Assessment of the importance of ostomy patients' understanding of dietary and lifestyle recommendations.

Introduction: Objective: the objective of our study was to evaluate the level of understanding of ostomy patients regarding lifestyle, diet, and high output stoma (HOS) management recommendations provided by healthcare professionals. Method: a prospective study to follow up ostomy patients at nutritional consultations was designed. The follow-up process was performed 7-10 days after hospital discharge and again one month later. At the first visit, patients were instructed in the detection and management of HOS. At the second visit, the level of understanding of the training received was assessed using an evaluation questionnaire. A descriptive analysis of the answers to each of the questionnaire's items was performed. Fisher's exact test was used to evaluate differences in the level of understanding recorded with the questionnaire. Results: a total of 35 patients were recruited; 71.4 % did not provide correct answers to all the questions. There were no significant differences in the correctness of the answers to the questionnaire according to education level. Conclusions: many patients do not adequately understand the information provided by healthcare professionals and this could have a negative impact on the incidence of clinical complications.

Introducción: Objetivo: el objetivo de nuestro estudio fue evaluar el nivel de comprensión de los pacientes ostomizados con respecto a las recomendaciones sobre estilo de vida, dieta y manejo de la ostomía de alto débito (OAD) proporcionadas por los profesionales de la salud. Método: se diseñó un estudio prospectivo para el seguimiento de pacientes ostomizados en consulta de nutrición. El seguimiento se realizó 7-10 días después del alta hospitalaria y a continuación un mes después. En la primera visita, se instruyó a los pacientes sobre la detección y el tratamiento de OAD. En la segunda visita se evaluó el nivel de comprensión de la formación recibida mediante un cuestionario de evaluación. Se registraron las respuestas dadas a cada uno de los ítems del cuestionario y se realizó un análisis descriptivo. Para evaluar las diferencias en el nivel de comprensión registrado con el cuestionario se utilizó la prueba exacta de Fisher. Resultados: se reclutaron 35 pacientes. El 71,4 % no respondieron correctamente a todas las preguntas. La exactitud de las respuestas al cuestionario no mostró diferencias significativas según el nivel educativo. Conclusiones: un gran número de pacientes no comprende adecuadamente la información que ofrecen los profesionales sanitarios y esto podría tener un impacto negativo en el desarrollo de complicaciones clínicas.

Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience.

BACKGROUND: Cancer patients are especially vulnerable to drug interactions, which may alter the efficacy and toxicity of treatment, leading to severe clinical consequences. OBJECTIVE: Determine the incidence of such interactions in patients receiving chemotherapy, as well as to identify the drugs most frequently involved, investigate the influence of the pharmacist's interventions and verify the degree of acceptance of pharmacist's recommendations by the medical team. SETTING: The oncology department of a Spanish tertiary hospital. METHODS: During 3 months, all the drug interactions in the regular combined with treatment for cancer were analysed using two databases, and recommendations were made when clinically significant interactions (CSI) were identified. MAIN OUTCOME MEASURE: Incidence of CSI in oncology outpatients; drugs involved in CSI. RESULTS: Of the 75 patients included, 31 (41%) presented CSI. Most interactions were among drugs included in the patient's usual treatment. The principal drug groups involved in CSI were cytostatic agents, antiemetics and antidepressants. The hospital pharmacist intervened on 20 occasions (35% of the patients presenting drug interactions). These interventions mainly focused on recommendations to modify or discontinue drug prescriptions, and were followed in 94% of cases. CONCLUSION: The incidence of drug interactions in cancer patients is high, and they most often involve medications to treat comorbid conditions. The pharmacist, as a member of the multidisciplinary team, can contribute significantly by checking the treatment prescribed and detecting interactions, to reduce medication-related problems and to optimise drug therapy for these patients.

Using failure mode and effects analysis to improve the safety of neonatal parenteral nutrition.

PURPOSE: Failure mode and effects analysis (FMEA) was used to identify potential errors and to enable the implementation of measures to improve the safety of neonatal parenteral nutrition (PN). METHODS: FMEA was used to analyze the preparation and dispensing of neonatal PN from the perspective of the pharmacy service in a general hospital. A process diagram was drafted, illustrating the different phases of the neonatal PN process. Next, the failures that could occur in each of these phases were compiled and cataloged, and a questionnaire was developed in which respondents were asked to rate the following aspects of each error: incidence, detectability, and severity. The highest scoring failures were considered high risk and identified as priority areas for improvements to be made. RESULTS: The evaluation process detected a total of 82 possible failures. Among the phases with the highest number of possible errors were transcription of the medical order, formulation of the PN, and preparation of material for the formulation. After the classification of these 82 possible failures and of their relative importance, a checklist was developed to achieve greater control in the error-detection process. FMEA demonstrated that use of the checklist reduced the level of risk and improved the detectability of errors. CONCLUSION: FMEA was useful for detecting medication errors in the PN preparation process and enabling corrective measures to be taken. A checklist was developed to reduce errors in the most critical aspects of the process.

[Hypersensibility reaction to parenteral nutrition approach; a case report]. / Abordaje de una posible reacción de hipersensibilidad a nutrición parenteral; a propósito de un caso.

Parenteral nutrition (PN) is essential in the treatment of many hospitalized patients. However, administration of PN is not without potential complications and patients are exposed to related possible adverse reactions such as hypersensitivity. For that reason and because of the complexity of this treatment, PNs are considered by the ISMP (Institute for Safe Medication Practice) a high risk medication. Following is introduced the case of an oncologic patient with severe malnutrition, who after receiving PN for several days, developed a hypersensitivity reaction that could have being associated with intravenous mixture administration. Our aim is to analize the difficulties related with pre-surgery nutrition and to clarify the main possible causes of the reaction.

La nutrición parenteral (NP) constituye un elemento esencial en el tratamiento de muchos pacientes hospitalizados. Sin embargo, su administración no está exenta de complicaciones quedando sujeta a la aparición de reacciones adversas de diversa índole como las de hipersensibilidad, por lo que es considerada por el ISMP (Institute for Safe Medication Practice) como medicación de riesgo. Se presenta el caso de una paciente oncológica con desnutrición severa, que tras recibir NPT durante varios días, desarrolla una reacción de hipersensibilidad que, ante la posibilidad de estar asociada a la administración de la mezcla intravenosa, nos planteo la dificultad de la nutrición preoperatoria y nos llevó a analizar las causas probables de esta reacción.

Abordaje de una posible reacción de hipersensibilidad a nutrición parenteral; a propósito de un caso / Hypersensibility reaction to parenteral nutrition approach; a case report

La nutrición parenteral (NP) constituye un elemento esencial en el tratamiento de muchos pacientes hospitalizados. Sin embargo, su administración no está exenta de complicaciones quedando sujeta a la aparición de reacciones adversas de diversa índole como las de hipersensibilidad, por lo que es considerada por el ISMP (Institutefor Safe Medication Practice) como medicación de riesgo. Se presenta el caso de una paciente oncológica con desnutrición severa, que tras recibir NPT durante varios días, desarrolla una reacción de hipersensibilidad que, ante la posibilidad de estar asociada a la administración de la mezcla intravenosa, nos planteo la dificultad de la nutrición preoperatoria y nos llevó a analizar las causas probables de esta reacción (AU)

Parenteral nutrition (PN) is essential in the treatment of many hospitalized patients. However, administration of PN is not without potential complications and patients are exposed to related possible adverse reactions such as hypersensitivity. For that reason and because of the complexity of this treatment, PNs are considered by the ISMP (Institute for Safe Medication Practice) a high risk medication. Following is introduced the case of an oncologic patient with severe malnutrition, who after receiving PN for several days, developed a hypersensitivity reaction that could have being associated with intravenous mixture administration. Our aim is to analize the difficulties related with pre-surgery nutrition and to clarify the main possible causes of the reaction (AU)

[Review of enteral drugs administration for viral diseases: HIV, HBV and HCV]. / Revisión de la administración por sonda nasogástrica o gastrostomía de fármacos para patologías víricas: VIH, VHB y VHC.

INTRODUCTION: Patients infected with HIV demographic have changed in recent years and sometimes, co-infections with hepatitis virus B and C are common. Due to their longer survival, these patients often present diseases or undergo surgical procedures that preclude the intake of drugs, requiring the use of the enteral administration. This practice, however, may fail due to the lack of adherence, unsuitable drug blood concentrations caused by malabsorption or interactions, and dosage errors. We aim to develop management guidelines for antiviral drugs enteral administration. MATERIAL AND METHODS: We reviewed the technical specifications of drugs used in HIV, HBV or HCV. A search was conducted in Pubmed® database and Micromedex®, manufacturers were contacted for futher information and other related literature was reviewed. RESULTS: The results are shown in table 1. DISCUSSION: Although in pharmaceutical practice crushing tablets is common, sometimes suspension of crushed drugs in water is not completely appropriate for enteral administration, because this practice may alter the bioavailability of drugs, which may modify the therapeutic effect. There is currently not enough evidence that supports the practice of crushed and suspension of drugs exposed in this study. Therefore, the bioavailability of different formulations should be studied more carefully, especially of recent marketing drugs.

Introducción: Las características demográficas de los pacientes infectados por VIH han cambiado en los últimos años y las co-infecciones por virus de la hepatitis B y C son muy comunes en estos pacientes. Debido al aumento de supervivencia, a menudo estos pacientes presentan patologías o tienen que ser sometidos a intervenciones quirúrgicas que imposibilitan o dificultan la ingesta siendo necesaria la utilización de la vía enteral para la administración de fármacos. De entre los factores que influyen en el fracaso terapéutico destacan falta de adherencia, la falta de concentraciones adecuadas en sangre por malabsorción o interacciones y los errores de dosificación. Por ello se pretende elaborar una guía con recomendaciones de administración por vía enteral de los medicamentos antivirales. Material y métodos: Se revisaron las fichas técnicas de los medicamentos utilizados en VIH, VHB o VHC. Se llevó a cabo una búsqueda en las bases de datos Pubmed® y Micromedex®, se contactó con los fabricantes y se revisó otra literatura al respecto. Resultados: Los resultados se detallan en la Tabla 1. Discusión: A veces, la mera suspensión del comprimido triturado en agua no basta y esta práctica hace que muchos fármacos vean alterada su biodisponibilidad con la consiguiente modificación del efecto terapéutico. Actualmente no existe suficiente evidencia que apoye las prácticas de triturado y suspensión de los fármacos expuestos en este estudio, y consideramos que deberían llevarse a cabo más estudios para determinar la biodisponibilidad de formulaciones diferentes a las convencionales, especialmente de los medicamentos de reciente comercialización.

Revisión de la administración por sonda nasogástrica o gastrostomía de fármacos para patologías víricas: VIH, VHB y VHC / Review of enteral drugs administration for viral diseases: HIV, HBV and HCV

Introducción: Las características demográficas de los pacientes infectados por VIH han cambiado en los últimos años y las co-infecciones por virus de la hepatitis B y C son muy comunes en estos pacientes. Debido al aumento de supervivencia, a menudo estos pacientes presentan patologías o tienen que ser sometidos a intervenciones quirúrgicas que imposibilitan o dificultan la ingesta siendo necesaria la utilización de la vía enteral para la administración de fármacos. De entre los factores que influyen en el fracaso terapéutico destacan falta de adherencia, la falta de concentraciones adecuadas en sangre por malabsorción o interacciones y los errores de dosificación. Por ello se pretende elaborar una guía con recomendaciones de administración por vía enteral de los medicamentos antivirales. Material y métodos: Se revisaron las fichas técnicas de los medicamentos utilizados en VIH, VHB o VHC. Se llevó a cabo una búsqueda en las bases de datos Pubmed® y Micromedex®, se contactó con los fabricantes y se revisó otra literatura al respecto. Resultados: Los resultados se detallan en la Tabla 1.Discusión: A veces, la mera suspensión del comprimido triturado en agua no basta y esta práctica hace que muchos fármacos vean alterada su biodisponibilidad con la consiguiente modificación del efecto terapéutico. Actualmente no existe suficiente evidencia que apoye las prácticas de triturado y suspensión de los fármacos expuestos en este estudio, y consideramos que deberían llevarse a cabo más estudios para determinar la biodisponibilidad de formulaciones diferentes a las convencionales, especialmente de los medicamentos de reciente comercialización (AU)

Introduction: Patients infected with HIV demographic have changed in recent years and sometimes, co-infections with hepatitis virus B and C are common. Due to their longer survival, these patients often present diseases or undergo surgical procedures that preclude the intake of drugs, requiring the use of the enteral administration. This practice, however, may fail due to the lack of adherence, unsuitable drug blood concentrations caused by malabsorption or interactions, and dosage errors. We aim to develop management guidelines for antiviral drugs enteral administration. Material and methods: We reviewed the technical specifications of drugs used in HIV, HBV or HCV. A search was conducted in Pubmed® database and Micromedex®, manufacturers were contacted for futher information and other related literature was reviewed. Results: The results are shown in table 1.Discussion: Although in pharmaceutical practice crushing tablets is common, sometimes suspension of crushed drugs in water is not completely appropriate for enteral administration, because this practice may alter the bioavailability of drugs, which may modify the therapeutic effect. There is currently not enough evidence that supports the practice of crushed and suspension of drugs exposed in this study. Therefore, the bioavailability of different formulations should be studied more carefully, especially of recent marketing drugs (AU)