Nutritional support and parenteral nutrition in cancer patients: an expert consensus report

Background. Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. Methods. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. Results. Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. Conclusions. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients

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Nutritional support and parenteral nutrition in cancer patients: an expert consensus report.

BACKGROUND: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. METHODS: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. RESULTS: Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.

Tratamiento farmacológico de la diabetes, de la obesidad y de otros componentes del síndrome metabólico / Pharmacologic treatment of diabetes, obesity and other components of metabolic syndrome

La diabetes, la obesidad y el síndrome metabólico (SM) son patologías relacionadas. Su prevalencia mundial alcanza cifras epidémicas, lo que plantea reforzar los programas preventivos. El tratamiento farmacológico no es el primer escalón terapéutico; el primer escalón es el establecimiento y mantenimiento de un «estilo de vida saludable». La farmacología de la diabetes tipo 1 requiere la administración de insulina, pero el tratamiento del tipo 2 es más amplio y permite al inicio del mismo la administración de antidiabéticos orales (ADO). Dentro de los ADO disponemos de clásicos como biguanidas, sulfonilureas e inhibidores de α-glucosidasa, y de aprobados recientemente como meglitinidas, tiazolidindionas e incretinas (inhibidores de dipeptidilpeptidasa IV [(DPP-IV) y análogos del glucagon-like peptide-1 (GLP-1)]; y dentro de las insulinas disponemos de acción rápida e intermedia y de más modernas de acción ultrarrápida y prolongada. Los estudios científicos centrados en el tratamiento preventivo de la diabetes tipo 1 están en fases preliminares. Para el tratamiento farmacológico de la obesidad se han probado diferentes mecanismos de acción, pero los resultados no han sido exitosos, por los efectos secundarios. Actualmente sólo puede prescribirse en España un principio activo, el orlistat. La dislipemia está asociada al SM, y para su tratamiento se utilizan los fármacos habituales, es decir estatinas, fibratos, resinas y ezetimiba (AU)

Diabetes, obesity and metabolic syndrome (MS) are related pathologies. Their prevalence has reached epidemic proportions globally, which enforces the need to establish preventive programmes. Efforts on promoting a healthy diet and physical activity should be undertaken. Insulin therapy is a critical part of treatment for type 1 diabetes and for many who have type 2, as well. Rapid, short, intermediate and long acting insulines are available. However, the therapeutical approach for the type 2 diabetes allows the oral route, at least as an initial treatment. To the classic antidiabetic drugs (biguanides, sulphonylureas and alpha-glucosidase inhibitors), new ones, such as meglitinides, thiazolidinediones and incretines (glucagon-like peptide-1 and gastric inhibitory peptide analogues) have been approved during the last years. Moreover, some studies for the type 1 diabetes prevention are currently conducted. Despite several drugs with different mechanisms of action have been investigated for the pharmacology treatment of the obesity, their side effects justifies that, to date, only orlistat is currently approved in Spain for this indication. Dyslipemia is a disorder linked to the MS. Statins, fibrates, resins and ezetimibe constitute the therapeutic options (AU)

Consenso español sobre la preparación de mezclas nutrientes parenterales 2008 / No disponible

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[Comparative study of errors in electronic versus manual prescription]. / Estudio comparativo de errores con prescripción electrónica versus prescripción manual.

OBJECTIVE: Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. METHOD: A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation. RESULTS: With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). CONCLUSIONS: Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.

Estudio comparativo de errores con prescripción electrónica versus prescripción manual / Comparative study of errors in electronic versus manual prescription

Objetivo: Evaluar la incidencia de errores que se producencon la prescripción electrónica comparada con la prescripciónmanual.Método: Estudio prospectivo, secuencial y abierto para valorarlos errores con prescripción electrónica comparándola con laprescripción manual tradicional en dos hospitales públicos de lasIslas Baleares. Se han valorado los errores de medicación, dietay/u órdenes de enfermería en cuatro fases del proceso: prescripciónmédica, transcripción/validación en farmacia, transcripciónde enfermería y dispensación.Resultados: Con la prescripción manual se detectaron 1.576errores/18.539 órdenes de tratamiento (8,50%), y con la prescripciónelectrónica 827 errores/18.885 órdenes de tratamiento(4,38%), lo que supone una reducción relativa del riesgo del 48%y una reducción absoluta del riesgo de 4,12% (p < 0,0001). Existeuna disminución de errores de transcripción/validación en farmacia(1,73 vs. 0,13%, p < 0,0001), transcripción de enfermería(2,54 vs. 0,81%, p < 0,0001) y dispensación (2,13 vs. 0,96%, p < 0,0001); sin embargo, en la prescripción se observa un aumentodel número de errores (2,10 vs. 2,40%, p = 0,0401).Conclusiones: La prescripción electrónica es una herramientamuy poderosa que ha mostrado en este trabajo disminuir deforma muy significativa los errores de medicación, dieta y cuidadosde enfermería, pero que hay que desarrollar y mantener paraconseguir la seguridad y efectividad que se pretende en la utilizaciónde medicamentos

Objective: Electronic prescribing is considered a basic measurefor the prevention and reduction of medications errors. Thegoal of this survey was to assess the incidence of errors occurringwith electronic versus standard prescription.Method: A prospective, sequential, open-label study to assesserrors with electronic prescribing as compared to traditional manualprescribing in two public hospitals in Balearic Islands. Errorsregarding medication, diet and/or nursing orders were assessesalong four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation.Results: With manual prescription 1,576 errors/18,539 therapyorders (8.50%) were identified, whereas with electronic prescription827 errors/18,885 therapy orders (4.38%) were detected,which represents a relative risk reduction by 48% and an absoluterisk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validationerrors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursingtranscription errors (2.54 vs. 0.81%, p < 0.0001) and dispensationerrors (2.13 vs. 0.96%, p < 0.0001); however, the number ofprescription errors increased (2.10 vs. 2.40%, p = 0.0401).Conclusions: Electronic prescription is a powerful tool, andone that in this work was shown to decrease medication-, diet-,and nursing care-related errors in a highly significant way; however,it should be developed and maintained in order to achieve safetyand effectiveness as required by drug usage

[Program for the substitution of therapeutic equivalents in the hospital setting]. / Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario.

BACKGROUND: A Program of Therapeutic Equivalents (TEP) is here reported which was elaborated and is currently in force at a third level university teaching hospital. MATERIALS AND METHODS: Therapeutic equivalents were selected within the same pharmacologic group on the basis of approved indications and both efficiency and safety data. RESULTS: TEP considers: a) the substitution of drugs which are considered therapeutic equivalents; b) withdrawal of drugs which have not proved efficiency or are of no interest for inpatients; c) continuation of therapies when changes are not advisable, and d) indistinct use of homologous drugs. From August 1998 up to April 1999, TEP was applied in 505 occasions; it was accepted in 499 (99%) and rejected in 6 (1%). DISCUSSIONS: The substitution of therapeutic equivalents should be viewed in the context of selecting the most appropriate drugs to be used in the hospital setting. TEP should be a consensus document and supervised by the Pharmacy and Therapeutics Commission.

Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario / Programme for the substitution of therapeutic equivalents in the hospital setting

Se presenta un Programa de Equivalentes Terapéuticos (PET) elaborado e implantado en un hospital universitario de tercer nivel. Material y métodos. Los equivalentes terapéuticos se seleccionaron dentro del mismo grupo farmacológico en función de las indicaciones aprobadas y los datos de eficacia y seguridad. Resultados. El PET contempla: a) sustitución de fármacos considerados equivalentes terapéuticos; b) suspensión de fármacos que no han mostrado eficacia o sin interés en pacientes hospitalizados; c) continuación de tratamientos que no es aconsejable modificar, y d) utilización indistinta de fármacos homólogos. Desde agosto de 1998 hasta abril de 1999 se aplicó el PET en 505 ocasiones, fue aceptado en 499 (99 por ciento) y rechazado en 6 (1 por ciento). Discusión. La sustitución de equivalentes terapéuticos debe englobarse en el contexto de la selección de medicamentos más adecuados para su utilización en el medio hospitalario. El PET debe ser un documento consensuado y supervisado por la Comisión de Farmacia y Terapéutica (AU)