Pharmacotherapeutic potential of Vitis vinifera(grape) in age-related neurological diseases / Potencial farmacoterapéutico de Vitis vinifera(uva) en enfermedades neurológicas asociadas a la edad

Age-related neurological disorders (ANDs), including neurodegenerative diseases, are complex illnesses with an increasing risk with advancing years. The central nervous system's neuropathological conditions, including oxidative stress, neuroinflammation, and protein misfolding, are what define ANDs. Due to the rise in age-dependent prevalence, efforts have been made to combat ANDs. Vitis viniferahas a long history of usageto treat a variety of illness symptoms. Because multiple ligand sites may be targeted, Vitis viniferacomponents can be employed to treat ANDs. This is demonstrated by the link between the structure and action of these compounds. This review demonstrates that Vitis viniferaand its constituents, including flavonoids, phenolic compounds, stilbenoidsandaromatic acids, are effective at reducing the neurological symptoms and pathological conditions of ANDs. This is done by acting as an antioxidant and anti-inflammatory. The active Vitis vinifera ingredients have therapeutic effects on ANDs, as this review explains.

Las enfermedades neurológicas asociadas a la edad (AND, por su sigla en inglés) incluyendo las enfermedades neurodegenerativas, son enfermedades complejas con un riesgo creciente con la edad. Las condiciones neuropatológicas del sistema nervioso central, que incluyen el estrés oxidativo, la neuro inflamación, y el plegado erróneo de proteínas, son lo que define las AND. Debido al aumento en la prevalencia dependiente de la edad, se han hecho esfuerzos para combatir las AND. Vitis vinifera tiene una larga historia de uso para el tratamiento de síntomas. Puesto que puede hacer objetivo a muchos sitios ligando, los componentes de Vitis viniferase pueden utilizar para tratar AND. Esto se demuestra por el vínculo entre la estructura y la acción de estos compuestos. Esta revisión demuestra que la Vitis viniferay sus constituyentes, incluídos los flavonoides, componentes fenólicos, estilbenoides, y ácidos aromáticos, son efectivos para reducir los síntomas neurológicos y las condiciones patológicas de AND. Esto se produce por su acción como antioxidante y antiinflamatorio. Los ingredientes activos de Vitis vinifera tienen efectos terapéuticos en AND, y esta revisión lo explica.

Ocorrência de indicações farmacológicas não recomendadas por estágios na endometriose e impacto no quadro de ansiedade por persistência de sintomas / Occurrence of pharmacological indications not recommended by stages in endometriosis and impact on anxiety due to persistence of symptoms / Presencia de indicaciones farmacológicas no recomendadas por etapas en la endometriosis e impacto en la ansiedad por la persistencia de los síntomas

Introdução: Endometriose é uma patologia pélvica crônica de caráter inflamatório e estrogênio-dependente. Manifesta-se em quatro tipos de estágio (EI, EII, EIII e EIV), caracterizados pelos números de lesões. Tem indicações farmacológicas recomendadas se baseadas nos estágios, sendo EI/EII sintomático com AINES e/ou uso de anticonceptivos de uso contínuo; e EIII/EIV com fármacos análogos de GnRH. O estilo de vida dessas mulheres é impactado pela dor, que altera a rotina e vida afetivo/sexual contribuindo para quadros de ansiedade. O presente estudo se norteia pela questão "qual impacto na ansiedade de mulheres com endometriose, quando não ocorrem indicações farmacológicas recomendadas para os estágios que se encontra? Logo, o objetivo deste estudo é avaliar os efeitos do tratamento medicamentoso não recomendado e risco de ansiedade. Metodologia: Levantamento de pacientes com diagnóstico de Endometriose, cadastradas no Banco de Dados do Projeto agrupadas em estágios de tratamentos farmacológicos similares (EI/EII e EIII/EIV). O relato de ansiedade, com diagnóstico médico e pós endometriose foi a variável dependente em estudo. As variáveis independentes (ou influenciadoras) foram [1] Estágio da doença, [2] Farmacoterapia recomendada (FR) ou não (FNR) e [3] esquema medicamentoso empregado (classes e combinações). Estatística feitas por chi quadrado e Fischer. Resultados: Do total de 375 mulheres, 274 apresentavam ansiedade. Destas, 170 estavam no grupo IFR; sendo 141 no agrupamento EI/EII, e 29 mulheres no EIII/EIV. No que se refere ao grupo IFNR, teve se um n=104 mulheres, sendo apenas 1 nos EI/EII e 103 nos EIII/EIV. Os casos de FNR estão mais presentes em EIII/EIV, com 90% dos casos (IC 95%, p<0,05). O esquema terapêutico mais presente foi AINEs em monoterapia, sendo 65% (IC 95%, p<0,05) em Estágio inadequado. Notou-se uma correlação positiva entre FNR e quadros de ansiedade, principalmente quando se empregava a monoterapia com AINEs (IC 95%, p<0,05). Conclusão: Dificuldades de acesso a especialistas para diagnóstico e aos medicamentos do EIII/EIV podem ser as causas, que serão investigadas em estudos futuros.

Introduction: Endometriosis is a chronic pelvic pathology with an inflammatory and estrogen-dependent nature. It manifests itself in four types of stages (EI, EII, EIII and EIV), characterized by the number of lesions. It has recommended pharmacological indications based on the stages, being symptomatic EI/EII with NSAIDs and/or use of continuous contraceptives; and EIII/EIV with GnRH analogue drugs. The lifestyle of these women is impacted by pain, which alters their routine and emotional/sexual life, contributing to anxiety. The present study is guided by the question "what impact on the anxiety of women with endometriosis, when there are no recommended pharmacological indications for the stage they are in?" Therefore, the objective of this study is to evaluate the effects of non-recommended drug treatment and the risk of anxiety. Methodology: Survey of patients diagnosed with Endometriosis, registered in the Project Database grouped into stages of similar pharmacological treatments (EI/EII and EIII/EIV). The report of anxiety, with medical diagnosis and post-endometriosis was the dependent variable under study. The independent (or influencing) variables were [1] Stage of the disease, [2] Pharmacotherapy recommended (FR) or not (FNR) and [3] medication regimen used (classes and combinations). Statistics made by chi square and Fischer. Results: Of the total of 375 women, 274 had anxiety. Of these, 170 were in the IFR group; 141 in the EI/EII group, and 29 women in the EIII/EIV group. Regarding the IFNR group, there were n=104 women, with only 1 in EI/EII and 103 in EIII/EIV. FNR cases are more present in EIII/EIV, with 90% of cases (95% CI, p<0.05). The most common therapeutic regimen was NSAIDs as monotherapy, with 65% (95% CI, p<0.05) in an inadequate stage. A positive correlation was noted between FNR and anxiety, especially when using monotherapy with NSAIDs (95% CI, p<0.05). Conclusion: Difficulties in accessing specialists for diagnosis and EIII/EIV medications may be the causes, which will be investigated in future studies.

Introducción: La endometriosis es una patología pélvica crónica de naturaleza inflamatoria y estrógeno-dependiente. Se manifiesta en cuatro tipos de estadios (EI, EII, EIII y EIV), caracterizados por el número de lesiones. Tiene indicaciones farmacológicas recomendadas según los estadios, siendo EI/EII sintomática con AINE y/o uso de anticonceptivos continuos; y EIII/EIV con fármacos análogos de GnRH. El estilo de vida de estas mujeres se ve impactado por el dolor, lo que altera su rutina y su vida emocional/sexual, contribuyendo a la ansiedad. El presente estudio se guía por la pregunta "¿qué impacto tiene en la ansiedad de las mujeres con endometriosis, cuando no existen indicaciones farmacológicas recomendadas para las etapas en las que se encuentra? Por tanto, el objetivo de este estudio es evaluar los efectos del tratamiento farmacológico no recomendado y el riesgo de ansiedad. Metodología: Encuesta a pacientes diagnosticadas de Endometriosis, registradas en la Base de Datos del Proyecto agrupadas en etapas de tratamientos farmacológicos similares (EI/EII y EIII/EIV). El reporte de ansiedad, con diagnóstico médico y post-endometriosis fue la variable dependiente en estudio. Las variables independientes (o influyentes) fueron [1] Estadio de la enfermedad, [2] Farmacoterapia recomendada (FR) o no (FNR) y [3] régimen de medicación utilizado (clases y combinaciones). Estadística realizada por chi cuadrado y Fischer. Resultados: Del total de 375 mujeres, 274 presentaron ansiedad. De ellos, 170 estaban en el grupo IFR; 141 en el grupo EI/EII y 29 mujeres en el grupo EIII/EIV. En cuanto al grupo IFNR, hubo n=104 mujeres, siendo sólo 1 en EI/EII y 103 en EIII/EIV. Los casos de FNR están más presentes en EIII/EIV, con un 90% de los casos (IC 95%, p<0,05). El régimen terapéutico más común fue el de AINE en monoterapia, con un 65% (IC 95%, p<0,05) en estadio inadecuado. Se observó una correlación positiva entre la FNR y la ansiedad, especialmente cuando se utilizaba monoterapia con AINE (IC del 95%, p<0,05). Conclusión: Las dificultades para acceder a especialistas para el diagnóstico y a los medicamentos EIII/EIV pueden ser las causas, que serán investigadas en futuros estudios.

Implementación del Proceso Estandarizado de Evaluación Farmacoterapéutica en pacientes hospitalizados y ambulatorios / Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients

Objetivos el seguimiento farmacoterapéutico (SFT) realizado por el farmacéutico clínico puede enmarcarse dentro de 3 actividades: la identificación, la resolución y la prevención de eventos adversos a medicamentos. Estas deben ajustarse a los requerimientos y los recursos de cada institución, generando la necesidad de desarrollar procedimientos que aumenten la eficiencia del SFT y garanticen la seguridad del paciente. Los farmacéuticos clínicos de la Red de Salud UC-CHRISTUS Chile desarrollamos un Proceso Estandarizado de Evaluación Farmacoterapéutica (PEEF). El objetivo principal del estudio fue evaluar el impacto de esta herramienta en términos del número de evaluaciones e intervenciones de los farmacéuticos clínicos y secundariamente determinar el ahorro de costos potenciales y directos asociados a las intervenciones en la Unidad de Cuidados Intensivos (UCI). Método estudio cuasi-experimental que evaluó la frecuencia y tipo de evaluaciones e intervenciones realizadas por los farmacéuticos clínicos en unidades de pacientes adultos de la Red UC-CHRISTUS, previo y posterior a la utilización del PEEF. La distribución de variables se evaluó mediante el test Shapiro–Wilk, la asociación entre el uso del PEEF y el número de evaluaciones e intervenciones fue realizada mediante el test Chi cuadrado. La evaluación de costos asociados a las intervenciones del farmacéutico clínico en UCI se realizó utilizando la metodología propuesta por Hammond et al.10. Resultados el total de pacientes evaluados pre- y pos-PEEF fue de 1.781 y 2.129, respectivamente. Las evaluaciones e intervenciones en el periodo pre-PEEF fueron 5.209 y 2.246, en el periodo pos-PEEF fueron 6.105 y 2.641, respectivamente. El aumento de las evaluaciones como de las intervenciones fue significativo solo en las unidades de mayor complejidad. La reducción potencial de costos estimados en el periodo pos-PEEF en UCI fue de 492.805 dólares americanos. ... (AU)

Objectives The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). Methods A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro–Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. Results A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805.... (AU)

Aspectos farmacológicos y adherencia al tratamiento antirretroviral en pacientes VIH

Introducción: La adherencia al tratamiento farmacológico favorece la supresión viral y reduce la resistencia a la terapia antirretroviral de gran actividad a largo plazo. Objetivo: Determinar la relación entre los aspectos farmacológicos y la adherencia al tratamiento antirretroviral de una IPS colombiana. Metodología: Estudio analítico transversal en pacientes con diagnóstico de VIH en tratamiento antirretroviral entre los años 2012 a 2020. Se utilizó un modelo de regresión logística binaria múltiple con fines explicativos. Resultados: Se analizaron 9835 pacientes donde la proporción de adherencia fue de 90 % y en el modelo ajustado se evaluó su relación con los antecedentes de no adherencia (ORa:0,52 IC95 °/o:0,40-0,66), grupo farmacológico (2 ITIAN + 1 IP u otro) (ORa:1,22 IC95 %:0,99-1,76), dos tomas al día (ORa:1,02 IC95 %:0,74-1,40), unidades al día (≥ 3) (ORa:0,69 IC95 %:0,47-1,02), reacciones adversas a medicamentos (ORa:0,56 IC95 °%:0,40-0,78), polimedicación (ORa:1,36 IC95 %:1,00-1,85), tiempo TAR (1 a 2 años) (ORa:1,63 IC95 %:1,27-2,09),tiempo TAR (6 a 12 meses) (ORa:1,66 IC95 %:1,27-2,18), tiempo TAR (<6 meses) (ORa:1,36 IC95 %:1,03-1,78), tasa de reclamación de los medicamentos (ORa:0,42 IC95 %:0,32-0,55) y antecedentes PRUM (ORa:0,11 IC95 %:0,09-0,14). Discusión: La proporción de adherencia obtenida es superior a lo descrito para otros países (entre 60-77 %); sin embargo se encuentra que los hallazgos correspondientes al efecto de las variables farmacológicas analizadas son acordes a lo descrito en estudios previos en el tema Conclusión: Los antecedentes de no adherencia, reacciones adversas, tasa de reclamación de los medicamentos y antecedentes de problemas relacionados con el uso de medicamentos son aspectos que reducen la probabilidad de adherencia; mientras que el mayor tiempo de uso del tratamiento aumenta la misma.

Introduction: Adherence to drug treatment promotes viral suppression and reduces long-term resistance to highly active antiretroviral therapy (HAART). Objective: To determine the relationship between the pharmacological aspects and adherence to antiretroviral treatment in a Colombian IPS. Methodology: Cross-sectional analytical study in patients with HIV on antiretroviral treatment between 2012 and 2020. A multiple binary logistic regression model was used for explanatory purposes. Results: A total of 9,835 patients were analyzed where the proportion of adherence was 90 % and in the adjusted model its relationship with history of non-adherence was assessed (ORa: 0,52 95 % CI: 0,40-0,66), pharmacological group (2 NRTI + 1 PI or other) (ORa: 1,22 95 % CI: 0,99-1,76), two doses per day (ORa: 1,02 95 % CI: 0,74-1,40), units per day (≥ 3 ) (ORa: 0,69 95 % CI: 0,47-1,02), adverse drug reactions (ORa: 0,56 95 % CI: 0,40-0,78), polypharmacy (ORa: 1,36 95 % CI : 1,00-1,85), ART time (1 to 2 years) (ORa: 1,63 95 % CI: 1,27-2,09), ART time (6 to 12 months) (ORa: 1,66 95 % CI: 1,27-2,18), ART time (<6 months) (ORa: 1,36 95 % CI: 1,03-1,78), inconsistency in the claim (ORa: 0,42 95 % CI: 0,32-0,55) and PRUM history (ORa: 0,11 95 % CI: 0,09-0,14). Discussion: The proportion of adherence obtained is higher than that described for other countries (between 60-77 %); however, the findings corresponding to the effect of the pharmacological variables analysed are in line with those described in previous studies on the subject. Conclusion: The history of non-adherence, adverse reactions, inconsistencies in the claim fill history and problems related to the use of medications are aspects that reduce the probability of adherence. While the longer time of use of the treatment increases adherence.

Aplicação da Medication Fall Risk Score em doentes com notificação de incidente de queda: Análise retrospetiva / Application of the Medication Fall Risk Score in patients will fall notification: A retrospective analysis / Aplicación de la Medication Fall Risk Score en pacientes con incidente de caída notificado: Análisis retrospectivo

Resumo Enquadramento: As quedas em contexto hospitalar são eventos adversos frequentes, sendo os medicamentos um importante fator contribuinte. Objetivo: Analisar notificações de queda de doentes internados e caracterizar o risco de queda com foco na terapia farmacológica, através da aplicação da Medication Fall Risk Score. Metodologia: Estudo observacional, descritivo e retrospetivo realizado num centro hospitalar português. Aplicada a Medication Fall Risk Score, numa amostra de 183 notificações de queda ocorridas no primeiro trimestre de 2021. Resultados: A Medication Fall Risk Score identificou 60,6% dos doentes com "sim" para o alto risco de queda. Relativamente à avaliação de risco de queda registada nas notificações com recurso a outra escala, identificou-se que 65,8% dos doentes foram classificados como "baixo risco" ou "sem risco". Desses, 53,9% foram classificados com "sim" para o alto risco através da Medication Fall Risk Score. Conclusão: A Medication Fall Risk Score poderá contribuir para melhorar a deteção de doentes com "alto risco" de queda, permitindo uma gestão mais segura dos medicamentos para a prevenção das quedas.

Abstract Background: Falls in hospital settings are frequent adverse events, with medications contributing significantly. Objective: To analyze inpatient fall notifications and characterize fall risk with a focus on drug therapy by applying the Medication Fall Risk Score. Methodology: An observational, descriptive, and retrospective study was conducted in a Portuguese hospital center. The Medication Fall Risk Score was applied to a sample of 183 patient fall notifications in the first quarter of 2021. Results: The Medication Fall Risk Score identified 60.6% of patients with "yes" for high fall risk. Regarding fall risk assessment recorded in the notifications using another scale, 65.8% of patients were classified as "low risk" or "no risk." Of these, 53.9% were classified as "yes" for high risk using the Medication Fall Risk Score. Conclusion: The Medication Fall Risk Score may help to improve the detection of patients at "high risk" of falling, allowing safer medication practices for fall prevention.

Resumen Marco contextual: Las caídas en los hospitales son eventos adversos frecuentes y la medicación es un factor importante. Objetivo: Analizar las notificaciones de caída de pacientes hospitalizados y caracterizar el riesgo de caída centrándose en el tratamiento farmacológico, mediante la aplicación de la Medication Fall Risk Score. Metodología: Estudio observacional, descriptivo y retrospectivo realizado en un centro hospitalario portugués. Aplicada la Medication Fall Risk Score en una muestra de 183 notificaciones de caída ocurridas en el primer trimestre de 2021. Resultados: La Medication Fall Risk Score identificó al 60,6% de los pacientes con un "sí" para riesgo de caída elevado. En cuanto a la evaluación del riesgo de caída registrada en las notificaciones mediante otra escala, el 65,8% de los pacientes fueron clasificados como de "riesgo bajo" o "sin riesgo". De ellos, el 53,9% se clasificaron con un "sí" para riesgo elevado a través de la Medication Fall Risk Score. Conclusión: La Medication Fall Risk Score podría ayudar a mejorar la detección de pacientes con "riesgo elevado" de caída, lo que permitiría una gestión más segura de los medicamentos para prevenirla.

Gestión integral de la farmacoterapia en un paciente hospitalizado con VIH y tuberculosis / Comprehensive medication management in a patient hospitalized with HIV and tuberculosis

Paciente varón de 27 años derivado desde infectología al Servicio de Gestión Integral de la Farmacoterapia para optimizar la administración del tratamiento antifímico. Se encontraba internado en hospital por un absceso submaxilar y axilar, candidiasis esofágica, desnutrición proteico-calórica, infección por VIH, tuberculosis pulmonar y ganglionar. Se analizó la experiencia farmacoterapéutica para lograr una mejor comprensión del uso de la medicación en el paciente y posteriormente lograr establecer un plan de cuidados individualizado para identificar y resolver 7 problemas farmacoterapéuticos mediante el sistema Pharmacotherapy Workup, obteniendo mejoría y estabilidad de su estado de salud. En las 11 condiciones clínicas que padecía el paciente, se realizaron un total de 7 intervenciones, para resolver los 6 problemas farmacoterapéuticos y prevenir la nueva aparición de uno de ellos. Uno de los problemas que consistía en que el paciente no deseaba tomar la medicación debido a los efectos adversos, fue resuelto con el propio paciente mediante la comprensión de su experiencia farmacoterapéutica, de esta forma se llegó a un acuerdo para lograr la tolerancia del fármaco. El resto se resolvieron mediante el trabajo colaborativo con la médica infectóloga y la nutricionista. (AU)

A 27-year-old male patient referred from infectious diseases to the Comprehensive medication Man-agement Service to optimize the administration of antifungal management. He was hospitalized for a submaxillary and axillary abscess, esophageal candida infection, protein-calorie malnutrition, HIV infection, pulmonary and ganglial tuberculosis.The pharmacotherapeutic experience was analyzed to achieve a better understanding of the patient's medication use and subsequently establish an indi-vidualized care plan to identify and solve 7 pharma-cotherapeutic problems through the Pharmacother-apy Workup system, obtaining improvement and stability in the patient's state of health.In the 11 clinical conditions suffered by the patient, a total of 7 interventions were performed to solve the 6 pharmacotherapeutic problems and prevent the new appearance of one of them. 1 of the prob-lems was solved by the patient himself because it was necessary to understand his medication expe-rience. The rest were solved through collaborative work with the infectious disease physician and the nutritionist. (AU)

[Translated article] Medication experience and clinical interventions in patients receiving pharmaceutical care: A scoping review of pharmaceutical care practice.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience-MedExp-and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: (1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management CMM and (2) explain which categories they establish and how they explain the individual, psychological, and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923, 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological, and social qualities. This MedExp is corporal, intentional, intersubjective, and relational, expanding to the collective because it implies beliefs, culture, ethics, and the socioeconomic and political reality of each person located in their context.

[Translated article] Implementation of the standardized process of drug therapy evaluation in inpatients and outpatients.

OBJECTIVES: The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). METHODS: A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1781 patients was evaluated before and 2129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5209 and 2246. In the after-SPEP period were 6105 and 2641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8072 in the study period. CONCLUSIONS: This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance / Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice

Objetivo: analizar la literatura científica sobre investigaciones cualitativas que estudian la experiencia con la medicación (MedExp) y las intervenciones farmacéuticas relacionadas que aportan cambios en la salud de los pacientes. A través del análisis de contenido de esta revisión de alcance se pretende: 1) comprender cómo analizan los farmacéuticos la MedExp de sus pacientes que reciben Comprehensive Medication Management (CMM) y 2) explicar cuáles categorías establecen y cómo explican las dimensiones individuales, psicológicas y culturales de MedExp. Métodos: la revisión de alcance siguió las recomendaciones PRISMA Extension for Scoping Reviews. Se hizo una búsqueda en Medline (Pubmed), SCOPUS, Web of Science y Psycinfo para identificar investigaciones sobre MedExp de pacientes atendidos por farmacéuticos y que cumplieran con estándares de calidad, Standards for Reporting Qualitative Research. Se incluyeron artículos publicados en inglés y español. Resultados: se identificaron 395 investigaciones cualitativas, se excluyeron 344. En total 19 investigaciones cumplieron con los criterios de inclusión. Concordancia entre los revisores, índice de kappa 0,923; IC 95% (0,836-1,010). Las unidades de análisis de los discursos de los pacientes se relacionaron con una construcción de la MedExp en el transitar de las personas con sus medicamentos, la influencia que tiene en la experiencia de enfermar, la conexión con aspectos socioeconómicos y las creencias. A partir de la MedExp, los farmacéuticos plantearon propuestas culturales, redes de apoyo, a nivel de políticas sanitarias, y brindar educación e información acerca de la medicación y la enfermedad. Adicionalmente, se identificaron características de las intervenciones como modelo dialógico, relación terapéutica, toma de decisiones compartidas, abordaje integral y derivaciones a otros profesionales. Conclusiones ... (AU)

Objective: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients’ health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. Methods: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. Results: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. Conclusions ... (AU)

Pharmaceutical interventions and factors associated with their acceptance in intensive care units in Brazil / Intervenciones farmacéuticas y factores asociados a su aceptación en unidades de cuidados intensivos en Brasil

Objetivo: El propósito de este estudio es evaluar las intervenciones farmacéuticas (IF) realizadas sobre PRM y los factores asociados a su aceptación. Método: Se trata de un estudio descriptivo y transversal que analizó las IF realizadas a pacientes adultos de dos UCI de Fortaleza, Brasil, en 2019. Las IF se analizaron en las categorías cantidad de fármaco y estrategia farmacológica, utilizando la clasificación propuesta por Sabater et al. Los fármacos se clasificaron además por el Sistema de Clasificación Anatómica, Terapéutica, Química y por la clasificación de Fármacos de Alta Vigilancia (FAV). Resultados: Se incluyeron 305 pacientes, siendo la mayoría del sexo masculino (55,1 %), ancianos (52,8 %) y atendidos en la UCI quirúrgica (51,4 %). Se analizaron 1.317 IF y se aceptaron el 88,0 %, siendo la sustitución de uno o más fármacos (28,0 %) y la adición de uno o más fármacos (27,7 %) las más frecuentes. La clase terapéutica más prevalente fue antiinfeccioso de uso sistémico (24,1 %) y los FAV estuvieron implicados en el 21,7 % de las IF. Se observó asociación entre las IF aceptadas e ingreso en UCI clínica (p<0,0001), FAV (p=0,0013), sustitución de uno o más fármacos (p=0,0062) y la clase sustitutos sanguíneos y soluciones de perfusión (p= 0,0187). Conclusiones: Se realizaron y aceptaron un elevado número de IF, lo que refuerza la importancia del farmacéutico en la revisión de las prescripciones médicas en UCI. (AU)

Objective: The purpose of this study is to evaluate the pharmaceutical interventions (PI) performed in PRM and the factors associated with their acceptance.Method: This is a descriptive and cross-sectional study that analyzed PIs performed on adult patients from two ICUs in Fortaleza, Brazil, in 2019. PIs were analyzed in the categories quantity of drug and pharmacological strategy, using the classification proposed by Sabater et al. The drugs were also classified by the Anatomical, Therapeutic, and Chemical Classification System and by the High Surveillance Drugs (FAV) classification.Results: 305 patients were included, most of them male (55.1 %), elderly (52.8 %) and treated in the surgical ICU (51.4 %). 1,317 PIs were analyzed and 88.0 % were accepted, being to replace one or more drugs (28.0 %), to add one or more drugs (27.7 %) and to change the dose (24.8 %) the most frequent types. The most prevalent therapeutic class was anti-infectives for systemic use (24.1 %) and AVFs were involved in 21.7 % of the PIs. An association was observed between PIs accepted and admission to the clinical ICU (p<0.0001), AVF (p=0.0013), substitution of one or more drugs (p=0.0062) and the class of blood substitutes and perfusion solutions. (p= 0.0187).Conclusions: A high number of PIs were performed and accepted, which reinforces the importance of the pharma-cist in the review of medical prescriptions in the ICU. (AU)

Conocimientos básicos para la preparación y uso de fórmulas magistrales en oftalmología

Los colirios fortificados o reforzados son fórmulas magistrales que reciben ese nombre por la vigorización que se les realiza a los colirios industriales con principios activos de antibióticos, antivirales, citostáticos y antimicóticos, en dependencia de los requerimientos individuales de los pacientes. Por tanto, la utilización de la formulación magistral es, por su capacidad y flexibilidad, un potencial para concebir nuevas pautas terapéuticas y posibilitar la creación de nuevas formulaciones o bien la actualización de antiguas fórmulas con principios activos más modernos, con el fin de lograr una alternativa a los colirios industriales de manera potente, eficaz y segura. El objetivo de este trabajo es describir los fundamentos teóricos, las tendencias nacionales e internacionales de la preparación y el uso oftalmológico de los colirios fortificados. Se realizó una revisión bibliográfica y documental actualizada, se utilizaron fuentes primarias, secundarias y terciarias y experiencias nacionales. La utilización de los colirios fortificados es cada día más frecuente en la especialidad de oftalmología, lo que obliga al farmacéutico hospitalario y al oftalmólogo a estar actualizado en temas como elaboración segura, composición, indicación y uso correctos.

Fortified or reinforced eye drops are masterful formulas that receive such name due to the industrial eye drops' invigoration with antibiotic, antiviral, cytostatic and antifungal active ingredients, depending on the patients' individual requirements. Therefore, the use of a masterful formulation is, due to its capacity and flexibility, a potential for conceiving new therapeutic guidelines and also for making possible the creation of new formulations or the updating of old formulations with more modern active ingredients, in order to achieve an alternative to industrial eye drops in a potent, effective and safe way. The objective of this work is to describe the theoretical foundations, the national and international trends in the preparation of fortified eye drops, as well as their ophthalmologic use. An updated bibliographic and documentary review was carried out, using primary, secondary and tertiary sources, together with national experiences. The use of fortified eye drops is becoming increasingly frequent in the ophthalmology specialty, which obliges the hospital pharmacist or the ophthalmologist to be updated on issues such as safe preparation, composition, prescription and correct use.

Deshabituación al consumo de tabaco desde las oficinas de farmacia mediante planes multidisciplinares / Smoking cessation from pharmacies through multidisciplinary plans

Fundamentos: El tabaco es la droga más consumida en el mundo y cada año provoca la muerte de más de ocho millones depersonas. El farmacéutico es el profesional de la salud más accesible a los fumadores, por lo que es fundamental en el tratamientoy prevención del tabaquismo. El objetivo de este estudio fue implantar un programa antitabaco multidisciplinar en una oficina defarmacia y evaluar el efecto de la atención farmacéutica en la cesación del consumo de tabaco. Métodos: El estudio se realizó en dos farmacias del Ejército de Tierra situadas en España y Líbano en las que se desarrolló unplan de deshabituación al consumo de tabaco durante los años 2020 y 2021. Como criterio de selección de participantes se aceptó atodos aquellos pacientes del área de influencia de las farmacias que aceptasen participar en el programa, siendo el tamaño muestralde treinta y ocho personas. Los pacientes se sometieron a test de adicción, motivación y hábito de consumo de tabaco, y se realizóun análisis descriptivo de los datos aportados, usando el test de chi-cuadrado para la comparación de valores, considerándoseestadísticamente significativos solo aquellos con un valor de probabilidad inferior a 0,05. Resultados: El trabajo multidisciplinar permitió el tratamiento con medicamentos mediante prescripción médica. El 63% de lospacientes del estudio consiguieron dejar de fumar. Conclusiones: Las oficinas de farmacia pueden implantar y liderar programas de deshabituación al consumo de tabaco quefaciliten la cesación y la adhesión a los tratamientos. La clasificación de los pacientes según su historial de tabaquismo resulta clavepara realizar un tratamiento adecuado y personalizado.(AU)

Background: Tobacco is the most consumed drug in the world and each year it causes the death of more than eight millionpeople. The pharmacist is the healthcare professional most accessible to smokers, therefore they are essential in the treatment andprevention of smoking. The study´s aim was to implement a multidisciplinary anti-smoking program in a pharmacy and evaluate theeffect of pharmaceutical care on smoking cessation. Methods: The study was carried out in two army pharmacies located in Spain and Lebanon in which a smoking cessation plan wasdeveloped in 2020 and 2021. As the requirements for participants selection, all those patients in the area of influence of pharmaciesthat agreed to participate in the program were accepted, with a sample size of thirty-eight people. The patients underwent an addiction,motivation and smoking habit test, and a descriptive analysis of the data provided was carried out, using the chi-square test for thecomparison of values. Only those with a probability value less than 0.05 are considered statistically significant.Results: The multidisciplinary work allowed treatment with prescription drugs. The study shows that 63% of patients managedto quit smoking. Conclusions: Pharmacies can implement and lead smoking cessation programs that facilitate cessation and adherence to treat-ments. The classification of patients according to their history of smoking is key to carrying out an adequate and personalized treatment.(AU)

Medication experience and clinical interventions in patients cared for by pharmacist: Scoping review of pharmaceutical care practice. / Experiencia con la medicación e intervenciones clínicas en pacientes valorados por farmacéuticos: revisión de alcance.

OBJECTIVE: Analyze scientific literature on qualitative research that studies the medication experience -MedExp- and related pharmaceutical interventions that bring changes in patients' health. Through the content analysis of this scoping review, we intend to: 1) understand how pharmacists analyze the MedExp of their patients who receive Comprehensive Medication Management and 2) explain which categories they establish and how they explain the individual, psychological and cultural dimensions of MedExp. METHODS: The scoping review followed recommendations from PRISMA Extension for Scoping Reviews. Medline (Pubmed), SCOPUS, Web of Science, and Psycinfo were used to identify research on MedExp from patients attended by pharmacists; and that they comply with quality standards, Standards for Reporting Qualitative Research. Articles published in English and Spanish were included. RESULTS: 395 qualitative investigations were identified, 344 were excluded. In total, 19 investigations met the inclusion criteria. Agreement between reviewers, kappa index 0.923 95% CI (0.836-1.010). The units of analysis of the patients' speeches were related to how they were progressing in their medications and how it was built through MedExp, the influence it has on the experience of becoming ill, the connection with socioeconomic aspects, and beliefs. Based on MedExp, the pharmacists raised cultural proposals, support networks, health policies, and provide education and information about medication and disease. Additionally, characteristics of the interventions were identified, such as a dialogic model, therapeutic relationship, shared decision-making, comprehensive approach, and referrals to other professionals. CONCLUSIONS: The MedExp is an extensive concept, which encompasses people's life experience who use medications based on their individual, psychological and social qualities. This MedExp is corporal, intentional, intersubjective and relational, expanding to the collective because it implies beliefs, culture, ethics and the socioeconomic and political reality of each person located in their context.

Revisión bibliográfica sobre la Gestión Integral de la Farmacoterapia en pacientes hospitalizados en Cirugía Ortopédica y Traumatología / Literature review on Medication Therapy Management in patients admitted to Orthopedic Surgery and Trauma Departments

Objetivo: Explorar la literatura científica sobre las intervenciones farmacéuticas (IF) y la Gestión Integral de la Farmacoterapia (GIF) brindada por farmacéuticos en pacientes hospitalizados en Cirugía Ortopédica y Traumatología (COT). Métodos: Se realizó una búsqueda de artículos originales y revisiones, publicados en inglés o castellano, hasta el 17 de junio de 2021, cuyo tema principal fueran las IF en pacientes hospitalizados en COT. Bases de datos consultadas: Medline, Cochrane Library y Scielo. Términos empleados: “Orthopedics”, “Traumatology”, “orhopedic surgery”, “orhopedic trauma”, “Medication Therapy Management”, “Pharmacy Service, Hospital”, “Pharmacists”, “Medication Reconciliation”, “Pharmaceutical Care”, “Clinical Pharmacy”. La IF fue considerada GIF cuando implicaba una revisión profunda de la medicación del paciente (Valoración inicial/“Assessment”), evaluando indicación, efectividad, seguridad y cumplimiento/adherencia de cada uno de los medicamentos, y comprobando que todas sus necesidades farmacoterapéuticas estuvieran cubiertas. La implantación de la GIF fue considerada completa cuando además se realizaba un plan de cuidados farmacoterapéutico (“Care Plan”) y evaluación/seguimiento (“Follow up-evaluation”). Resultados: Se seleccionaron 29 artículos, principalmente estudios observacionales descriptivos (51,7%). La mayoría fueron publicados en Estados Unidos (27,6%) y España (20,7%). IF mayoritarias: conciliación de medicación (55,2%), revisión de medicación (44,8%), seguimiento farmacoterapéutico (SFT) (34,5%), manejo del dolor físico postquirúrgico (27,6%) y evaluación/reducción de riesgos (27,6%). La GIF fue analizada en cinco referencias bibliográficas (17,2%); siendo su implantación completa solamente en tres (10,3%). Conclusiones: La presente revisión bibliográfica sintetiza las principales IF en pacientes hospitalizados en COT, destacando: conciliación de medicación, revisión de medicación y SFT... (AU)

Objective: To review the scientific literature on Pharmaceutical Interventions (PIs) and Medication Therapy Management (MTM) by pharmacists in patients admitted to Orthopedic Surgery and Trauma (OST) Departments. Methods: A search was conducted of Medline, Cochrane Library, and Scielo databases for original articles and reviews on PIs in adults (≥18 yrs) hospitalized in OST published in English or Spanish up to June 17 2021. Search terms were: “orthopedics”, “traumatology”, “orthopedic surgery”, “orthopedic trauma”, “medication therapy management”, “pharmacy service, hospital”, “pharmacists”, “medication reconciliation”, “pharmaceutical care”, “clinical pharmacy”. Titles and abstracts of retrieved items were examined. A PI was considered MTM when part of a more in-depth review of the patient’s medication, evaluating the indication, effectiveness, safety, and treatment adherence for each medication and ensuring that all pharmacotherapeutic needs were covered (Assessment). MTM implementation was considered complete when plans for pharmacotherapy care (Care Plan) and follow-up (Follow-up evaluation) were developed. Results: The review included 29 articles, mainly descriptive observational studies (51.7%). The majority were published in the USA (27.6%) or Spain (20.7%). The most frequent PIs were: medication reconciliation (55.2%); medication review (44.8%); pharmacotherapeutic follow-up (34.5%); post-surgical physical pain management (27.6%); health education (27.6%); and risk assessment/reduction (27.6%). MTM was analyzed in five retrieved articles (17.2%) and its complete implementation in only three (10.3%). Conclusions: This literature review compiles the main PIs implemented in patients hospitalized in OST, highlighting medication conciliation, medication review, and pharmacotherapeutic follow-up. MTM implementation remains scarce in these patients. (AU)

Mutismo selectivo: cuando la timidez se hace extrema / Selective mutism: when shyness becomes extreme

El mutismo selectivo es un trastorno poco frecuente y a menudo infradiagnosticado, que puede afectar al rendimiento escolar y repercutir negativamente en su desarrollo. Ocurre antes de los 5 años y está caracterizado por la incapacidad de comunicarse en ámbitos donde el niño no se siente cómodo, como puede ser la escuela; en cambio, en otros lugares, como el domicilio, se comunica y actúa sin problemas. Genera inquietud familiar. Su tratamiento principal es la terapia cognitivo conductual. La combinación de esta terapia con la administración de fármacos se reserva para casos más graves. Se describe a continuación un caso diagnosticado hace 6 meses y en tratamiento desde entonces (AU)

Selective mutism is a less frequent disorder, often underdiagnosed, which negatively affects the child’s development and school performance. This disorder takes place before the age of five. It is characterized with the incapacity to speak in places where the child does not feel comfortable, as school, but at home they speak without problem. In fact, the detection occurs at school, and generates family distress due to their surprise for their child’s attitude. The treatment is based on cognitive-conductive therapy, and just in severe cases pharmacotherapy is needed. A case diagnosed 6 months ago and under treatment since then is described below. (AU)

Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients. / Implementación del Proceso Estandarizado de Evaluación Farmacoterapéutica en pacientes hospitalizados y ambulatorios.

OBJECTIVES: The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). METHODS: A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8,072 in the study period. CONCLUSIONS: This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Análisis de un algoritmo de riesgo de errores de medicación: una experiencia portuguesa / Analysis of a medication error risk algorithm: a portuguese experience

Los errores de medicación son cada vez más comunes lo cual pone en peligro la salud de los pacientes, de ahí la importancia de prevenirlos y controlarlos. El concepto de crear una herramienta de decisión clínica que permita gestionar mejor estos eventos no es nuevo. Utilizando una experiencia danesa, decidimos aplicar el algoritmo de MERIS (Medication Risk Score) en un servicio de accidente cerebrovascular de un hospital portugués con el fin de probar su aplicabilidad, determinar volumen de pacientes de riesgo y comprobar cual variable del algoritmo se correlaciona más con paciente de riesgo. Con una muestra de 65 pacientes con sus respectivos reportes MERIS se determinó que durante dos meses más de la mitad de los pacientes admitidos eran de alto riesgo para errores en su medicación. Se seleccionó la prueba de correlación de Spearman para determinar cuál de todas las variables de MERIS estaba más relacionada a un puntaje alto. Encontramos correlaciones positivas fuertes y estadísticamente significativas entre el puntaje de Meris y: función renal reducida, número de fármacos con bajo riesgo de daño, número de fármacos con alto riesgo de daño, número de fármacos, número de fármacos con riesgo medio de daño y número de fármacos con riesgo de interacción bajo a medio, siendo estos últimos tres los más significativos. No hubo una correlación estadísticamente significativa entre el puntaje MERIS y el número de fármacos con alto riesgo de interacción. Finalmente, modificamos la lista de medicamentos propuesta por los autores anteriores adaptada a nuestro hospital. (AU)

Medication errors are gradually more common, risking patients health, hence the importance of preventing and controlling them. The concept of creating a clinical decision tool to better manage these events is not new. Using a Danish experience, we applied the MERIS (Medication Risk Score) algorithm in a stroke unit of a Portuguese hospital in order to test its applicability, determine the volume of patients at risk and check which variable of the algorithm correlates more with patient risk. Using a sample of 65 patients with their respective MERIS reports, we determined that for two months more than half of the admitted patients were at high risk of errors in their medication. The Spearman correlation test was selected to determine which MERIS variable was most related to a high score. We found strong and statistically significant positive correlations between the Meris score and: reduced kidney function, number of drugs with low risk of damage, number of drugs with high risk of damage, number of drugs, number of drugs with medium risk of damage and number of drugs with low to medium risk of interaction, the latter three being the most significant. There was no statistically significant correlation between the MERIS score and the number of drugs with a high risk of interaction. Finally, we modify the list of medications proposed by the previous authors adapted to our hospital. (AU)

Implementación de un programa de optimización de la farmacoterapia en pacientes institucionalizados (ÓPTIMA) / Implementation of a pharmacotherapy optimisation programme for institutionalised patients (ÓPTIMA)

Objetivo: Las personas institucionalizadas en centros sociosanitarios (CSS) tienen una mayor probabilidad de presentar más problemas relacionados con los medicamentos (PRM) que el resto de la población. El objetivo del presente trabajo ha sido describir la implementación de un proceso de mejora continua (ciclo PDCA) de la prescripción farmacológica de pacientes institucionalizados en CSS concertados/ privados orientado a reducir los PRM.Metodología: Tras una búsqueda bibliográfica, se seleccionaron varias recomendaciones sobre los PRM detectados con mayor frecuencia en los pacientes institucionalizados de nuestra área, que abarca aproximadamente 5.000 residentes en 55 CSS, y se identificaron aquellos que presentaban alguno de los PRM seleccionados. Posteriormente, se constituyó un panel de expertos multidisciplinar para definir los objetivos del proyecto, realizar un análisis de causas y determinar posibles acciones de mejora.Resultados: Tras presentarse el proyecto a los centros de salud (CS), se crearon comisiones ejecutivas entre los farmacéuticos de atención primaria, los profesionales de los CSS y de sus CS de referencia para adaptar las diferentes acciones de mejora. En el análisis intermedio se puede ver una reducción del 4,5% de los pacientes con algún PRM y del 5,2% de las prescripciones por paciente asociadas a los mismos. Debido al elevado número de pacientes institucionalizados, la revisión transversal de PRM permite disminuir la iatrogenia medicamentosa con los recursos disponibles. El ciclo de mejora continua PDCA, tras analizar la prevalencia de los PRM, nos permitirá implementar nuevas acciones o valorar iniciar el ciclo con otros PRM.  (AU)

Objective: People institutionalised in social and healthcare centres (SHCs) are more likely to present more drug related problems (DRPs) than the rest of the population. The aim of this study was to describe the implementation of a process of continuous improvement (PDCA cycle) of the pharma- cological prescription of institutionalised patients in private/contracted SHCs to reduce DRPs.Method: Following a literature search, recommendations were selected on the most frequently detected DRPs in institutionalised patients in our area (approximately 5,000 residents in 55 SHCs). Those presenting any of the selected DRPs were identified. Subsequently, a multidisciplinary panel of experts was formed to define the objectives of the project, carry out an analysis of causes and determine possible actions for improvement.Results: The project was presented to health centres (HCs) and executive committees were set up between primary care pharmacists, professionals from SHCs and their reference HCs to adapt the different improvement actions. The interim analysis shows a 4.5% reduction in the number of patients with DRPs and a 5.2% reduction in the number of prescriptions per patient associated with DRPs. Due to the high number of institutionalised patients, the cross-sectional review of DRPs allows us to reduce drug iatrogenesis. The PDCA cycle will allow us to implement new actions or consider starting the cycle with other DRPs.  (AU)

Perfil farmacoterapêutico de pacientes com insuficiência renal crônica submetidos à hemodiálise em um centro de referência do estado do Ceará / Pharmacotherapeutical profile of patients with chronic kidney failure submitted to hemodialysis in a reference center in the state of Ceará / Perfil farmacoterapéutico de pacientes con insuficiencia renal crónica sometidos a hemodiálisis en un centro de referencia del estado de Ceará

O regime terapêutico hemodialítico engloba alterações no cotidiano do paciente pacientes com Doença Renal Crônica (DRC) que estão relacionadas às características do tratamento. Este estudo teve como objetivo traçar o perfil farmacoterapêutico de pacientes em tratamento hemodialítico em uma unidade de referência do estado do Ceará (Hospital e Maternidade Divina Providência de Russas - HMDPR). Tratou-se de um estudo de natureza descritiva, transversal, com análises quantitativas e qualitativas de informações contidas em prontuários. Foram coletadas variáveis socioepidemiológicas, clínicas e as prescrições farmacológicas registradas no período de janeiro a julho de 2020. O estudo avaliou 161 pacientes em terapia renal substitutiva (TRS) e grande parte destes foram do sexo masculino (63,35%), idade média de 53,89 anos e maioria com idade entre 35-44 anos (22,98%). Os Anti-hipertensivos destacaram-se como de maior frequência (15,99%), sendo que 50,94% dos pacientes utilizam 6 a 10 diferentes fármacos concomitantes. Em relação a terapêutica adjuvante à TRS, as principais classes foram os antianêmicos seguida pelos suplementos vitamínicos e mineral. Os dados demonstram que o paciente com DRC necessita de uma atenção diferenciada em sua farmacoterapia, demostrando a importância do profissional farmacêutico junto a equipe multidisciplinar.

The hemodialysis treatment regimen includes changes in the daily life of patients with Chronic Kidney Disease (CKD) that are related to the characteristics of the treatment. This study aimed to outline the pharmacotherapeutic profile of patients undergoing hemodialysis in a referral unit in the state of Ceará (Providence Divine Hospital and Maternity Hospital of Russas - HMDPR). It was a study a descriptive, cross- sectional study, with quantitative and qualitative analysis of information contained in the medical records. Both socio-epidemiological variables, clinical were collected, and the pharmacological prescriptions recorded from January to July 2020. The study evaluated 161 patients on renal replacement therapy (RRT) and most of them were male (63.35%), mean age 53.89 years and most aged 35-44 years (22.98%). Antihypertensive drugs stood out as the most frequent (15.99%), with 50.94% of patients using 6 to 10 different concomitant drugs. Regarding adjunctive therapy to RRT, the main classes were antianemic followed by vitamin and mineral supplements. The data demonstrate that the patient with CKD needs differentiated attention in his pharmacotherapy, demonstrating the importance of the pharmaceutical professional in the multidisciplinary team.

El régimen terapéutico hemodialítico implica cambios en el estilo de vida de los pacientes con enfermedad renal crónica (ERC) que están relacionados con las características del tratamiento. El objetivo de este estudio fue trazar el perfil farmacoterapéutico de pacientes en tratamiento hemodialítico en una unidad de referencia del estado de Ceará (Hospital y Maternidad Divina Providencia de Russas - HMDPR). Este es un estudio descriptivo, transversal, con análisis cuantitativos y cualitativos de la información contenida en los registros médicos. Se recolectaron variables socioepidemiológicas, clínicas y prescripciones farmacológicas registradas en el período de enero a julio de 2020. Se evaluaron 161 pacientes en terapia renal sustitutiva (TRS) y la mayoría de ellos eran hombres (63,35%), con una edad promedio de 53,89 años y la mayoría con edades entre 35 y 44 años (22,98%). Los antihipertensivos fueron los más frecuentes (15,99%), y el 50,94% de los pacientes usaban de 6 a 10 fármacos diferentes concomitantes. En cuanto a la terapia adyuvante a la TRS, las principales clases fueron los antianémicos seguidos por los suplementos vitamínicos y minerales. Los datos muestran que el paciente con ERC necesita una atención diferenciada en su farmacoterapia, demostrando la importancia del profesional farmacéutico en el equipo multidisciplinario.