vaccine as compared to FLU vaccine only based on the known reactogenicity of mRNA vaccines. In general, antibody levels were high at 4 weeks post-vaccination and differences were found only for the H3N2 virus when administered in different arms compared to the other groups at day 28 post-vaccination. Additionally, our data showed that subjects that received the FluCOVID vaccine in different arm tended to have better antibody induction than those receiving FLU vaccines for H3N2 virus in the absence of pre-existing immunity. Furthermore, no notable differences in the influenza-specific cellular immune response were found for any of the vaccination groups. Our data supports the concomitant administration of seasonal influenza and mRNA COVID-19 vaccines.

Deglufarm: aplicación móvil con recomendaciones para la administración segura de medicamentos en pacientes con disfagia o problemas de deglución / Deglufarm: Mobile application with recommendations for safety drug administration in patients with dysphagia or deglution disorders

Objetivo desarrollar una app para su uso en la práctica asistencial, con información actualizada y veraz sobre la manipulación de medicamentos en los pacientes con disfagia y otros problemas de deglución, así como su compatibilidad con alimentos y espesantes. Método el desarrollo de la app Deglufarm® se hizo con un proyecto de los grupos de trabajo CRONOS, Nutrición y Tecno de la Sociedad Española de Farmacia Hospitalaria. Se constituyó un grupo de farmacéuticos especialistas, de diferentes ámbitos de la atención al paciente con disfagia. La creación de Deglufarm® constó de varias etapas: selección de principios activos, revisión bibliográfica, elaboración de contenidos, diseño (se contactó con una empresa experta en diseño de apps), testing, lanzamiento, actualización de contenidos y seguimiento. Resultados Deglufarm® está disponible para Android e IOS gratuitamente desde julio de 2022. Ha sido testada entre los miembros del grupo investigador y colaboradores. En la actualidad se han revisado y registrado en Deglufarm® 540 monografías de principios activos. La primera versión está dirigida a profesionales sanitarios. Conclusiones Deglufarm® es una herramienta fácil y sencilla de consultar, con la evidencia más actual sobre la manipulación de los medicamentos que contiene. (AU)

Objective Develop an App to use in healthcare practice, with updated and accurate information on the handling of medications in patients with dysphagia or deglution disorders, as well as their compatibility with food and thickeners. Methods The development of the Deglufarm® App was based on the CRONOS, Nutrition and Techno working groups of the Sociedad Española de Farmacia Hospitalaria. A group of specialist pharmacists was created from different care areas for patients with dysphagia. The creation of Deglufarm® consisted of several stages: Selection of active drugs, literature review, content development, design (an expert company in App design was contacted), testing, launch, content update and follow-up. Results Deglufarm® is available for Android and IOS free of charge from July 2022. It has been tested among the members of the research group and collaborators, currently, 540 monographs of active drugs have been reviewed and registered in Deglufarm. The first version is aimed at healthcare professionals. Conclusions Deglufarm® is an easy tool to consult, with the most current evidence on handling the medicines it contains. (AU)

Patient-reported outcome measures in severe asthma: an expert consensus.

OBJECTIVE: The study aimed to reach a consensus on the most relevant patient-reported outcomes (PROs), the corresponding measures (PROMs), and measurement frequency during severe asthma patient follow-up. METHODS: Two Delphi rounds were conducted. The questionnaire was developed based on a systematic literature review, a focus group with patients, and a nominal group with experts. It assessed PROs' relevance and the appropriateness (A) and feasibility (F) of PROMs using a Likert scale (1=totally agree; 9=totally disagree). The consensus was established when ≥75% of participants agreed (1-3) or disagreed (7-9). RESULTS: Sixty-three professionals (25 hospital pharmacists, 14 allergists, 13 pulmonologists, and 11 nurses) and 5 patients answered the Delphi questionnaire. A consensus was reached on all PROs regarding their relevance. Experts agreed on the use of ACT (A:95.24%; F:95.24%), mini AQLQ (A:93.65; F:79.37%), mMRC dyspnea scale (A:85.71%; F:85.71%), TAI (A:92.06%; F:85.71%), MMAS (A:75.40%; F:82%), and the dispensing register (A:96.83%; F:92.06%). Also considered suitable were: SNOT-22 (A:90.48%; F:73.80%), PSQI (A:82.54; F:63.90%), HADS (A:82.54; F:64%), WPAI (A:77.78%; F:49.20%), TSQM-9 (A:79.37; F:70.50%) and knowledge of asthma questionnaire (A:77%; F:68.80%); however, their use in clinical practice was considered unfeasible. Panelists also agreed on the appropriateness of EQ-5D, which was finally included despite being considered unfeasible (A: 84.13%; F:67.20%) in clinical practice. Agreement was reached on using ACT, TAI, mMRC, and a dispensing register every three months; mini-AQLQ and MMAS every six months; and EQ-5D every twelve months. CONCLUSION: This consensus paves the way toward patient-centered care, promoting the development of strategies supporting routine assessment of PROs in severe asthma management.

Versión en español de los criterios STOPP/START 3. Avances en la detección de la prescripción inapropiada de medicamentos en personas mayores / Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people

Los criterios STOPP/START son criterios explícitos basados en sistemas fisiológicos que resumen la evidencia sobre problemas de prescripción relevantes clínicamente relacionados con el uso de medicamentos potencialmente inapropiados (criterios STOPP) y con potenciales omisiones de prescripción (criterios START). Las dos versiones anteriores de los criterios STOPP/START se publicaron en 2008 y en 2015, y sus versiones en español, en 2009 y en 2015. En 2023 se acaba de publicar la versión3 de dichos criterios. El objetivo de este artículo es presentar la versión traducida al español, así como revisar la utilización y el impacto que ha tenido la versión2 del año 2015 en nuestro idioma. Se realizó una traducción del inglés al español por profesionales expertos y con alto nivel de inglés de la versión3 de los criterios STOPP/START, que incorporan la evidencia publicada desde abril de 2014 hasta marzo de 2022. Además, se hizo una revisión sistemática de las publicaciones que han usado la traducción española de la versión previa (versión2 de 2015) de los criterios STOPP/START. La nueva versión, presentada en este artículo, cuenta con 190 criterios STOPP/START (133 criterios STOPP y 57 criterios START), lo que supone un aumento del 40% en el número de criterios en comparación con la versión anterior. En la revisión se encontraron 37 estudios (21 observacionales, 11 de intervención y 5 de otro tipo) que han usado la versión española en lugar de la internacional. La versión3 en español de los criterios STOPP/START es una lista explícita actualizada de medicamentos potencialmente inapropiados y posibles omisiones en la prescripción que tienen el objetivo de optimizar la medicación y minimizar las reacciones adversas a los medicamentos durante la revisión de la medicación en las personas mayores, en particular aquellas con multimorbilidad y polifarmacia (AU)

The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy (AU)

[Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people]. / Versión en español de los criterios STOPP/START 3. Avances en la detección de la prescripción inapropiada de medicamentos en personas mayores.

The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy. With this new version, the original criteria are intended to be more widely disseminated within the Spanish-speaking healthcare community. The Spanish version2 of the STOPP/START has been widely used, so we consider that the translation into Spanish has helped to improve pharmacotherapy in older patients with polypharmacy and multimorbidity in our linguistic environment.

Deglufarm: Mobile application with recommendations for safety drug administration in patients with dysphagia or deglution disorders. / Deglufarm: aplicación móvil con recomendaciones para la administración segura de medicamentos en pacientes con disfagia o problemas de deglución.

OBJECTIVE: Develop an App to use in healthcare practice, with updated and accurate information on the handling of medications in patients with dysphagia or deglution disorders, as well as their compatibility with food and thickeners. METHODS: The development of the Deglufarm® App was based on the CRONOS, Nutrition and Techno working groups of the Sociedad Española de Farmacia Hospitalaria. A group of specialist pharmacists was created from different care areas for patients with dysphagia. The creation of Deglufarm® consisted of several stages: Selection of active drugs, literature review, content development, design (an expert company in App design was contacted), testing, launch, content update and follow-up. RESULTS: Deglufarm® is available for Android and IOS free of charge from July 2022. It has been tested among the members of the research group and collaborators, currently, 540 monographs of active drugs have been reviewed and registered in Deglufarm. The first version is aimed at healthcare professionals. CONCLUSIONS: Deglufarm® is an easy tool to consult, with the most current evidence on handling the medicines it contains.

Optimisation of the quality of care for patients with severe asthma: ASfarMA project.

Severe asthma has an important impact on patients and healthcare resources. Recently, the new specific treatments have defined a new scenario in which person-focused care and specialist multidisciplinary teams are necessary. Our Severe Asthma Unit (SAU) started the ASfarMA project along with an external human-centered design company to understand patients' vision of their illness, treatment, and healthcare experience, and to define the ideal SAU by performing a core group session, in-depth semistructured interviews and co-creation workshop. Herein, a series of tips classified as either 'transformative solutions' or 'quick wins', according to a value versus effort matrix are presented. Successful implementation of the proposed solutions will be valuable for patients and healthcare professionals, optimising patient care and resources. These findings can also be helpful to other SAUs or other humanisation projects involving complex, chronic and multidisciplinary pathologies.

Impact of Activity-Oriented Propioceptive Antiedema Therapy on the Health-Related Quality of Life of Women with Upper-Limb Lymphedema Secondary to Breast Cancer-A Randomized Clinical Trial.

BACKGROUND: Alterations derived from lymphedema in the upper-limb secondary to breast cancer-related lymphedema (BCRL) decrease the health-related quality of life (HRQoL), but there is limited evidence of the impact of the different interventions on it. The aim of this research was to compare the effect of conventional treatment with another treatment based on Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) on HRQoL in women diagnosed with BCRL. METHODS: A prospective clinical study was designed with two parallel arms. The study population consisted of women diagnosed with BCRL in stage I and II, belonging to different institutions in Córdoba and Aragon, Spain. Sociodemographic and HRQoL-related variables, pain, tightness, heaviness and functionality were obtained before and after treatments. RESULTS: 51 women participated in the study, 25 received the conventional treatment and 26 the TAPA, with a mean age of 59.24 ± 9.55 years. HRQoL was significantly related to upper-limb function and pain on the participants' affected side. In addition, covariance analysis (ANCOVA) showed that the TAPA treatment interfered less in the performance of activities of daily life and produced significant improvements in the social dimension of HRQoL. CONCLUSIONS: the non-use of compressive elements in the rehabilitative treatment of the BCRL that is proposed with TAPA improves aspects such as self-image and participation in social and recreational activities.

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial.

BACKGROUND: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb's functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. METHODS: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. RESULTS: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η2 ≤ 0.080). In the rest of the variables, no significant differences were found. CONCLUSIONS: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.

Cytokine profiles in cord blood in relation to prenatal traffic-related air pollution: The NELA cohort.

BACKGROUND: Outdoor air pollution may disturb immune system development. We investigated whether gestational exposure to traffic-related air pollutants (TRAP) is associated with unstimulated cytokine profiles in newborns. METHODS: Data come from 235 newborns of the NELA cohort. Innate response-related cytokines (IL-6, IFN-α, IL1-ß, and TNF-α), Th1-related (IFN-γ and IL-2), Th2-related (IL-4, IL-5, and IL-13), Th17-related (IL-17 and IL-23), and immunomodulatory cytokine IL-10 were quantified in the supernatant of unstimulated whole umbilical cord blood cells after 7 days of culture using the Luminex technology. Dispersion/chemical transport modeling was used to estimate long-term (whole pregnancy and trimesters) and short-term (15 days before delivery) residential exposures to traffic-related nitrogen dioxide (NO2 ), particulate matter (PM2.5 and PM10 ), and ozone (O3 ). We fitted multivariable logistic regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) regression models. RESULTS: NO2 during the whole pregnancy increased the odds of detection of IL-1ß (OR per 10 µg/m3 increase = 1.37; 95% CI, 1.02, 1.85) and IL-6 (OR per 10 µg/m3 increase = 1.32; 95% CI 1.00, 1.75). Increased odds of detected concentrations of IL-10 was found in newborns exposed during whole pregnancy to higher levels of NO2 (OR per 10 µg/m3 increase = 1.30; 95% CI 0.99, 1.69), PM10 (OR per 10 µg/m3 increase = 1.49; 95% CI 0.95, 2.33), and PM2.5 (OR per 5 µg/m3 increase = 1.56; 95% CI 0.97, 2.51). Exposure to O3 during the whole pregnancy increased the odds of detected IL-13 (OR per 10 µg/m3 increase = 1.22; 95% CI 1.01, 1.49). WQS model revealed first and third trimesters of gestation as windows of higher susceptibility. CONCLUSIONS: Gestational exposure to TRAP may increase detection of pro-inflammatory, Th2-related, and T regulatory cytokines in newborns. These changes might influence immune system responses later in life.

Intervention study for the reduction of medication errors in elderly trauma patients.

OBJECTIVE: To analyse the impact of a set of measures designed by a working group to reduce medication errors (MEs) during the care transition of elderly trauma patients. The secondary objectives were to classify MEs and determine their location. METHODS: A 43-month pre-post prospective intervention study in a university hospital. A working group was set up in the Trauma Service. A pharmacist analysed the pharmacotherapeutic processes of all patients admitted to the Trauma Service in different healthcare locations from Monday to Friday. To detect MEs, the pharmacist reviewed this process at the following points: reconciliation, prescription, validation, dispensing, and administration records. Errors were classified according to the Ruiz Jarabo classification. Subsequently, the working group designed a set of measures that were implemented with the incorporation into the Acute Care Team and the intervention of a pharmacist. Data on MEs were again collected in a post-implementation phase. RESULTS: There was a statistically significant reduction in MEs between phases. A total of 132 (31.3%) patients experienced MEs during the pre-implementation phase and 75 (16.2%) during the post-implementation phase. Among the measures implemented, the incorporation of the pharmacist to the team, as well as training sessions and design of medication protocols. During the pre-implementation and post-implementation phases, the ME rates were respectively as follows: reconciliation 31.6% (172) vs 14.8% (91); prescription 7.7% (79) vs 1.9% (23); dispensing 1% (10) vs 0.3% (3); administration record 0.4% (4) vs 0.0% (0); and validation 0.3% (3) vs 0.1% (1). There were significant reductions in reconciliation, prescription, and dispensing errors. The majority of the MEs occurred in the Trauma Service. CONCLUSIONS: The implementation of specific measures by a Multidisciplinary Safety Group reduced MEs in the care transition of elderly trauma patients, particularly those MEs that occurred during reconciliation. The greatest reduction in MEs occurred in the Trauma Service.

Air pollution from traffic during pregnancy impairs newborn's cord blood immune cells: The NELA cohort.

BACKGROUND: Hazards of traffic-related air pollution (TRAP) on the developing immune system are poorly understood. We sought to investigate the effects of prenatal exposure to TRAP on cord blood immune cell distributions; and to identify gestational windows of susceptibility. METHODS: In-depth immunophenotyping of cord blood leukocyte and lymphocyte subsets was performed by flow cytometry in 190 newborns embedded in the Nutrition in Early Life and Asthma (NELA) birth cohort (2015-2018). Long-term (whole pregnancy and trimesters) and short-term (15-days before delivery) residential exposures to traffic-related nitrogen dioxide (NO2), particulate matter (PM2.5 and PM10), and ozone (O3) were estimated using dispersion/chemical transport modelling. Associations between TRAP concentrations and cord blood immune cell counts were assessed using multivariate Poisson regression models. RESULTS: Mean number of natural killer (NK) cells decreased 15% in relation to higher NO2 concentrations (≥36.4 µg/m3) during whole pregnancy (incidence relative risk (IRR), 0.85; 95% CI, 0.72, 0.99), with stronger associations in the first trimester. Higher PM2.5 concentrations (≥13.3 µg/m3) during whole pregnancy associated with a reduced mean number of cytotoxic T cells (IRR, 0.88; 95% CI, 0.78, 0.99). Newborns exposed to higher PM10 (≥23.6 µg/m3) and PM2.5 concentrations during the first and third trimester showed greater mean number of helper T type 1 (Th1) cells (P < 0.05). Decreased number of regulatory T (Treg) cells was associated with greater short-term NO2 (IRR, 0.90; 95% CI, 0.80, 1.01) and PM10 (IRR, 0.88; 95% CI, 0.77, 0.99) concentrations. CONCLUSIONS: Prenatal exposure to TRAP, particularly in early and late gestation, impairs fetal immune system development through disturbances in cord blood leukocyte and lymphocyte distributions.

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial.

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.

Gravedad de los errores de conciliación producidos en el servicio de urgencias en pacientes ancianos / Seriousness of medication reconciliation errors in patients of advanced agein the emergency department

OBJETIVOS: Analizar la gravedad de los errores de conciliación (EC) producidos en el servicio de urgencias (SU) en pacientes que ingresan en una unidad de agudos de geriatría. Cuantificar y describir las discrepancias y los EC. Analizar los grupos farmacológicos y los factores de riesgo. MÉTODO: Estudio observacional prospectivo. Un farmacéutico realizó la historia farmacoterapéutica y comparó el tratamiento habitual con el prescrito en el SU, identificó discrepancias y posibles EC y un geriatra evaluó su gravedad. RESULTADOS: Se incluyeron 351 pacientes, de los que 328 (93,8%) presentaron discrepancias, 151 pacientes (43,02%) presentaron al menos 1 EC. Se observaron 300 EC de los que 248 (82,7%) alcanzaron al paciente, y 27 EC (9%) produjeron daño reversible. No hubo ningún error que causase daño prolongado o mortal. CONCLUSIONES: Los EC fueron frecuentes pero de escasa gravedad, y los daños que ocasionaron fueron reversibles

OBJECTIVES: To analyze the seriousness of medication reconciliation errors (MREs) in the treatment of older patients admitted to an emergency department's acute geriatric unit. To identify and describe discrepancies, including the drug groups involved, and to explore risk factors. METHODS: Prospective, observational 6-month study. A pharmacist recorded medications in each patient's history and compared the patient's usual treatment to the regimen prescribed in the emergency department; discrepancies were flagged for evaluation as possible MREs. A geriatric medicine specialist evaluated MRE seriousness. RESULTS: Three hundred twenty-eight discrepancies were detected (93.8% of the total of 351 patients); 151 patients (43.02%) had at least 1 MRE. Three hundred MREs were identified, 248 (82.7%) reached the patient, and 27 (9%) caused reversible injury. No errors led to prolonged injury or death. CONCLUSIONS: MREs were common but not serious, and the injuries caused were reversible

Seriousness of medication reconciliation errors in patients of advanced age in the emergency department. / Gravedad de los errores de conciliación producidos en el servicio de urgencias en pacientes ancianos.

OBJECTIVES: To analyze the seriousness of medication reconciliation errors (MREs) in the treatment of older patients admitted to an emergency department's acute geriatric unit. To identify and describe discrepancies, including the drug groups involved, and to explore risk factors. MATERIAL AND METHODS: Prospective, observational 6-month study. A pharmacist recorded medications in each patient's history and compared the patient's usual treatment to the regimen prescribed in the emergency department; discrepancies were flagged for evaluation as possible MREs. A geriatric medicine specialist evaluated MRE seriousness. RESULTS: Three hundred twenty-eight discrepancies were detected (93.8% of the total of 351 patients); 151 patients (43.02%) had at least 1 MRE. Three hundred MREs were identified, 248 (82.7%) reached the patient, and 27 (9%) caused reversible injury. No errors led to prolonged injury or death. CONCLUSION: MREs were common but not serious, and the injuries caused were reversible.

OBJETIVO: Analizar la gravedad de los errores de conciliación (EC) producidos en el servicio de urgencias (SU) en pacientes que ingresan en una unidad de agudos de geriatría. Cuantificar y describir las discrepancias y los EC. Analizar los grupos farmacológicos y los factores de riesgo. METODO: Estudio observacional prospectivo. Un farmacéutico realizó la historia farmacoterapéutica y comparó el tratamiento habitual con el prescrito en el SU, identificó discrepancias y posibles EC y un geriatra evaluó su gravedad. RESULTADOS: Se incluyeron 351 pacientes, de los que 328 (93,8%) presentaron discrepancias, 151 pacientes (43,02%) presentaron al menos 1 EC. Se observaron 300 EC de los que 248 (82,7%) alcanzaron al paciente, y 27 EC (9%) produjeron daño reversible. No hubo ningún error que causase daño prolongado o mortal. CONCLUSIONES: Los EC fueron frecuentes pero de escasa gravedad, y los daños que ocasionaron fueron reversibles.

Uso potencialmente inapropiado de fármacos en cuidados paliativos: versión en castellano de los criterios STOPP-Frail (STOPP-Pal) / Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)

La polimedicación y la utilización inapropiada de medicamentos en los pacientes mayores con enfermedad en fase terminal constituyen un grave problema sanitario, tanto por el incremento de efectos adversos prevenibles como por los costes sanitarios asociados a los mismos. Existen diferentes publicaciones que recomiendan la suspensión de determinados medicamentos cuando la esperanza de vida es limitada y el objetivo terapéutico no es la prevención ni la curación, sino el control de los síntomas. Recientemente se han publicado una lista de criterios explícitos (STOPP-Frail) que pueden ayudar al médico prescriptor a la toma de decisiones en la deprescripción de determinados fármacos en pacientes de edad avanzada y con enfermedad en fase terminal. En este artículo se presenta la versión traducida al castellano de los STOPP-Frail que pasará a llamarse STOPP-Pal para evitar confusiones con el concepto de fragilidad más utilizado

Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty

[Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]. / Uso potencialmente inapropiado de fármacos en cuidados paliativos: versión en castellano de los criterios STOPP-Frail (STOPP-Pal).

Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.

BACKGROUND: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. METHODS: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. RESULTS: With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. CONCLUSIONS: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.

Lytic cell death induced by melittin bypasses pyroptosis but induces NLRP3 inflammasome activation and IL-1ß release.

The nucleotide-binding domain and leucine-rich repeat-containing receptor with a pyrin domain 3 (NLRP3) inflammasome is a sensor for different types of infections and alterations of homeostatic parameters, including abnormally high levels of the extracellular nucleotide ATP or crystallization of different metabolites. All NLRP3 activators trigger a similar intracellular pathway, where a decrease in intracellular K+ concentration and permeabilization of plasma membrane are key steps. Cationic amphipathic antimicrobial peptides and peptide toxins permeabilize the plasma membrane. In fact, some of them have been described to activate the NLRP3 inflammasome. Among them, the bee venom antimicrobial toxin peptide melittin is known to elicit an inflammatory reaction via the NLRP3 inflammasome in response to bee venom. Our study found that melittin induces canonical NLRP3 inflammasome activation by plasma membrane permeabilization and a reduction in the intracellular K+ concentration. Following melittin treatment, the apoptosis-associated speck-like protein, an adaptor protein with a caspase recruitment domain (ASC), was necessary to activate caspase-1 and induce IL-1ß release. However, cell death induced by melittin prevented the formation of large ASC aggregates, amplification of caspase-1 activation, IL-18 release and execution of pyroptosis. Therefore, melittin-induced activation of the NLRP3 inflammasome results in an attenuated inflammasome response that does not result in caspase-1 dependent cell death.

Technology-induced errors associated with computerized provider order entry software for older patients.

Background The introduction of new technologies in the prescribing process has seen the emergence of new types of medication errors. Objective To determine the prevalence and consequences of technology-induced prescription errors associated with a computerized provider order entry (CPOE) system in hospitalized older patients. Setting Patients 65 years or older admitted to the Departments of Internal Medicine, General Surgery, and Vascular Surgery of a tertiary hospital. Method Prospective observational 6-month study. Technology-induced errors were classified according to various taxonomies. Interrater reliability was measured. Consequences were assessed by interviewing patients and healthcare providers and classified according to their severity. Main outcome measure Prevalence of technology-induced errors. Results A total of 117 patients were included and 107 technology-induced errors were recorded. The prevalence of these errors was 3.65%. Half of the errors were clinical errors (n = 54) and the majority of these were classified as wrong dose, wrong strength, or wrong formulation. Clinical errors were 9 times more likely to be more severe than procedural errors (14.8 vs 1.9%; OR 9.04, 95% CI 1.09-75.07). Most of the errors did not reach the patient. Almost all errors were related to human-machine interactions due to wrong (n = 61) or partial (n = 41) entries. Conclusion Technology-induced errors are common and intrinsic to the implementation of new technologies such as CPOE. The majority of errors appear to be related to human-machine interactions and are of low severity. Prospective trials should be conducted to analyse in detail the way these errors occur and to establish strategies to solve them and increase patient safety.