ABSTRACT
BACKGROUND: Polipharmacy has been identified as a contributing factor to the high hospital readmission rates of heart failure (HF) patients. Nevertheless, there limited evidence on pharmacist-led intervention on the reduction of inappropriate medication use in patients. OBJECTIVE: To summarize the available evidence resulting from interventions, led by pharmacists (alone or as part of a professional team), aimed at reducing inappropriate medications in patients with heart failure. METHODS: A systematic review was conducted using MEDLINE through PubMed, Embase, the Cochrane Library and Scopus until June 2020. We reviewed both randomized controlled trials and non-randomized intervention studies.The quality of evidence was assessed in accordance with the modified Cochrane Collaboration tool to assess risk of bias for randomized controlled trials. The search and extraction process followed PRISMA guidelines. RESULTS: Of the 4367 records screening, 9 studies were included in the analysis. In 4 (44.4%) studies, the intervention was carried out by a pharmacist working together with a physician; in 4 (44.4%) the intervention was carried out by a pharmacist alone, and in 1 study, the pharmacist collaborated with a nurse. Only 5 (55.5%) studies described the utilization of guidelines or recommendations to carry out the deprescription, and 3 of these showed improved clinical outcomes in the interventional group compared to the control group. The other studies (4, 44.4%) did not follow a specific guideline or recommendation to evaluate the appropriateness of medication, and none of them showed statistically significant differences in clinical outcomes between interventional and control groups. CONCLUSION: Only those studies where pharmacists evaluated the appropriateness of treatment to specific HF guidelines showed significant differences in patients' clinical outcomes. The development and validation of a specific tool to evaluate medication appropriateness in patients with HF, could contribute to the improvement of patient health.
Subject(s)
Heart Failure , Pharmacists , Heart Failure/drug therapy , Hospitalization , Humans , Patient Readmission , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies. DESIGN: Cality study. SETTING: Short Stay Medical Unit in Elda General Hospital, Alicante, Spain. PARTICIPANTS: All patients discharged were included. INTERVENTION: The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation. CONCLUSION: Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.
Subject(s)
Medication Errors/statistics & numerical data , Patient Discharge , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Young AdultABSTRACT
Objetivo. Evaluar y describir las discrepanciasno justificadas encontradas al conciliar lamedicación crónica de los pacientes con lamedicación prescrita en el momento del altahospitalaria. En una segunda parte, se evaluóel impacto del proceso de conciliación y sevaloró la gravedad de las discrepancias.Diseño. Estudio de calidad.Emplazamiento. Unidad Médica de CortaEstancia del Hospital General de Elda,Alicante.Participantes. Pacientes dados de alta.Intervención. Tras realizar una entrevistapersonal previa al alta, se obtuvo lamedicación que tomaba el paciente antesdel ingreso. Un farmacéutico identificólas discrepancias no justificadas con eltratamiento en el momento del alta y conla historia farmacoterapéutica, y en los casosnecesarios se modificó tras consultarlo conel médico.Mediciones y resultados principales. Serealizaron intervenciones en 434 pacientes yse detectaron 249 errores de conciliación, loque supone 0,57 discrepancias por pacienteintervenido.Dentro del 35,2% de lospacientes que presentaron errores deconciliación, la media de discrepanciasfue de 1,62. De estos errores, 153 (61,5%)se produjeron en el momento del altahospitalaria, mientras que 96 (38,5%) fueronerrores de omisión o comisión en la historiafarmacoterapéutica. El 11% de los informesde alta revisados no recogían informaciónsobre el tratamiento previo del paciente. Eltipo de error mayoritario tanto en la historiacomo en el momento del alta fue el deomisión. Respecto al daño potencial de loserrores detectados, un 30% podría habercausado lesiones temporales o lahospitalización.Conclusión. Los errores de medicación en lahistoria farmacoterapéutica en el momentodel ingreso son comunes y potencialmenteimportantes si se mantienen en el tiempo.La incorporación del farmacéutico al equipomédico, así como la disponibilidad de accesoa datos de distintos niveles asistenciales,podrían contribuir a reducir la frecuenciade estos errores
Objective. To evaluate and describe the nonjustifieddiscrepancies found on reconcilingchronic medication prescribed to patientswhen discharged from hospital. Secondly,the impact of the reconciliation process isevaluated by assessing the seriousness of thediscrepancies.Design. Cality study.Setting. Short Stay Medical Unit in EldaGeneral Hospital, Alicante, Spain.Participants. All patients discharged wereincluded.Intervention. The medication that the patientwas taking before admission was obtained bypersonal interview before being discharged.The discrepancies that were non-justifiablewith the treatment on discharge and withthe pharmacotherapeutic history wereidentified and modified, where necessary,after consulting with the doctor.Meditions and results. Of the 434 patientsinterviewed, 249 conciliation errors weredetected, which was 0.57 discrepanciesper treated patient. Among the 35.2%of patients who had conciliation errors,the mean number of discrepancies was 1.62.Of these errors, 153 (61.5%) were producedwhen being discharged, while 96 (38.5%)were errors of omission or commission inthe pharmacotherapeutic history. Of all thedischarge reports reviewed, 11% did notrecord information on the previous treatmentof the patient. Omission was the main type oferror, both in the history and on discharge.As regards the potential harm of thedetected errors, 30% could have causedtemporary harm or hospitalisation.Conclusion. Medication errors in thepharmacotherapeutic history at the time ofbeing admitted are common and potentiallysignificant if they are continued. Includingthe pharmacist in the medical team, alongwith being able to access data at the differentcare levels, could help to reduce thefrequency of these errors
Subject(s)
Humans , Male , Female , Patient Discharge/statistics & numerical data , Patient Discharge/standards , Patient Discharge/trends , Homeopathic Anamnesis , Drug Prescriptions/classification , Drug Prescriptions/statistics & numerical data , Drug Prescriptions/standards , Medication Errors/ethics , Medication Errors/prevention & controlABSTRACT
El objetivo de este estudio consiste en determinar el estado nutricional de los 83 residentes de un centro sociosanitario y evaluar su evolución tras la aplicación del protocolo de valoración nutricional diseñado a tal efecto desde la Consejería de Bienestar Social de la Comunidad Valenciana. La muestra se clasificó según los hallazgos de índice de masa corporal (IMC), hipoalbuminemia y la aplicación del índice de riesgo nutricional geriátrico. Las intervenciones nutricionales consistieron en efectuar recomendaciones generales y seguimiento en caso de ausencia de desnutrición, la adecuación de dietas adaptadas trituradas en residentes con problemas de masticación-deglución y riesgo de broncoaspiración, la adecuación de nutrición enteral completa en residentes con catéter de alimentación nasogástrica y la instauración de suplementos nutricionales en casos de desnutrición severa. Transcurridos 3 meses se obtuvo un incremento del IMC medio, aunque no de manera significativa (p = 0,168), y se redujo el porcentaje de residentes con desnutrición del 29 al 23%. Además, disminuyó el número de residentes que recibían suplementos nutricionales sin indicación, con un ahorro mensual estimado de 965 euros. La participación activa del equipo multidisciplinario en el seguimiento nutricional de los residentes, de forma coordinada y continua, contribuye a la consecución de un adecuado estado nutricional, mejorando el uso racional de la nutrición artificial en el entorno sociosanitario (AU)
The aim of this study was to determine nutritional status in 83 residents of a nursing home and to evaluate outcomes after the application of a nutritional assessment protocol designed by the Department of Social Welfare of the autonomous community of Valencia (Spain). The sample was classified according to body mass index (BMI), hypoalbuminemia and application of the geriatric nutritional risk index. Nutritional interventions consisted of applying general recommendations and follow-up in residents without malnutrition, providing adequate powdered diets in residents with chewing and swallowing disorders and risk of bronchoaspiration, adjusting total enteral nutrition in residents with nasogastric feeding tubes and initiating vitamin supplementation in residents with severe malnutrition. After 3 months, the mean BMI showed a nonsignificant increase (P=.168), reducing the number of residents with malnutrition from 29% to 23%. The number of residents who received nutritional supplements without indication also decreased, resulting in an estimated saving of 965 euros. Active participation of the multidisciplinary team in the coordinated and continuous follow-up of nutritional status in residents contributed to achieving adequate nutritional status and improved the rational use of artificial nutrition in the nursing home (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Nutrition Assessment , Nutritional Status/physiology , Elderly Nutrition , Nutrition Disorders/epidemiology , Geriatric Assessment/methods , /trends , Health of Institutionalized Elderly , Enteral Nutrition/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Carbamazepine/pharmacokinetics , Drug Interactions/physiology , Acenocoumarol/pharmacokinetics , Risk FactorsSubject(s)
Analgesics, Non-Narcotic/adverse effects , Analgesics, Non-Narcotic/pharmacokinetics , Anticonvulsants/adverse effects , Anticonvulsants/pharmacokinetics , Ibuprofen/adverse effects , Ibuprofen/pharmacokinetics , Neurotoxicity Syndromes/etiology , Phenytoin/adverse effects , Phenytoin/pharmacokinetics , Aged , Drug Interactions , Female , HumansABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Neurotoxicity Syndromes/diagnosis , Phenytoin/adverse effects , Ibuprofen/adverse effects , Drug Interactions , Epilepsy/drug therapyABSTRACT
No disponible
No disponible
Subject(s)
Female , Pregnancy , Adult , Humans , Pregnancy Complications, Cardiovascular/diagnosis , Coronary Disease/diagnosis , Risk Factors , Cardiac Catheterization , Coronary Disease/surgery , Adrenergic beta-Antagonists/therapeutic use , Anti-Arrhythmia Agents/therapeutic useABSTRACT
OBJECTIVE: Risperidone is an atypical neuroleptic drug widely used due to the lower incidence and severity of hepatic adverse effects in comparison to phenothiazines. Although idiosyncratic reversible hepatotoxicity may occur in association with risperidone, the interaction with fluoxetine might increase the risk of toxic liver injury in a vulnerable patient. METHODS AND RESULTS: We present a case of acute cholestatic hepatitis probably associated with the use of risperidone after only a few days of therapy in a patient also treated with fluoxetine. The patient, a 64-year-old male, developed a rapid increase in liver enzymes after starting treatment with only four doses of risperidone 2 mg/day. CONCLUSIONS: We recommend obtaining baseline liver function tests before starting risperidone and regular monitoring to screen patients for liver damage during therapy whenever a patient is also receiving fluoxetine.
Subject(s)
Antipsychotic Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/physiopathology , Risperidone/adverse effects , Acute Disease , Chemical and Drug Induced Liver Injury/blood , Humans , Male , Middle AgedSubject(s)
Acetamides/adverse effects , Anti-Infective Agents/adverse effects , Mycobacterium bovis/isolation & purification , Optic Nerve Diseases/chemically induced , Oxazolidinones/adverse effects , Peripheral Nervous System Diseases/chemically induced , Tuberculosis, Multidrug-Resistant/drug therapy , Aged , Humans , Linezolid , Male , Treatment Outcome , Tuberculosis, Multidrug-Resistant/microbiologyABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Tuberculosis/drug therapy , Oxazolidinones/adverse effects , Peripheral Nervous System Diseases/chemically induced , Mycobacterium Infections/drug therapy , Mycobacterium bovis/pathogenicity , Eye Diseases/chemically inducedABSTRACT
OBJECTIVE: To describe the first case, to the best of our knowledge, of posttraumatic Scedosporium apiospermum (ScA) keratitis successfully treated with systemic and topical voriconazole. CASE SUMMARY: A 19-year-old man was admitted to the hospital with an incisive wound of his left eye and the cornea totally sectioned after trauma with a cutter used in gardening. Initial empirical treatment was followed by systemic and topical voriconazole, and the eye did not have to be enucleated. Five months after the trauma, a penetrating keratoplasty and chamber intraocular lens implantation was performed with a favorable visual outcome. DISCUSSION: ScA keratitis is rare, but it must be suspected if a history of ocular injury with contaminated objects exists. Among the antifungals available to treat ScA keratitis, voriconazole has shown advantages such as the lowest minimum inhibitory concentration and the availability of an oral formulation. CONCLUSIONS: Voriconazole shows promise as an effective alternative to conventional antifungals in the treatment of ScA keratitis. It is available both as oral and intravenous preparations, which is a great advantage in these lengthy infections.
