FARMACIA HOSPITALARIA最新文献

Introduction: Since the post-antibiotic era, there has been significant difficulty in treating infectious diseases due to the increase in antimicrobial resistance, the scarcity of new antimicrobials, and the complexity of the healthcare system. The World Health Organization (WHO) recognized it as one of the main public health problems. To mitigate this issue, Antimicrobial Stewardship Programs (ASPs) have been established in hospital settings and in primary care, through multidisciplinary teams with specific objectives and measurable results. However, their implementation faces multiple challenges. Digital tools and artificial intelligence (AI) can enhance these ASPs, contributing to the discovery of new molecules, the identification of resistance patterns, and improvements in infection control and prevention.

Objective: To analyze the role of digital tools and AI in the interventions carried out by hospital-based ASP teams to improve established outcomes.

Material and methods: This protocol follows the PRISMA-P methodology and has been registered in PROSPERO (ID: CRD42024601221). A literature search will be conducted in PubMed, Scopus, and the Cochrane Library (2014-2024); gray literature will subsequently be reviewed in Google Scholar. Articles (clinical trials, interventional and observational) involving hospitalized adult patients requiring antimicrobial treatment will be included. The risk of bias will be assessed according to the study type, and methodological quality will be evaluated using the GRADE scale. Two independent researchers will perform study selection, quality assessment, and data extraction. Discrepancies will be resolved by consensus or through the intervention of a third researcher.

Discussion: Previous studies highlight the role of ASPs and digital tools in antimicrobial optimization. However, the difficulty and difference in the degree of implementation have also become apparent. The heterogeneity of interventions and indicators could be a limiting factor for conducting a meta-analysis. Despite these limitations, this systematic review will provide a better understanding of the potential use of digital tools and AI in hospital-based ASPs.

Protocol registration: This protocol has been registered in PROSPERO with the ID: CRD42024601221.

Objective: Pivotal study on perioperative toripalimab in resectable non-small-cell lung cancer showed population differences by histological subtype compared with other immunotherapy regimens, raising doubts about therapeutic positioning. The aim of this study was to interpret the methodological analysis by subgroups according to histological subtype of perioperative toripalimab in resectable non-small-cell lung cancer.

Methods: Validated subgroup analysis applicability tool was used. This tool had two parts: preliminary questions to directly rule out analysis without relevant minimum conditions, and checklist. This checklist assessed statistical association, biological plausibility and consistency of subgroup results, and related these criteria to recommendations on applicability.

Results: Preliminary question regarding differences in effect between subgroups p(i) < 0.1 was answered negatively, and checklist was not applied due to direct discard. Even if the checklist had been applied, statistical association criterion would have been rated 'null' due to absence of statistically significant differences. Biological plausibility would have been rated 'probable' due to non-squamous histology being a negative prognostic factor. Consistency would have been rated 'null' for absence of heterogeneity between subgroups in similar studies.

Conclusions: This methodological interpretation recommended against applying histology-based subgroup results for perioperative toripalimab in resectable non-small-cell lung cancer, avoiding ruling out the use of toripalimab in the non-squamous subgroup.

Objective: Pediatric palliative care aims to provide a professional, scientific, and compassionate response to the needs of terminally ill pediatric patients, with pain management being one of its fundamental pillars. This systematic review analyzes the ethical aspects involved in the management of pain in pediatric patients at the end of life, using the core principles of clinical bioethics: autonomy, beneficence, non-maleficence, and justice as a framework.

Materials and methods: A systematic review was conducted following the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Original qualitative or quantitative studies published between 2010 and 2024 in English or Spanish were included, provided they addressed pain management in pediatric palliative care from an ethical perspective. The databases consulted were PubMed, Scopus, and Web of Science. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

Results: A total of 18 studies met the inclusion criteria. Autonomy was addressed in a limited manner, often through indirect participation of the child via their caregivers. The principles of beneficence and non-maleficence were compromised by the underuse of analgesics due to fear of adverse effects, delays in referral to palliative care, and the continuation of futile treatments. The principle of justice was reflected in structural barriers, unequal access to opioids, and limited availability of specialized care, particularly in resource-limited settings.

Conclusions: Bioethical principles are present in the management of terminal pediatric pain, but their application remains inconsistent. There is a clear need to enhance professional training, implement standardized clinical protocols, and promote effective communication with families.

Objective: To develop a risk stratification tool for pharmaceutical care in patients with cardiovascular disease who require a comprehensive and personalized pharmaceutical approach.

Method: The risk stratification model was collaboratively developed by hospital pharmacists specialized in managing cardiovascular risk patients, all members of the Spanish Society of Hospital Pharmacy. Through three workshops and a pilot study, relevant variables were identified, grouped into four dimensions, and assigned relative weights. In the pilot study, data from patients in the participating centers were collected and analyzed to determine priority levels and assess the contribution of each variable. The Kaiser Permanente pyramidal model was adopted, classifying patients into three priority levels: priority 1 (intensive pharmaceutical care, 90th percentile), priority 2 (60-90th percentiles), and priority 3 (below the 60th percentile). Cut-off points were established based on this stratification, and each center recorded variables in an Excel sheet to calculate mean weighted scores per priority level and total risk scores.

Results: Participants completed a questionnaire consisting of 20 variables grouped into four dimensions: demographic, socio-health and functional status, clinical and healthcare utilization, and treatment-related factors. Based on the tool application in a pretest study, the following cut-off points were established: 23 or more points for priority 1, 17-22 points for priority 2, and fewer than 16 points for priority 3. Over 80% of the total score was attributed to the dimensions of "clinical and healthcare utilization" and "treatment-related factors". Consequently, interventions based on the pharmaceutical care model were recommended for cardiovascular risk patients, tailored to their prioritization level.

Conclusion: This stratification tool enables the identification of cardiovascular patients who require a higher level of pharmaceutical care, facilitating the adjustment of healthcare capacity. Validation of the model in a representative population is necessary to establish its broader applicability.

Introduction: In the perioperative setting, appropriate management of chronic medications is of great importance in determining which medications to discontinue and when to reintroduce them. Although individual decisions based on patient and surgical risk are required, the need for national consensus has been identified.

Objective: To provide a set of specific recommendations for the perioperative management of chronic medication, based on recent scientific evidence and expert consensus, with the aim of improving the safety of surgical patient care.

Method: A review of the available literature was conducted on perioperative recommendations for the drugs most commonly included in the chronic medication regimens of patients undergoing surgery. The review encompassed drug datasheets, literature from Medline and the Cochrane Library, as well as information from other databases such as UpToDate® and Micromedex®.

Results: Recommendations are summarized for various medications grouped by pharmacotherapeutic group, specific medications for the treatment of immune-mediated diseases, and finally natural supplements and herbal therapy.

Conclusions: The information collected in this article can help the healthcare team to determine the approach to the patient's chronic medication.