High incidence of pulmonary thromboembolism in hospitalized SARS-CoV-2 infected patients despite thrombo-prophylaxis.

BACKGROUND: SARS-CoV-2 infected patients present thrombotic complications caused by direct endothelial cells injury of the microvessels. Pulmonary thromboembolism (PE) has been reported by Computed Tomography pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia with high D-dimer levels. OBJECTIVES: We present the characteristics of SARS-CoV-2 infected patients diagnosed of PE by CTPA in our hospital. We also present the comparison of these findings with non-infected patients with PE data. METHODS: Retrospective observational cohort study that included patients over 18 years of age hospitalised consecutively between 26th February and 20th May 2020 in an European Hospital with SARS-CoV2 virus infection, and with suspected infection at beginning of admission but with negative PCR, who were studied with CTPA for suspicion of VTE, during their hospitalization. RESULTS: During the study period, 52 CTPA were performed in our hospital, sixteen in SARS-CoV-2 infected patients, with 4 cases (33%) of PE in the infected group, and 11 (44%) in the non-infected group. No significant differences in age (p = 0.43) and sex (p = 0.31) were found between the two groups, infected and non-infected patients. In the infected group, the patients who had PE had a much lower median age (47.8 years) than those without PE (73.3 years). No differences between infected and non-infected patients were detected in the diagnosis of PE with CTPA, 28.6% versus 27.8% (p = 1.00). Overall patient mortality was 1.9%; one patient died (6.3%) in the infected group, and none in the non-infected group (p = 0.31). CONCLUSION: A considerable incidence of PE diagnosed by CTPA in SARS-CoV-2 infected patients has been observed, despite thrombo-prophylaxis.

Is there any effect of flu vaccine on the SARS-CoV-2 infected patients?

Objectives: On 11 March, WHO declared a global pandemic caused by a new virus of the family Coronaviridae that has since been called SARS-CoV-2. COVID-19 does not have specific antiviral drug treatment currently. There are currently more than one hundred research projects into vaccines against SARS-CoV-2 worldwide, and 17 of them are already being tested on humans, according to the WHO. Until we have an effective vaccine, the possible preventive effect of flu vaccine for SARS-CoV-2 infection based on cross-reactivity has been postulated.Our objective was to analyse the effect of vaccination against flu virus in the season prior to the COVID-19 pandemic in our hospitalized SARS-CoV-2 infected patients. Methods: We performed a retrospective observational cohort study of patients admitted to hospital with SARS-CoV2 infection. We analysed the differences between patients who had received or had not the flu vaccination for the 2019-2020 season. Results: We found no significant differences (p = 0.09) in patients who died (43 in total), of whom 23 (21.5%) were vaccinated against the flu and 20 (13.5%) were not. In mortality, we obtained an adjusted OR = 0.873 (95% CI: 0.294-2.083), and about the success of health care the adjusted OR was 1.447 (95% CI: 0.610-3.430). Conclusions: Flu vaccination in patients admitted for SARS-CoV-2 infection had neither a beneficial nor a harmful effect on the clinical courses or outcomes of patients admitted to an European hospital.

Objetivos: El 11 de marzo, la OMS declaró una pandemia global causada por un nuevo virus de la familia Coronaviridae que desde entonces ha sido denominado SARS-CoV-2. Actualmente no existe ningún tratamiento frente a la COVID-19 con fármacos antivirales específicos. A día de hoy existen más de 100 proyectos de investigación sobre vacunas frente a SARS-CoV-2 a nivel mundial, habiendo sido ya probados 17 de ellas en humanos, según la OMS. Hasta que no se disponga de una vacuna efectiva se ha postulado el posible efecto preventivo de la vacuna frente a la gripe para la infección por SARS-CoV-2, basado en la reactividad cruzada.Nuestro objetivo fue analizar el efecto de la vacuna frente a la gripe en la temporada previa a la pandemia de COVID-19 en nuestros pacientes hospitalizados infectados por SARS-CoV-2. Métodos: Realizamos un estudio retrospectivo observacional de cohorte de pacientes hospitalizados por SARS-CoV-2. Analizamos las diferencias entre los pacientes que habían recibido y los que no habían recibido aún la vacuna para la temporada 2019-2020. Resultados: No encontramos diferencias significativas (p = 0,09) en cuanto a los pacientes fallecidos (43 en total), de los cuales 23 (21,5%) habían sido vacunados frente a la gripe y 20 (13,5%) no habían sido vacunados. En términos de mortalidad, obtuvimos un OR: 0,873 (IC 95%: 0,294-2,083), y en lo referente al éxito de los cuidados sanitarios el OR ajustado fue de 1,447 (IC 95%: 0,610-3,430). Conclusiones: La vacunación frente a la gripe en los pacientes ingresados por SARS-CoV-2 no tuvo un efecto beneficioso ni perjudicial en los cursos clínicos o resultados de los pacientes ingresados en un hospital europeo.

Hospitalization budget impact during the COVID-19 pandemic in Spain.

OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at €15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was €10,744. The main costs were staffing costs (10,131 to 11,357 €/patient for physicians and 10,274 to 11,215 €/patient for nurses). Scenario analysis showed that the range of hospital expenditure was between €14,693,256 and €16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was €9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and €10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.

Suministro de medicamentos desde hospitales a centros de Atención Primaria y gestión de la calidad / Drug supply and distribution from hospitals to Primary Care centres and total quality management

El presente trabajo consiste en el estudio descriptivo del desarrollo de un procedimiento de suministro de medicamentos desde los servicios de farmacia hospitalaria a los botiquines de los centros de Atención Primaria y, cuando el servicio de farmacia del hospital de referencia tiene implantado un sistema integral de gestión de la calidad, su inclusión en el manual de calidad. Con este fin se han desarrollado los documentos normativos correspondientes, así como los indicadores de actividad (muestran el volumen de trabajo realizado) y de calidad (identifican los puntos de mejora), que permiten una monitorización y mejora continua del proceso. El suministro a los centros de Atención Primaria desde el hospital de referencia del Sector Sanitario permite una mejor racionalización del uso de medicamentos en los mismos y el sistema integral de gestión de la calidad va un paso más allá, permitiendo asegurar una óptima prestación del servicio (AU)

The objective of this paper is to describe the development of a procedure of drug distribution from hospital pharmacy service to primary care centres and, when the reference hospital pharmacy service has a quality management total system, their incorporation into the quality management total system. For this purpose, we have developed normative documents, activity indicators (they show the amount of work done) and quality indicators (they allow to identify items to improve) in order to monitor the correct performance of activities. Distribution from health area hospitals to ambulatory care allows a better rational use of drugs in primary care centres and the quality management total system allows to guarantee the best service (AU)

[Assessment of a pharmaceutical interventional programme in patients on medications with renal risk]. / Evaluación de un programa de intervención farmacéutica en pacientes con medicamentos de riesgo renal.

OBJECTIVE: To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk. METHOD: Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmacotherapeutic profile. The study was designed to be carried out in two descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease. RESULTS: The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7 % and 2.1 %, representing a statistically significant reduction in non-adaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1,939.63 euro over two months, the average saving per medication intervened amounting to 62.57 euro (CI 95 %, 23.99-101.14 euro; p = 0.02). CONCLUSIONS: The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease.

Evaluación de un programa de intervención farmacéutica en pacientes con medicamentos de riesgo renal* / Assessment of a pharmaceutical interventional programme in patients on medications with renal risk

Objetivo: Comparar la adecuación de las prescripciones médicas según las guías de dosificación, en pacientes con enfermedad renal, antes y después de aplicar un programa de intervención farmacéutica. Los objetivos secundarios fueron la elaboración de una guía de dosificación en enfermedad renal y medir la prevalencia de prescripción de fármacos con riesgo renal. Método: Estudio experimental de intervención no aleatorizado (antes/después) realizado en un hospital general de 800 camas, que incluyó a pacientes ingresados, mayores de 18 años, con enfermedad renal y medicamentos con riesgo renal prescritos en su perfil farmacoterapéutico. El estudio se diseñó para realizarlo en dos fases: un corte transversal descriptivo (grupo control) y un estudio de intervención de cohortes prospectivo (grupo de intervención). La variable principal fue el porcentaje de inadecuación posológica según el grado de enfermedad renal. Resultados: El estudio incluyó a 185 pacientes, 88 en el grupo control y 97 en el de intervención. En el grupo de intervención la prevalencia de incumplimiento antes y después de la intervención fue del 18,7 y el 2,1 %, lo que supone una reducción estadísticamente significativa en la inadecuación posológica. El coste evitado con el programa de intervención farmacéutica fue de 1.939,63 euros en 2 meses; la media por cada medicamento en el que se intervino fue de 62,57 euros (intervalo de confianza del 95 %, 23,99-101,14 euros; p = 0,02). Conclusiones: Los resultados del estudio indican que la aplicación de un modelo de atención farmacéutica, basado en la validación prospectiva de los medicamentos con riesgo renal, mejora de forma muy significativa la adecuación de las pautas posológicas en enfermos renales (AU)

Objective: To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk. Method: Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmacotherapeutic profile. The study was designed to be carried out in two descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease. Results: The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7 % and 2.1 %, representing a statistically significant reduction in non-adaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1,939.63 euro over two months, the average saving per medication intervened amounting to 62.57 euro (CI 95 %, 23.99-101.14 euro; p = 0.02). Conclusions: The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease (AU)

Trombocitopenia grave inducida por levofloxacino / No disponible

No disponible