Cribado oportunista del pulso irregular para la detección de fibrilación auricular asintomática en farmacias comunitarias de cataluña. proyecto: Pren-Te El Pols / Opportunistic screening of irregular pulse to detect asymptomatic atrial fibrillation in community pharmacies: TAKE YOUR PULSE PROJECT

Objetivo: Cribado oportunista de pulso irregular desde las farmacias comunitarias en pacientes mayores de 60 años como indicador de fibrilación auricular asintomática y evaluación de la idoneidad del proceso en cuanto a su factibilidad e implementación. Material y métodos: Estudio observacional descriptivo transversal basado en la toma de pulso radial a pacientes asintomáticos. Profesionales sanitarios de un total de 240 farmacias comunitarias voluntarias y de 105 centros de salud realizaron la formación necesaria para adherirse a la campaña ‘Pren-te el pols’ de 40 días de duración. Los farmacéuticos comunitarios reclutaron a 4.729 sujetos y 666 fueron excluidos. Finalmente se cribaron 4.063 sujetos mayores de 60 años. Se registraron las diferentes variables en una plataforma online creada para el proyecto en la que se accedía mediante un usuario y contraseña. Además, se evaluó la idoneidad del proceso mediante una encuesta autoadministrada a los farmacéuticos participantes. Resultados: El 5,9% de los sujetos cribados presentaron pulso irregular, siendo la proporción de varones estadísticamente significativa respecto a la de mujeres. La media del grado de satisfacción de los farmacéuticos fue de 8,07/10. Conclusiones: El cribado de pulso irregular para la detección de fibrilación auricular asintomática en farmacias comunitarias presenta un alto grado de factibilidad para su incorporación sistemática en grupos de pacientes susceptibles. Además, incorpora la accesibilidad de la determinación al permitir el cribado de muestras amplias en periodos cortos de tiempo. No obstante, aspectos de gestión compartida, trabajando coordinadamente con los equipos de atención primaria, devienen imprescindibles para evaluar de manera fehaciente su efectividad real en el aumento de la tasa de diagnósticos de ciertas patologías prevalentes

Background: Atrial fibrillation is the most common arrhythmia. It is associated with a high morbidity and mortality. It increases fivefold the probability of suffering an ischemic stroke, which is the most serious and incapacitating one. Its early diagnosis and treatment improve its clinical outcome. Objective: This study aims to describe the proportion of irregular pulses found from community pharmacies in patients over 60 years as an indicator of asymptomatic atrial fibrillation and it also evaluates the suitability of the process in terms of its feasibility and implementation. Methods: It was conducted an observational, descriptive and cross-sectional study. It was based on taking the radial pulse (RP) of asymptomatic patients. For a period of 40 days, healthcare professionals from 240 community pharmacists and 105 health centres attended the training and joined the ‘Take your pulse’ campaign. Community pharmacies recruited 4,729 subjects, 666 were excluded. Finally, 4,063 subjects over 60 years were screened. It was created an online platform, which was accessed by validating a user code and password, to record the different variables. In addition, the suitability of the process was evaluated through a self-administered survey of participating pharmacists. The suitability of the organisational model was evaluated using a validated self-report questionnaire completed by the participating pharmacists. Results: An irregular pulse was found in 5.9 % of the subjects among whom the percentage of males was statistically significant. The average level of pharmacists satisfaction was 8.07/10. Conclusion: Irregular pulse screening to detect asymptomatic atrial fibrillation in community pharmacies has a high degree of feasibility to be incorporated systematically into groups of susceptible patients. In addition, it incorporates the accessibility of the determination by allowing the screening of large samples in short periods of time. However, some aspects related to sharing management and working in coordination with Primary Care teams become essential to measure reliably its real effectiveness in the diagnostic rate rise of certain prevalent diseases

Optimización de la farmacoterapia antidiabética en paciente con enfermedad rara (Síndrome de MELAS) / Optimization of the anti-diabetic pharmacotherapy in a patient with a rare disease (MELAS Syndrome)

Paciente de 49 años habitual de la farmacia que se encuentra en seguimiento farmacoterapéutico. En Noviembre de 2017 acude a la consulta farmacéutica para informarnos del diagnóstico de una nueva enfermedad de tipo genético denominada MELAS. Es diabético tipo 2, con buen control de la enfermedad y en Junio de 2017 sufrió un accidente cerebrovascular. En Octubre de 2017 realizamos un informe de optimización de su tratamiento antidiabético a través de su médico de familia, consiguiendo reducir su farmacoterapia de ocho comprimidos diarios a tres, manteniendo un buen grado de control de su diabetes. Atendiendo a nuestro proceso asistencial y la aparición de un problema de salud como es el Síndrome de MELAS, procedemos a realizar una fase de estudio, para profundizar la relación entre su medicación actual y los problemas de salud del paciente. Teníamos a un paciente angustiado y con mucha incertidumbre por el desconocimiento tras dicho diagnóstico

A 49-year-old patient from the pharmacy who is in pharmacotherapy follow-up. In November 2017, he went to the pharmacy to inform us about the diagnosis of a new genetic disease called MELAS. He is type 2 diabetic, with good control of the disease and in June of 2017 he suffered a stroke. In October of 2017 we carried out an optimization report of his antidiabetic treatment through his family doctor, managing to reduce his pharmacotherapy from eight tablets a day to three, maintaining a good degree of control of his diabetes. In response to our healthcare process and the appearance of a health problem such as MELAS Syndrome, we proceed to carry out a study phase, to deepen the relationship between his current medication and the patient's health problems. We had an anguished patient with a lot of uncertainty due to ignorance after the diagnosis

Equipo multidisciplinar de atención al paciente crítico: ¿qué aporta la integración del farmacéutico? / Multidisciplinary team of critically ill patient care: What is the contribution of the pharmacist?

Antecedentes y objetivo: La gravedad e inestabilidad de los pacientes, junto con el alto grado de complejidad de la medicación, hacen de las unidades de cuidados intensivos (UCI) un área crítica de problemas relacionados con la medicación. El objetivo de nuestro estudio fue analizar y evaluar la actividad clínica realizada por el farmacéutico clínico integrado en una UCI y conocer la opinión del personal. Material y método: Estudio descriptivo, prospectivo, de 42 meses de duración. El farmacéutico se integró en la actividad diaria del equipo multidisciplinar de una UCI de 12 camas perteneciente al Servicio de Anestesiología y Reanimación. Se registraron todas las intervenciones farmacoterapéuticas (IF) realizadas, el grado de aceptación, el método de comunicación y destinatario de la intervención, así como la evaluación clínica de las intervenciones aceptadas. Posteriormente, se realizó una encuesta al personal de la unidad sobre la seguridad del paciente y la influencia de la integración del farmacéutico en la unidad. Resultados: Se realizaron un total de 2399 IF con un 97,0% de aceptación. De estas, las mayoritarias fueron las relacionadas con la posología (37,8%) y las consultas al farmacéutico (25,7%). De las IF aceptadas, el 53,7% influyeron sobre la eficacia del tratamiento farmacológico y el 35,1% sobre la tolerancia. En la encuesta realizada al personal de la unidad para valorar la percepción de la integración del farmacéutico se obtuvo una valoración global de de 8,58 ± 1,40 sobre 10. Conclusiones: El farmacéutico hospitalario integrado en el equipo multidisciplinar de UCI puede aportar un valor añadido al proceso farmacoterapéutico del paciente crítico

Background and objective: The severity and instability of the patients, together with the high degree of complexity of the medication, make the intensive care units (ICU) a critical area of problems related to medication. The aim of our study was to analyze and assess the activity performed by the clinical pharmacist integrated in an ICU and to know the opinion of the staff about it. Material and method: A 42 month descriptive and prospective study was conducted. The pharmacist was integrated into the daily activity of the multidisciplinary team of a 12-bed ICU belonging to the Anaesthesiology and Resuscitation Department. Every pharmacotherapeutic intervention (PI) carried out, the degree of acceptance, the method of communication and the receiver of the intervention, as well as the clinical evaluation of the accepted interventions were recorded. Subsequently, a survey was carried out to the staff of the unit on the patient's safety and the influence of the integration of the pharmacist in the unit. Results: A total of 2399 PIs were carried out with a 97.0% of acceptance. Of these, most were those related to posology (37.8%) and consultations with the pharmacist (25.7%). Among the accepted PIs, 53.7% had an influence on the efficacy of drug therapy, and 35.1% on treatment tolerance. In the survey to the unit's staff in order to assess the perception of the pharmacist's integration, an overall assessment of 8.58 ± 1.40 out of 10 was obtained. Conclusions: The hospital pharmacist integrated in the ICU multidisciplinary team can add value to the pharmacotherapeutic process of the critical patient

Pain management in hospitals: patients' satisfaction and related barriers

Background: Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients' health. Patients' perception regarding pain management may influence their satisfaction regarding treatment. Objectives: This study focuses on the assessment of patients' satisfaction regarding pain therapy and defining patient-related barriers for its implication. Methods: A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients' attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done. Results: Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients' barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p<0.05). Conclusions: Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice

No disponible

Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large Veterans Affairs medical center

Background: Management of diabetes mellitus (DM) remains a challenge in the US, as almost half of patients with diabetes are uncontrolled with a hemoglobin A1c (HbA1c) >7%. Over the last decade there has been increasing evidence supporting the integration of Clinical Pharmacy Specialists (CPSs) to multidisciplinary medical teams which have demonstrated improved glycemic control and better clinical outcomes in the primary care setting. Objectives: The primary objective of this study was to evaluate the change in HbA1c levels in patients with diabetes followed by a CPS. The secondary objectives of this study were to evaluate the percent of patients who reached American Diabetes Association (ADA) goal HbA1c (<7%) by study conclusion and evaluate documentation of hypoglycemic events in progress notes. Methods: A retrospective chart review evaluating glycemic control was conducted on patients with DM managed by a CPS at a large Veterans Affairs Medical Center. Patients with a diagnosis of Type 1 or Type 2 DM with a baseline HbA1c ≥9% and at least three CPS visits over twelve months were included in this study. Patients with cognitive impairment as documented by ICD-9 codes or with less than three CPS visits over twelve months were excluded. Results: A sample of 79 patients was identified. The mean HbA1c declined by 1.5 percentage points (from 10.6%, SD=1.4 to 9.1%, SD=1.5) after one year. No patients reached ADA goal of HbA1c <7% at study conclusion, however 23% of patients reached a less stringent goal of <8%. All CPS progress notes assessed episodes of hypoglycemia and provided education, and no hospitalizations were related to hypoglycemic events. Conclusions: Integration of a CPS into a veteran's diabetes care was associated with improved outcomes and enhanced hypoglycemic education. Our results advance the existing literature by demonstrating a positive association between CPS intervention and improved glycemic control in a complex veteran population

No disponible

Assessing adherence to current national guidelines for appropriate albumin use at an academic medical center

Objective: To assess adherence to current national guidelines for appropriate albumin use at an academic medical center. Methods: This retrospective chart review of 150 randomly selected patients prescribed and administered at least one dose of albumin was conducted in an urban academic medical center to evaluate the adherence of albumin orders to current national guidelines. Inclusion criteria consisted of discharged patients at least 18-years-old admitted to the intensive care unit or medical/surgical unit from September 1, 2015 to August 31, 2016. The primary outcome was the number of patients who inappropriately received albumin based on national guidelines and FDA approved indications. Secondary outcomes included the number of patients who received the incorrect concentration or dose of albumin based on indication, as well as the cost associated with inappropriate albumin prescribing. Descriptive statistics were used to report outcomes. Results: There were 68 instances (45%) where albumin was prescribed inappropriately according to guideline recommendations. Of the 82 instances where albumin was used appropriately, 18 patients received an incorrect dose (22%), and 6 received the inappropriate concentration of albumin (7%). The cost for the 150 patients included in the study associated with inappropriate albumin prescribing was approximately $13,000. Conclusions: This study identified areas for pharmacist intervention to ensure appropriate albumin utilization, as well as proper dosing for the most frequently incorrectly dosed indications, including hepato-renal syndrome, spontaneous bacterial peritonitis, and paracentesis. This study also identified an unexpected indication with significant inappropriate albumin utilization, perioperative hypotension, which is an area for further intervention to monitor and decrease use

No disponible

Caso Clínico: Bradicardia desencadenada por propafenona / Bradicardia desencadenada por propafenona

Existen varias alternativas para el manejo de las taquicardias supraventriculares, algunas de ellas farmacológicas y otras no farmacológicas. Dentro de las farmacológicas, los antiarrítmicos bloqueantes de los canales del sodio, clase IC como la propafenona, han demostrado ser de alto riesgo en pacientes ancianos, por la posibilidad de precipitar el fallo cardiaco. Este caso ilustra un error de medicación consistente en un problema relacionado con la selección del medicamento antiarrítmico, en el cual el haber ignorado la alerta generada por el servicio farmacéutico, provocó una reacción adversa seria (fallo cardiaco), lo cual corresponde a un problema de seguridad completamente prevenible

There are several alternatives for the treatment of supraventricular tachycardias, some of them are pharmacological and others non-pharmacological. Among pharmacological agents, class IC antiarrhythmics such as propafenone have been shown to be highly dangerous in elderly patients because the potential of cardiac failure. This case shows a medication error, a problem related to the selection of the antiarrhythmic drug, ignoring the warning of the pharmaceutical service and causing a serious adverse reaction (heart failure) which was completely preventable

Detección de duplicidades terapéuticas en farmacia comunitaria: Importancia del seguimiento farmacoterapéutico en pacientes atendidos por varios especialistas. Posibles mejoras / Detection of therapeutic duplications in community pharmacy: Importance of the pharmaceutical follow-up service in patients cared by several specialists. Possible improvements

Los pacientes mayores de 65 años con patologías crónicas, polimedicados y que se ven obligados a acudir a diferentes especialistas, son el colectivo más propenso a sufrir no sólo problemas relacionados con los medicamentos, sino también errores de prescripción. Estos errores son detectados por el farmacéutico comunitario, ya que suele ser el primer profesional sanitario con el que tienen contacto tras la consulta con el especialista. En este caso clínico, detectamos una duplicidad de antiespasmódicos urinarios en un paciente que había acudido a la farmacia preocupado por diversos problemas de salud y al que se le ofreció participar en nuestro servicio de seguimiento farmacoterapéutico. La incidencia fue solventada, pero consideramos que el tiempo de resolución podría ser menor con ligeras modificaciones en el sistema de comunicación entre el farmacéutico y otros profesionales sanitarios, aumentando así la calidad de la asistencia sanitaria y la eficiencia del sistema nacional de salud

Patients over 65 years old with chronic pathologies, polymedicated and who receive interdisciplinary care by different medical specialists, are the pronest ones to suffer problems related to medications as prescription errors that can be detected by the community pharmacist as the first healthcare professional with whom they have contact after a treatment modification by the specialist. In this clinical case, we detected a duplicity of urinary antispasmodics in the treatment of a patient who attended the pharmacy concerned about various health problems and who was offered to participate in our pharmacotherapy follow-up program. The incidence was solved. Nevertheless, we believe that the resolution time could be shorter with slight changes in the communication system between the pharmacist and other health professionals, increasing the quality of healthcare and the efficiency of the national health system

Assessing appropriateness of drug therapy in older persons: development and application of a medication assessment tool for long-term management of atrial fibrillation

Background: Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs). Objective: To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons. Methods: Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a "qualifying statement" followed by a "standard". The developed MAT was given the designation MAT-AF. An application guide was compiled where justifications for non-adherence were specified. Content validity was tested by an expert group using a three-round Delphi process. Inter- and intra-observer reliability testing was conducted with agreement expressed by Cohen's kappa and application time measured to assess feasibility. MAT-AF was applied to 150 patients with a diagnosis of AF admitted to a rehabilitation hospital. Results: MAT-AF consists of 15 criteria sectioned into antithrombotic, rate control and rhythm control therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.84 and 0.91 for inter- and intra-observer agreements. Mean application time for the two observers was 3.9 and 2.4 minutes, which decreased significantly in the second application conducted after a four-week interval (p<0.001). Overall adherence to applicable criteria was 59.8%. Non-adherence was evident for prescription of anticoagulation in patients with a CHA2DS2VASc score ≥1 (29.5%). Monitoring of laboratory parameters for digoxin was suboptimal. Ophthalmic and pulmonary monitoring and patient counselling regarding amiodarone therapy could not be assessed since relevant records were not readily available. Conclusion: MAT-AF application highlighted key aspects which need to be addressed to improve patient care (AU)

No disponible

Hospital consumer assessment of healthcare providers and systems scores relating to pain following the incorporation of clinical pharmacists into patient education prior to joint replacement surgery

Background: Pharmacist involvement has been shown to improve various aspects of patient care. Patients undergoing knee and hip replacement surgery generally experience post-operative pain and discomfort. Pain control can impact patient satisfaction, as reported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Objective: The current pilot study aims to measure the potential impact that incorporating pharmacists into preoperative patient education programs has on the response to select HCAHPS questions. Methods: Patient responses to two select HCAHPS questions related to pain were recorded for a year prior to pharmacist involvement in a comprehensive preoperative patient education program (2012) and a year after pharmacists became actively involved (2013). Results: In all reporting surgical patients, there was a modest 3.68% improvement in mean scores reflecting patient’s feelings that hospital staff did "everything they could" to attend to their pain (mean 2012=3.66, SD=0.63 versus mean 2013=3.80, SD=0.43, p=0.018, Mann-Whitney U test). There was a non-significant 2.98% improvement in scores reflecting the level that pain was "well controlled" (mean2012=3.54, SD=0.651 versus mean2013=3.65, SD=0.554, p=0.069, Mann-Whitney U test) in surgical patients. Conclusion: The results suggest comprehensive pharmacist involvement in patient education prior to joint replacement surgery may impact HCAHPS scores related to pain control. While the observed potential improvements were modest, the current results justify larger, multi-institution prospective studies to better elucidate the impact pharmacists can have on pain management in patients undergoing joint replacement (AU)

No disponible

Adequancy of treatment with canaglifozin alter alerts pharmacovigilance in the health management área / Adecuación del tratamiento con canaglifozina tras alerta de farmacovigilancia en un área de gestión sanitaria

Objective: To analyze the impact of a strategy on the suitability of canaglizozin, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency (AEMPS). Method: A prospective intervention from may 2016 to october 2016. Location: South Seville Health Management Area. Participants: Patients with active canagliflozin prescription. Interventions: The study was conducted in three phases, the first one linked to the issuance of the safety information note on the canaglifozin by the AEMPS, the obtaining of the patient lists and the recommendations of the adequacy in the sending of letters. A second phase where the medical professional performed the actions and a final phase in which the degree of acceptance of the recommendations made by the Pharmacy Service is evaluated. Main measurements: Suitability of canaglizozin treatment and the level of acceptance by physicians. Results: A total of 61 patients at baseline were included in treatment canagliflozin. Of the total number of patients referred to, some type of intervention was performed by the family and community medicine doctor after the pharmaceutical intervention (PI), by means of letters (n = 30), 56.7% were monitored, 33.3% were discontinued and 10.0% were closely monitored Conclusions: Interventions aimed at reviewing patients on canagliptin, based on pharmacovigilance alerts, have been effective, with a high degree of acceptance by the family and community medicine practitioner (AU)

Objetivo: Analizar el impacto de una estrategia de adecuación de canaglifozina tras la emisión de recomendaciones en base a las notas de farmacovigilancia emitidas por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), así como el grado de aceptación. Método: Estudio prospectivo de intervención desde mayo de 2016 a octubre de 2016. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de canaglifozina. Intervenciones: Se realizó en tres fases: la primera ligada a la emisión de una nota informativa de seguridad sobre canaglifozina por la AEMPS, la obtención de listados de pacientes y las recomendaciones de adecuación mediante cartas, una segunda fase en la que el médico realizaba las actuaciones y una última fase en la cual se evalúo el grado de aceptación de las recomendaciones. Variables principales: Adecuación del tratamiento con canaglifozina y grado de aceptación de las recomendaciones por los facultativos médicos. Resultados: Se incluyeron un total de 61 pacientes en nuestro estudio en tratamiento con canaglifozina. Del total de los pacientes a los que se les realizó algún tipo de intervención por el médico de atención primaria tras la intervención farmacéutica (IF), realizada mediante el envío de cartas (n=30), al 56,7% se les monitorizó, al 33,3% se le suspendió el tratamiento y al 10,0% se les vigiló estrechamente. Conclusiones: Las intervenciones dirigidas a la revisión de pacientes en tratamiento con canaglizozin, en base a las alertas de farmacovigilancia, han sido efectivas, con un alto grado de aceptación por el especialista en medicina familiar y comunitaria (AU)

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia

Background: Patients' behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. Objectives: This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. Methods: A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. Results: This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. Conclusion: Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems (AU)

No disponible

Derivación al médico de un paciente con dolor abdominal agudo como parte del servicio de indicación farmacéutica en Costa Rica / A patient with acute abdominal pain is referred to a doctor as a result of the drug indication service in Costa Rica

Paciente masculino de 18 años, sin antecedentes de salud relevantes, que acude a la farmacia con: malestar general, astenia, dolor epigástrico agudo e intenso, náuseas de más de doce horas de evolución. El paciente solicita al farmacéutico de guardia, como parte del servicio de indicación farmacéutica, que le recomiende algún tipo de medicamento para este tipo dolor. Menciona que ha utilizado medicamentos previos, por automedicación, sin alcanzar beneficio. Como intervención el farmacéutico deriva al paciente al servicio de urgencias, debido a la sospecha de un problema de salud insuficientemente tratado que puede poner en riesgo la vida del paciente. La intervención es aceptada y el cuadro clínico mejora (AU)

An 18 year old male patient, with no relevant medical history, goes to the pharmacy with: asthenia, acute and severe epigastric pain, nausea lasting more than twelve hours. The patient requests the pharmacist on duty, as part of the minor ailments service, to recommend some type of medication for this type of pain. He mentions that he has used previous medications, by self-medication, without achieving benefit. As an intervention the pharmacist refers the patient to the emergency department, due to the suspicion of an insufficiently treated health problem that can endanger the life of the patient. The intervention was accepted and the clinical picture improved (AU)

Interdisciplinary approach to the management of medical supplies in the nursing home setting / Abordaje interdisciplinar de la gestión de productos sanitarios en el ámbito sociosanitario

Objective: To describe and evaluate the management of medical supplies by an interdisciplinary team in order to promote their rational use in the nursing home setting. Methods: An interdisciplinary team was set up, coordinated by a Pharmacy Unit including representatives of 18 elderly nursing homes (1,599 beds). Team interventions were assessed in terms of improvements in the management of wound care supplies. In addition, a retrospective descriptive study was carried out on those patients with pressure ulcers, in order to consider future interventions. Results: The team interventions led to a selection of 15% of the 180 wound care supplies from the public tender process. The monthly savings in wound dressing material purchases was at least 17%. Furthermore, a reduction in consumption greater than 50% was found in 7 centres. The prevalence of ulcers was 5.59%. A fourth of these ulcers were originated outside nursing homes. Conclusions: The creation of an interdisciplinary team, in which the pharmacist gets closer to patient needs, and where nurses share responsibility for the selection and management of medical supplies, leads to positive results and represents an opportunity for improvement in elderly care (AU)

Objetivo: Describir y evaluar la gestión de los productos sanitarios por un equipo interdisciplinar con la finalidad de racionalizar su utilización en el ámbito de la atención sociosanitaria. Métodos: Se creó un equipo interdisciplinar coordinado por un servicio de farmacia con representantes de 18 residencias para personas mayores dependientes (1.599 plazas asistenciales). Las intervenciones del equipo se valoraron en términos de mejora en la gestión de los productos sanitarios para curas. Además, se realizó un estudio descriptivo retrospectivo de los pacientes con úlceras por presión para considerar futuras intervenciones. Resultados: Las intervenciones del equipo resultaron en una selección del 15% de los 180 productos sanitarios para curas a partir del concurso público. El ahorro mensual en las compras de productos para cuidado de las úlceras fue como mínimo de un 17%. Además, se constató una reducción en el consumo superior al 50% en 7 centros. La prevalencia de úlceras fue del 5,59%. La cuarta parte de las úlceras tuvo un origen externo a la residencia. Conclusiones: La formación de un equipo interdisciplinar, en el que el farmacéutico se aproxima a las necesidades del paciente, y los profesionales de enfermería comparten la responsabilidad en la selección y gestión de los productos sanitarios, conduce a resultados positivos y supone una oportunidad de mejora en la atención a los mayores (AU)

Sarcopenia: what should a pharmacist know? / Sarcopenia: ¿qué tiene que saber un farmacéutico?

Sarcopenia (or muscle insufficiency) is a geriatric syndrome characterized by a progressive and generalized loss of skeletal muscle mass and function which has adverse consequences, particularly physical disability, falls and death. It can develop slowly, as a chronic condition that emerges over many years, or acutely, generally due to immobilization associated with an acute disease. The physiopathology of sarcopenia is complex, and affects both the muscle and its neurological and hormonal regulation. The prevalence of sarcopenia increases with age and in certain healthcare settings (nursing homes, hospitals, rehabilitation centres). Its diagnosis is based on the documentation of a low muscle mass associated with low muscle strength and/or low physical performance. Once confirmed, a syndromic approach is needed, based on a comprehensive geriatric assessment in order to determine its causes and prepare a treatment plan which addresses the treatment of symptoms as well as the etiology. Prevention of sarcopenia starts in the adult age, through the promotion of adequate nutritional habits, an increase in physical activity and, ideally, resistance exercise. Sarcopenia treatment must necessarily include resistance exercises (that can be associated with other types of exercise) and an improvement in diet, increasing protein intake up to 1.2-1.5 g/kg/day and covering caloric requirements. In some cases, this will require the use of nutritional supplements, which can contain leucine, beta-hydroxy beta-methylbutyrate acid (HMB) and vitamin D, in order to optimize its effects on the muscle. There are still no medications available to treat sarcopenia (AU)

La sarcopenia (o insuficiencia muscular) es un síndrome geriátrico caracterizado por una pérdida progresiva y generalizada de masa y función del músculo esquelético que tiene consecuencias adversas, especialmente la discapacidad física, las caídas y la muerte. Puede producirse de forma crónica, a lo largo de muchos años, o aguda, generalmente por una inmovilización asociada a una enfermedad aguda. La fisiopatología de la sarcopenia es compleja y afecta tanto al músculo como a su regulación neurológica y hormonal. La prevalencia de la sarcopenia aumenta con la edad y en determinados entornos asistenciales (residencias, hospitales, centros de rehabilitación). Su diagnóstico se basa en la documentación de una baja masa muscular asociada a baja fuerza muscular y/o bajo rendimiento físico. Una vez se confirma, es preciso adoptar un enfoque sindrómico y usar una valoración geriátrica integral para determinar sus causas y elaborar un plan de tratamiento que incluya tanto el tratamiento de los síntomas como el etiológico. La prevención de la sarcopenia comienza en la edad adulta, a través de la promoción de hábitos de alimentación correctos, un aumento de la actividad física e, idealmente, ejercicios de resistencia. El tratamiento de la sarcopenia debe incluir necesariamente ejercicios de resistencia (que pueden asociarse a otros tipos de ejercicio) y la mejora de la dieta, aumentando la ingesta proteica hasta 1,2-1,5 g/kg/día y cubriendo los requerimientos calóricos. En algunos casos será preciso para ello el uso de suplementos nutricionales, que pueden contener leucina, ácido β-hidroxi β-metilbutírico (HMB) y vitamina D, para optimizar sus efectos en el músculo. Aún no disponemos de medicamentos para tratar la sarcopenia (AU)

Concentraciones sanguíneas infraterapéuticas de everólimus asociado al consumo de caramelos con extracto de hipérico (Hypericum perforatum o hierba de San Juan) / Decreased everolimus blood concentration associated with consumption of St. John’s wort (Hypericum perforatum) extract sweets

No disponible

Development of a risk stratification model for pharmaceutical care in HIV patients / Desarrollo de un modelo de estratificación de atención farmacéutica destinado a pacientes VIH+

Background: The increasing number of HIV-patients and their complexity makes it necessary to develop risk classification tools to improve the optimization of resources. Objective: To design a risk-stratified model for pharmaceutical care (PC) in HIV-patients. Methods: A cross-sectional, multicenter study. An expert panel was created by Hospital Pharmacist experienced in PC for HIV-patients. The study was designed in 4 phases. The first phase included a review of literature and the development of a summary of the scientific evidence available. According to their score, patients were stratified into three levels of PC. In the second and third phases, a sample of patients was assessed and data information was recorded. The overall analysis also allowed pharmacists to define the actions to be applied at each level of priority. Finally, each stratification model was applied to a new sample of patients to verify their applicability and usefulness. Results: All variables included in the model were weighted in terms of their relative relevance compared to the rest. A sample of 215 patients was evaluated to obtain their score and distribution: Priority-1: score ≥ 32 and 10% of the sample; Priority-2: 18-31.9 and 30%; Priority-3: ≤ 17 and 60%. The PC interventions corresponding to each level of priority were classified into ‘pharmacotherapeutic monitoring’, ‘training, education and patient tracking’ and ‘coordination of all the healthcare team members’. Conclusions: This study supported the design and adaptation of a selection and stratification model for PC in HIV-patients as a tool to identify those who may benefit from priority intervention (AU)

Antecedentes: El aumento del número de pacientes VIH+ en las consultas de atención farmacéutica (AF) y de su complejidad implica la necesidad de desarrollar herramientas de estratificación para mejorar la optimización de recursos. Objetivo: Diseñar un modelo de estratificación en atención farmacéutica al paciente VIH+. Métodos: Estudio multicéntrico trasversal llevado a cabo por un panel de experto en Farmacia Hospitalaria con experiencia en AF al paciente VIH+. El estudio consta de 4 fases. En primer lugar, se realizó una revisión de la literatura y un resumen de la evidencia científica hasta la fecha estableciendo 3 niveles de estratificación. En las fases 2 y 3 una muestra de pacientes fue analizada para definir las intervenciones específicas de cada nivel de estratificación. Finalmente, se empleó el modelo de estratificación en una nueva muestra de pacientes para comprobar su utilidad y correcta aplicación. Resultados: Las variables incluidas en el modelo fueron ponderadas en función de su relevancia. Se analizaron 215 pacientes con el nuevo modelo obteniéndose una puntuación y distribución como sigue: Prioridad-1: puntuación ≥32 y 10% de la muestra; Prioridad-2: 18-31.9 y 30%; Prioridad-3: ≤17 y 60%. Las diferentes intervenciones de cada nivel se clasificaron en ‘seguimiento farmacoterapéutico’, ‘entrenamiento y formación de pacientes’ y coordinación con el resto del equipo multidisciplinar’. Conclusión: Este el primer modelo de estratificación para la atención farmacéutica al paciente VIH+. Su uso permitirá identificar aquellos pacientes que más se podrán beneficiar de cada tipo de intervención (AU)

Off-label and unlicensed drug use in a Spanish Neonatal Intensive Care Unit / Utilización de medicamentos fuera de ficha técnica y sin licencia en una Unidad de Cuidados Intensivos Neonatales española

Objective: To describe off-label and unlicensed drugs in clinical practice in a Neonatal Intensive Care Unit (NICU). Method: The design of the study was a descriptive and retrospective three months research in a NICU of a Spanish University Hospital. All prescriptions were classified as approved, off-label and unlicensed drug used, according to the information available on the Summary of Product Characteristics. Off-label drugs prescriptions were divided into four groups (dose, frecuency, age and indication of use) depending on the reason of disconformity. Results: Forty-one neonates were included (46.3% premature patients) and a total of 273 drug prescriptions were evaluated. Of them, 53.1% (145) were classified as an approved drug prescriptions, 41.4% (113) were off-label use and 5.5% (15) were unlicensed drugs. 90.2% of the patients (37/41) received at least one off label prescription, with a median of 3 (range 1-7). Age was the foremost reason for off-label use (42.5%), followed by dose (31.0%), frecuency (16.8%) and dose-frecuency off-label drug use (8.8%). The last place was reserved for off-label drug use by indication (0.9%). Group J (corresponding with antiinfectives for systemic use) was the most frecuently prescribed, with ampicillin (18.6%) and gentamicin (16.8%) as the drugs most commonly use as off-label prescriptions. Finally, caffeine citrate was the unlicensed drug most frecuently prescribed. Conclusion: Off-label and unlicensed drug use prescriptions in our NICU clinical practice are highly frecuent as other authors have previously published in other countries where they were studied. Although there are few studies in newborn patients, both off-label and unlicensed drug prescriptions are commonly recomended in Paediatrics Guidelines (AU)

Objetivo: Describir la utilización de medicamentos fuera de ficha técnica (FFT) y sin licencia en una Unidad de Cuidados Intensivos Neonatales (UCIN). Método: Estudio descriptivo y retrospectivo realizado durante tres meses en la UCIN de un hospital público español. Las prescripciones se clasificaron según la ficha técnica oficial en tres grupos: dentro de ficha técnica, FFT y sin licencia. Las prescripciones FFT se clasificaron según la razón por la que no se ajustaban a ella en cuatro grupos: dosis, frecuencia, edad e indicación. Resultados: Se incluyeron 41 neonatos (46,3% prematuros) y 273 prescripciones. De ellas, el 53,1% (145) se prescribieron según ficha técnica, el 41,4% (113) FFT y el 5,5% (15) sin licencia. El 90,2% de los pacientes (37/41) recibieron al menos un tratamiento FFT, con una media de 3 (rango 1-7). En el 42,5% de los casos la razón por la cual se consideró al fármaco FFT fue la edad, en el 31,0% la dosis, en el 16,8% la frecuencia, en el 8,8% la dosis y la frecuencia y en el 0,9% la indicación. El grupo terapéutico prescrito con más frecuencia fue el J (antiinfecciosos para uso sistémico), con ampicilina (18,6%) y gentamicina (16,8%) como fármacos más prescritos FFT. El fármaco sin licencia con mayor número de prescripciones fue la cafeína citrato. Conclusiones: En nuestra UCIN la utilización de fármacos FFT y sin licencia es muy habitual y similar a la de otros países. La mayoría de las prescripciones analizadas no disponen de estudios específicos en neonatos, aunque sí está ampliamente recomendado su uso en las guías de práctica clínica pediátricas (AU)

61.º Congreso de la SEFH. Nutrición parenteral libre de aminoácidos ramificados para el manejo urgente de una descompensación grave de la enfermedad del jarabe de arce / No disponible

No disponible

61.º Congreso de la SEFH. Complicaciones asociadas con medicamentos en un postoperatorio tórpido de trasplante hepático / No disponible

No disponible