Gestión integral de la nutrición artificial domiciliaria: humanización e innovación al servicio del paciente / Holistic management of home artificial nutrition: humanization and innovation at patient's service

La desnutrición relacionada con la enfermedad es una patología frecuente en el mundo desarrollado. Afecta a 30 millones de personas en Europa y tiene un coste asociado de ciento setenta mil millones de euros anuales. En España atañe en torno a 1,7 millones de adultos, lo que supone el 4,4% de la población. La desnutrición aqueja a uno de cada cuatro pacientes en el ingreso hospitalario. Se estima que los pacientes hospitalizados que se encuentran en estado de desnutrición a lo largo de su estancia oscilan entre un 23,7% y un 37%; agudizándose estas cifras en el caso de pacientes pluripatológicos mayores de 70 años, y casi un 10% se desnutre durante su estancia hospitalaria. Todo ello supone un aumento de las estancias hospitalarias y de los costes asociados; en concreto, los costes directos de la desnutrición hospitalaria se estimaron en 1,143 millones anuales en 2009, lo que supone el 1,8% del gasto sanitario del sistema nacional de salud. Los avances en tecnología e infraestructuras han facilitado la transferencia de servicios complejos de hospitales al hogar. Actualmente, la tendencia internacional apunta a un desarrollo cada vez mayor del domicilio como centro de cuidados. Un meta-análisis de 61 ensayos de asignación aleatoria y controlados, publicado en 2012, evidenció que los pacientes atendidos en el domicilio tenían una tasa de mortalidad a los seis meses entre un 19% y un 38% menor que los hospitalizados. La nutrición artificial domiciliaria (NAD) es la administración a domicilio de los nutrientes y demás agentes terapéuticos adjuntos a través de la vía digestiva -nutrición enteral domiciliaria (NED)- o intravenosa -nutrición parenteral domiciliaria (NPD)-, con la finalidad de mejorar o mantener, en el ámbito domiciliario, el estado de nutrición de un paciente. Esta modalidad de prestación facilita al paciente poder seguir con los compromisos familiares, sociales y laborales. El entorno en el que trabajan los profesionales sanitaros del siglo XXI está cambiando de manera significativa. Son múltiples las innovaciones en gestión por procesos, facilitadas por el creciente potencial que ofrecen las nuevas tecnologías en los cuidados a distancia. Todo ello favorece la permanencia del paciente en su casa, en su comunidad o en un entorno más familiar, es decir, en un ambiente más humanizado. Por último, se demuestra que la NPD es una alternativa coste-efectiva en relación con la atención hospitalaria clásica, lo que redunda en la adopción del criterio de eficiencia como elemento de priorización en sanidad

Disease-related malnutrition is a common pathology in the developed world. It affects 30 million people in Europe and it has an associated cost of one hundred and seventy billion euros per year. In Spain, around 1.7 million adults, 4.4% of total population, are negatively affected. Malnutrition affects one out of four patients on hospital admissions. It is estimated that hospitalized patients who are malnourished throughout their stay range from 23.7% to 37%; sharpening these figures for multi-patients over 70 years old, and almost 10% are disensuaded during their hospital stay. All this implies an increase in hospital stays and associated costs; in particular, the direct costs of hospital malnutrition were estimated at 1.143 million annually in 2009, representing 1.8% of health expenses within the national health system. Advances in technology and infrastructure have facilitated the transfer of complex hospital-to-home services. Nowadays, the international trend points to the increasing development of the domicile as a care center. A meta-analysis of 61 randomized and controlled trials, published in 2012, showed that patients treated at home had a six-month mortality rate between 19% and 38% lower than those who were hospitalized. Home artificial nutrition (HAN) is the nutrients home-administration, among other therapeutic agents, administered through the digestive tract -home enteral nutrition (HEN)- or intravenously -home parenteral nutrition (NPD-), with the objective of improving or maintaining, at home, the patient's nutritional status. That reports into a benefit for the patient as being able to continue the family, social and work commitments. The environment, in which 21st century health professionals work, is changing significantly. There are multiple innovations in process management, given by the growing potential offered by new technologies in remote care. It supports the patient's home stay, either in the community or in a more familiar environment, that is, in a more humanized environment. Finally, HAN is shown to be an effective-cost alternative in relation to classical hospital care, resulting in the adoption of the efficiency criterion as an element of prioritization in healthcare

An Unparalleled Spirit of Collaboration Amid the COVID-19 Pandemic.

The COVID-19 pandemic is having a profound impact across the United States and the rest of the world. Health care professionals, including pharmacists, are working on the frontlines and across the spectrum of public health and research. To fully optimize the contribution of pharmacists during this crisis, state and federal policies and regulations that limit pharmacists' roles had to be identified and modified. A strong coalition of national pharmacy organizations, including the American Association of Colleges of Pharmacy, embarked upon an unprecedented level of collaboration to produce a joint statement identifying key policy recommendations. This collective continued working together as the full force of the pandemic was realized and engaged with policy makers at the state and national levels to advocate for these policy recommendations. Ideally the lessons learned in terms of the power of working together in a crisis will reframe future collaborations to the benefit of the profession and ultimately to the patients we serve.

A survey of the European Society of Clinical Pharmacy members' research involvement, and associated enablers and barriers.

Background Building research capacity of European Society of Clinical Pharmacy (ESCP) members aligns to the organisation's aim of advancing research. Objective To determine members' aspirations and needs in research training and practice, and to explore ways in which ESCP could provide support. Setting ESCP's international membership. Method Cross-sectional survey of members in 2018, followed by focus groups with samples of respondents attending an ESCP symposium. Survey items were: research activities; interests, experience and confidence; and Likert statements on research conduct. Principal component analysis (PCA) clustering of Likert statements from a previous study was used, with scores for each component calculated. Focus groups discussed barriers to research and how ESCP could provide support. Data analysis involved collating and comparing all themes. Main outcome measures Research interest, experience and confidence; attitudinal items; barriers to research; ESCP support. Results The response rate was 16.7% (83/499), with 89.2% (n = 74) involved in research and 79.5% (n = 66) publishing research in the preceding 2 years. While overwhelmingly positive, responses were more positive for research interest than experience or confidence. PCA component scores (support/opportunities, motivation/outcomes, and roles/characteristics) were positive. Thirteen members participated in focus groups, identifying barriers of: insufficient collaboration; lack of knowledge, skills, training; unsupportive environment; insufficient time; and limited resources. ESCP could support through mentorship, collaboration, education and funding. Conclusion Study participants were highly active, interested, experienced, confident and positive regarding research. There is an opportunity for ESCP to harness these activities and provide support in the form of mentoring, education and training, and facilitating collaboration.

Association between student characteristics and rankings when applying for a residency in health-system pharmacy administration.

PURPOSE: Results of a study to identify characteristics associated with pharmacy residency applicant success in obtaining an invitation to interview and a top candidate ranking are reported. Subsequent development and initial validation of a predictive model based on those characteristics are described. METHODS: Bivariable analyses were performed for planned stratifications of applicants to a health-system pharmacy administration residency program according to whether they were offered an on-site interview or were among the 8 top candidates by final candidate ranking. A Random Forest algorithm was created to identify predictors of the likelihood of an applicant being offered an on-site interview. RESULTS: Applicants who were offered interviews had a higher median pharmacy school grade point average (GPA) than those not invited to interview: 3.63 (interquartile range [IQR], 3.46-3.79) versus 3.35 (IQR, 3.2-3.49); p < 0.001. Invited applicants also received more scholarships during pharmacy school (median, 2 [IQR, 1-3) versus 1 [IQR, 0-2]; p = 0.002). Applicants with prior work experience as a hospital pharmacy intern were also more likely than those without such experience to be offered an interview (70.0% versus 37.8% were invited, p = 0.001), as were applicants who presented a poster at a national meeting during pharmacy school (80% versus 60%, p = 0.02) or who served in a national pharmacy organization leadership position (41.4% versus 20%, p = 0.03). Pharmacy school GPA was associated with final candidate ranking; top-ranked candidates had a significantly higher median GPA than lower-ranked applicants (3.68 [IQR, 3.51-3.8] versus 3.48 [IQR, 3.23-3.7]; p = 0.003). CONCLUSION: Objective criteria within the realms of academic performance and prior work experience may be used to streamline the applicant screening process when determining candidates to invite for an on-site interview. Pharmacy school GPA was the only characteristic found to be associated with applicant final ranking.

[The Report: Promotion of Social Contributions of Research on Clinical Pharmacy and Pharmaceutical Sciences].

The Science Council of Japan issued "The report: Promotion of Social Contributions of Research on Clinical Pharmacy and Pharmaceutical Sciences" on September 29, 2017. This report was prepared based on the analysis of current situation of the four-year doctoral course in the graduate school of pharmacy and the contents of the symposium of 137th annual meeting of the Pharmaceutical Society of Japan (PSJ), "Pharmaceutical Sciences in the Future: The Bridge Linking between Basic and Clinical Research". The goal of the 4-year doctoral program is to nurture the pharmacist-scientist who has both researcher mind and professionalism as a clinical pharmacist. Research on clinical pharmacy and pharmaceutical sciences is a core research area of the 4-year doctoral course, therefore its promotion is an important issue for the faculty of pharmacy. "Research on clinical pharmacy and pharmaceutical sciences" has to be based on various subjects and needs of the clinical site and be conducted not only at the clinical setting but also in universities, industries, research institutions and so on. Finally, the results have to be fed back to medical care and contribute to society. In this symposium, several representatives from various academic societies and one research institution which have important functions for academic interchanges, will give presentations on issues and initiatives for promoting research on clinical pharmacy and pharmaceutical sciences.