Search

Institutionalized patients who require nutrition support regularly visit the Unit of Nutrition Support of the Hospital Pharmacy Service. During these visits, prior to establishing a nutrition regime and followup scheme, an initial nutritional status assessment is performed. Telemedicine and Telepharmacy have expanded in recent years for remote monitoring of institutionalized persons.To evaluate the implementation of a Telemedicine informatics application for nutritional support surveillance of instutionalized persons in nursing homes from a hospital pharmacy service. Method: A multidisciplinary team led by the Hospital Pharmacy Service was created. Data of institutionalized persons in nursing homes needing artificial nutritional support was extracted from the SILICON prescription system and the internal ecords of the hospital pharmacy service. Nursing homes were selected on the basis of their previous experience using the Telemedicine informatics application TELEA. The following nutritional support variables were assessed: score on Mini-Nutritional Assessment questionnaire; a 24-h food record; pressure ulcer control; and laboratory parameters. The existing information flow between nursing homes and hospital specialists was analyzed. The functionalities available on TELEA were considered.In 2021, over 300 institutionalized persons from 28 nursing homes were incluided for nutritional support surveillance program of the hospital pharmacy service. The project was implemented in two nursing homes serving 38 patients, although only 13 were involved in the nutrition surveillance program of the Nutrition Support Unit. Nutritional status assessment and nutritional support surveillance reports were adapted to the Telemedicine informatics application. Paper reports were replaced with electronic data or online questionnaires available on the informatics application. An information flow protocol was established. An instantaneous messaging and alert system was activated, which allowed continuous communication. Some Telepharmacy requests were categorized as preferential when the clinical status of the patient so required. All the information generated during the nutritional status assessment and nutritional support surveillance process was integrated into the electronic medical history of each patient.TELEA-based nutritional support surveillance facilitates the continuum of care by enabling direct communication between nursing homes and secondary care for institutionalized persons. This model makes it possible to record nutrition-related data on the electronic medical history of patients through a Telepharmacy process. This model also eliminates paper prescriptions and medical reports, and unnecessary travels. A nutritional status profile should also be made available to facilitate nutrition surveillance in institutionalized persons with chronic diseases. That would be the first step for a new integrated healthcare informatics application for frail/polymorbid elderly patients.Introducción: Los pacientes institucionalizados que requieren soporte nutricional artificial acuden de forma periódica a las consultas de la Unidad de Soporte Nutricional del Servicio de Farmacia. En ellas se realiza una valoración nutricional inicial, a partir de la cual se establece la pauta nutricional y el plan de seguimiento. La Telemedicina y la Telefarmacia se han expandido en los últimos años para la monitorización remota de personas institucionalizadas.Evaluar la implementación de una aplicación informática de Telemedicina para la vigilancia del soporte nutricional de personas nstitucionalizadas en residencias de ancianos desde un servicio de farmacia hospitalaria.Método: Se formó un equipo multidisciplinar liderado por el Servicio de Farmacia. Los datos de pacientes institucionalizados que requieren soporte nutricional artificial se obtuvieron del programa SILICON y de los registros internos del Servicio de Farmacia. Se eligieron las primeras residencias candidatas según la experiencia previa en el manejo de la aplicación informática de asistencia domiciliaria. Se analizaron llas variables de soporte nutricional necesarias para el seguimiento nutricional: Mini Nutritional Assessment, recordatorio de ingestas de las últimas 24 horas, control de úlceras por presión y parámetros analíticos. Se analizó el flujo de información existente entre las residencias sociosanitarias y la atención hospitalaria y se valoraron las opciones disponibles a través de la plataforma tecnológica de asistencia domiciliaria.El Servicio de Farmacia realizó seguimiento nutricional a más de 300 pacientes institucionalizados en 28 residencias sociosanitarias en el año 2021. El proyecto se implantó en dos residencias sociosanitarias que cuentan con 38 pacientes institucionalizados, aunque solo 13 pacientes estaban en seguimiento por la Unidad de Soporte Nutricional. Todos los registros generados en la valoración y seguimiento nutricional se adecuaron a la aplicación informática de asistencia domiciliaria, se cambiaron los registros en papel por información incluida en la plataforma o cuestionarios online facilitados a través de la misma. Además, se protocolizó el flujo de información generada y se activó un sistema de mensajería con alertas que permite una comunicación continua. En caso de que la situación clínica del paciente lo requiera se puede programar una teleconsulta preferente.Toda la información generada en el proceso de valoración y seguimientonutricional de cada paciente se integró en la historia clínica electrónica.El seguimiento nutricional a través de la aplicación informática de asistencia domiciliaria facilita la continuidad asistencial por el establecimiento de una comunicación directa entre las residencias sociosanitarias y la atención hospitalaria, permitiendo la integración de la información nutricional de los pacientes en la historia clínica electrónica mediante un proceso de Telefarmacia. Se han eliminado las prescripciones en papel, informes clínicos impresos y los desplazamientos innecesarios. El desarrollo de este perfil podría ser extensible al seguimiento nutricional de pacientes con patologías crónicas, y ser el precedente de un nuevo programa de cuidado integral del paciente anciano frágil o pluripatológico.

Aims Adalimumab is a biological therapy used to treat different chronic inflammatory diseases. At present, there is an increasing number of adalimumab biosimilars. To assume the acceptability of interchangeability between reference adalimumab and biosimilars, there should be evidence about efficacy and safety of this switching. Regulation of this practice falls under the authority of individual European Union Member States. The aim of this study is to systematically review the evidence on the efficacy, safety and immunogenicity of switching between reference adalimumab and biosimilars in different chronic immune-mediated inflammatory diseases. Methods Studies presenting data about switching between reference adalimumab and biosimilars were identified by sensitive search strategies in Medline and EMBASE from 1 January 2004 to 30 June 2021. Results A total of 471 references were obtained and 21 finally included in the analysis (total number of patients switching: 2802). Eight different adalimumab biosimilars were tested after receiving reference adalimumab. Eight articles included rheumatoid arthritis (RA), one miscellaneous rheumatic disease, six psoriasis (PSO) and six inflammatory bowel disease (IBD) patients. Overall, the efficacy results in the switching groups were comparable to those obtained in the arms of continuous biosimilar and continuous reference adalimumab. There were no significant differences in treatment emergent adverse events, anti-drug or neutralising antibodies among the three groups. Conclusions Switching between reference adalimumab and biosimilars has no impact on efficacy, safety and immunogenicity in patients with RA, PSO and IBD. This finding was consistent for the different adalimumab biosimilars analysed. These conclusions could probably be extended to other rheumatic diseases such as psoriatic arthritis and ankylosing spondylitis.

Colorectal cancer is the ninth leading cause of death in Spain. The latest therapeutic developments in the advanced stages of this disease are the oral drugs trifluridine/tipiracil and regorafenib.Results of clinical trials (CTs) are not in real conditions and therefore, we want to study the effectiveness and the safety profile in the usual clinical practice and compare it with the bibliography.A retrospective and unicentric study was carried out in a health area of 500,000 inhabitants. Patients who started treatment with regorafenib and/or trifluridine/tipiracil were included from the date of marketing until June 2019. Patient-related variables, pathology, effectiveness, and treatment toxicity were collected. The statistical analysis was carried out with the PSPP program.Fifty-four patients were analyzed. Men accounted for 59.3% of patients. Regorafenib was the treatment for 22.2% of patients and 77.8% received trifluridine/tipiracil. The reason for the drug's suspension was the disease progression in 85.2% of patients. No patient had a full response and 3.2% achieved partial response. The median progression-free survival time in treatments with regorafenib was 2.5 months (95% confidence interval [CI]: 0.0-5.4) and the overall survival time was 3.1 months (95% CI: 0.0-6.7), while in treatments with trifluridine/tipiracil, these data were, respectively, 2.8 (95% CI: 2.5-3.2) and 5.7 months (95% CI: 3.8-7.6). Side effects occurred in 91.7% of patients treated with regorafenib and in 100% of treated with trifluridine/tipiracil. Hematological adverse reactions were, on average, 0.4 ± 0.5/patient with regorafenib and 1.5 ± 0.9 with trifluridine/tipiracil. General (77.8%) and gastrointestinal disorders (50%) were common with both drugs.The effectiveness results of standard clinical practice are lower than those described in CTs and in the literature. The toxicity profile does reproduce what is described in the bibliography.

Objective To analyse the volume and content of tweets in relation to biological treatments for chronic inflammatory arthropathies. Methods A Twitter analysis was carried out during one month using the following keywords: ’rheumatoid arthritis9, ’ankylosing spondylitis9, ’psoriatic arthritis9 and their biological therapies: ’abatacept9, ’adalimumab9, ’certolizumab9, ’etanercept9, ’golimumab9, ’infliximab9 and ’tocilizumab9. Tweets were hand-coded and filtered for content. Results 25 441 tweets contained at least one of the keywords. After filtering, 2480 tweets were included in the analysis. Regarding the 983 tweets about therapies, the most frequently mentioned biologics were ’adalimumab9 (n=359), ’infliximab9 (n= 278) and ’etanercept9 (n= 205). In the 1497 tweets about diseases, the term ’rheumatoid arthritis9 (n= 1109) was used more frequently than ’psoriatic arthritis9 (n= 233) and ’ankylosing spondylitis9 (n= 155). The most commonly addressed subjects in the tweets in relation to biological therapies were related to safety/adverse events (136 of 983 (13.8%)) and to administration, particularly drug infusion (60 of 983 (6.1%)) and self-administration (57 of 983 (5.8%)). Regarding diseases, the most commonly addressed subjects were non-pharmacological recommendations such as alternative therapies (145 of 1497 (9.7%)), nutrition (128 of 1497 (8.5%)) and exercise (91 of 1497 (6.1%)). Conclusions Twitter is widely used to search for information about biological treatments for chronic athropathies. Learning more about the subjects dealt with in the tweets will enable us to improve our understanding of the areas of greater interest and concern among patients. This could help hospital pharmacists establish patient-focused strategies addressing the needs of the patients.

Resumen Objetivo Evaluar el impacto de medidas que mejoren la calidad de la atencion farmaceutica y la distribucion de medicamentos en pacientes hospitalizados. Material y metodos Estudio observacional prospectivo en un hospital general. En 12 unidades de hospitalizacion, durante 2 semestres se recogieron los errores de medicacion cometidos en los procesos de transcripcion de prescripciones medicas y la dispensacion de medicamentos en dosis unitarias. Tras 6 meses, se implantaron las medidas a evaluar: asignacion de farmaceuticos de referencia y un nuevo protocolo de preparacion/revision de la medicacion. Se realizaron analisis descriptivos y estadisticos (pruebas de la t de Student y ANOVA) de los resultados obtenidos mediante el programa SPSS version 14. Resultados En transcripcion, ninguna unidad mejoro sin un farmaceutico de referencia. Los errores descendieron en 3 unidades de manera significativa: ginecologia-urologia (el 3,24 frente al 0,52%), traumatologia (el 2 frente al 1,69) y neurologia-neumologia (el 2,81 frente al 2,02%). En dispensacion, solo disminuyeron de manera significativa en las unidades con nuevo protocolo (el 1,77 frente al 1,24%). Conclusiones La integracion del farmaceutico en equipos multidisciplinarios y protocolos seguros para dispensar medicamentos fueron medidas eficaces para detectar y reducir errores de medicacion en pacientes hospitalizados.

Case A 44-year-old man was diagnosed with ankylosing spondylitis, on treatment with infliximab. After three doses, he was admitted to hospital with fever, fatigue and nausea. A bone marrow biopsy confirmed haemophagocytic syndrome. He was treated with immunoglobulin, cyclosporine and corticosteroids. CT scan revealed tuberculosis. Tuberculostatic treatment was started 26 days after admission. One month later, he was transferred intensive care with septic shock and acute respiratory distress syndrome. After improvement, he was transferred to the medical ward and later discharged. Two weeks after discharge, he was readmitted with a suspected paradoxical reaction (PR) to tuberculostatics and treated with prednisone. He was discharged 15 days later. Conclusions In patients treated with anti-TNF therapy it may be advisable to monitor the signs and symptoms of tuberculosis. HPS is a rare complication of rheumatic diseases. The possibility of developing a PR in immunosuppressed patients treated with antituberculous should be considered.

To evaluate the impact of implementing new programs to improve the quality of the pharmaceutical care and unit-dose distribution system for in-patients.An observational and prospective study was carried out in a general hospital during two different six-monthly period. Transcription and dispensation errors were evaluated in twelve wards during the first six months. Then, two new measures were introduced: the first- reference ward-pharmacist and the second-a new protocol for checking medication on the ward. Results were evaluated by SPSS v. 14 program.In the transcription evaluation, units without a ward pharmacist did not improve. Transcription errors significantly decreased in three units: gynaecology-urology (3.24% vs. 0.52%), orthopaedic (2% vs. 1.69%) and neurology-pneumology (2.81% vs. 2.02%). In dispensing, only units with the new protocol decreased their medication errors (1.77% vs. 1.24%).The participation of pharmacists in multidisciplinary teams and exhaustive protocols for dispensing medication were effective in detecting and decreasing medication errors in patients.