FARMACIA HOSPITALARIA最新文献

Background: Polypharmacy, using 6 or more medications, may increase the risk of high medication regimen complexity index (MRCI). We aimed to identify the interrelationship between trajectories of polypharmacy and MRCI.

Methods: People living with HIV (PLWH) (aged ≥18) were included in from 2010 to 2021. Group-based trajectory modeling (GBTM) was used to identify polypharmacy trajectories and the complexity index of the medication regimen and the dual GBTM to identify their interrelationship.

Results: In total, 789 participants who met the eligibility criteria were included in the study, with a median age of 47 years. GBTM analysis was used to reveal latent polypharmacy trajectories among PLWH. The findings disclosed four distinctive trajectories, with the majority (50.8%) of the PLWH falling into the 'low increasing' trajectory. Furthermore, GBTM identified 2 trajectories characterized by high MRCI, and a substantial proportion (80.2%) was assigned to the 'slightly increasing low' trajectory group. The study revealed that younger age (<50 years) was a significant predictor of membership in the 'consistently low' trajectory, while male gender was associated with the groups of 'low increasing' and 'moderately decreasing' polypharmacy trajectory.

Conclusions: GBTM failed to discern a discernible interrelationship between polypharmacy and the high MRCI. It is imperative to undertake future studies within this research domain, considering potential effect modifiers, notably the specific type of concomitant drug. This approach is crucial due to the outcomes induced by both polypharmacy and the magnitude of the pharmacotherapeutic complexity in PLWH.

Objective: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns.

Methods: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC greater than 80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. A p < 0.05 indicated statistical significance.

Results: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (DE 15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of macitentan + tadalafil and ambrisentan + tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%).

Conclusions: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.

Objective: Inhaled therapy is essential in cystic fibrosis; however, inhalers have a significant environmental impact due to the greenhouse gases (GHGs) emitted. The environmental impact of a product is estimated by its carbon footprint (CF). Pressurized metered-dose inhalers (pMDIs) have a higher CF than dry powder inhalers (DPIs) and soft mist inhalers (SMIs) due to the incorporation of GHGs. The objectives are to analyze the consumption of inhalers (β2-adrenergic agonist bronchodilators, anticholinergics, and/or corticosteroids) in a cystic fibrosis unit and estimate the generated CF.

Method: Retrospective determination (January 2018-December 2023) of consumption and CF (tCO2eq) by type of inhaler was conducted. Consumption and CF trends were evaluated using lineal regression.

Results: Annually, 1,529 (1,279-1,613) pMDIs, 1,055 (855-1,333) DPIs, and 28 (20-42) SMIs were dispensed, representing 55.97%, 42.33%, and 1.70%, respectively. A statistically significant positive trend in the consumption of SMIs was observed. The median annual CF was: pMDI 38.3 (31.2-40.3) tCO2eq, DPIs 0.8 (0.6-0.9) tCO2eq, and SMIs 0.02 (0.02-0.03) tCO2eq, representing 97.86, 2.04, and 0.10%, respectively.

Conclusions: pMDIs were the inhalers with the highest consumption and CF, although their consumption appears to be decreasing, with an increase in the consumption of SMIs.

Objective: The aim of this study was to evaluate the real-world persistence, effectiveness, and safety of secukinumab in adult patients with moderate-to-severe psoriasis in two different hospitals.

Methods: Retrospective cohort study that used registries and medical records from 2 different hospitals (February 2015-March 2024). Adults with moderate-to-severe psoriasis who initiated secukinumab treatment were identified and followed-up until March 2024, or disenrollment. Baseline demographic and clinical characteristics studied included sex, age at diagnosis, weight, prior failed treatments, duration of treatment and psoriasis area severity index (PASI) score. Adherence was measured using medication possession ratio (MPR); patients with MPR ≥ 80% were considered adherent. Persistence, effectiveness, safety, and dosage regimen of secukinumab were collected. Kaplan-Meier analysis was used to estimate secukinumab persistence using 1-year intervals.

Results: A total of 88 patients with moderate-to-severe psoriasis were included, of whom 45 (51.1%) had not received prior biological treatment. Baseline PASI score was 15.0 ± 2.9 and patients received 1.4 ± 0.8 prior biological treatments. The most common previous biological treatments included anti-TNFα (60.5%) and ustekinumab (20.9%). 34 (38.6%) patients discontinued secukinumab treatment due to the following reasons. 19 (21.5%) due to a lack of effectiveness, 8 (9.2%), due to achieve only a partial response, and 7 (7.9%) due to adverse effects. Secukinumab persistence was 61.5 ± [21.7] months for all patients. When performing a subgroup analysis, non-naïve patients obtained a persistence of 63.5 ± [12.4] months followed by 54.1 ± [14.8] months for naïve patients (p = .804). Secukinumab persistence at 1 year, 2 years, and 3 years was 72.7%, 51.1%, and 39.8%, respectively.

Conclusions: Secukinumab demonstrated persistence in more than 70% of patients with moderate to severe psoriasis after the first year of treatment.

Background: Medication reconciliation is relevant in transitional care, however, given limited resources, it is necessary to identify the patients who benefit most from this activity.

Aim: To validate criteria to identify patients at high risk of medication errors undergoing major orthopedic surgery.

Method: Delphi Method in 3 phases, April-June 2023, to obtain consensus on the inclusion criteria, previously defined. Each expert rated criteria according to a 5-point Likert scale. Consensus was assumed in round 1 if the rate average was ≥4 (inclusion) or <2 (exclusion) and in rounds 2 and 3 if 50% of the responses were ≥4 (inclusion) or <2 (exclusion). It was possible to suggest the inclusion of new criteria.

Results: 10 experts from Faculties of Pharmacy and Medicine participated. In the first phase, consensus was reached on 18 criteria: polypharmacy, anticoagulants, oral chemotherapy (not hormone), immunosuppressants, antiretrovirals, antimyasthenics, insulin, corticoids, neuroleptics, antiarrhythmics, digoxin, carbamazepine, phenytoin, valproate, thyroid drugs, antiglaucoma, antiaggregants, and urgent surgery. Systemic antifungals and opioids were suggested. In the second phase, consensus was reached on 11 criteria: antiparkinsonics, beta-blockers, age ≥ 65 years, length of stay ≥5 days, lamotrigine, diuretics, antidepressants, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, anxiolytics, opioids, and systemic antifungals. In the last phase, 1 criterion reached consensus (sulfonylureas) and 1 criterion did not reach consensus (calcium channel blockers).

Conclusions: We develop and validate a list of 30 criteria to identify patients at high risk of experiencing medication errors undergoing major orthopedic surgery. These may help improve human resource management for clinical pharmacy activities by prioritizing patients who would benefit most.

Objective: To study medication adherence and persistence among heart failure patients, assess the methods utilized for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes.

Methods: A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalization, emergency visits, and mortality. The I statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42024509542.

Discussion: This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

Introduction: The objective of this study was to assess the implementation of safe medication practices in hospital emergency services, in order to understand the points of greatest risk as well as the safety challenges faced by these departments, and to plan collaboratively improvement initiatives.

Method: Multicentric and descriptive study based on completion of the "Medication safety self-assessment of emergency services" from May 16, 2023 to November 16, 2023, at voluntarily participating emergency services. The survey contained 93 items grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation, were determined.

Results: A total of 72 emergency services completed the questionnaire. The mean score obtained for the overall questionnaire was 428.3 points (51.1% of the maximum score). Results showed a large variation among the scores of the participating services (range: 164.0-620.5). Four key elements had values below 50%, corresponding to competence and training of professionals in safety practices (38.4%); incorporation of pharmacists in emergency departments (42.1%), availability and accessibility of information about patients (43.1%), and patient education (48.1%). The highest values corresponded to labeling, packaging, and naming of medications (69.2%) and communication of prescriptions and other medication information (64%). No differences were found between emergency departments in the key elements according to the dependency or size of the hospital, or the type of department, except for the item referring to the incorporation of pharmacists in the emergency service, where differences were observed between hospitals with less than 200 beds (28.9%) and those with more than 500 (52.2%).

Conclusion: The application of the specific self-assessment questionnaire has made it possible to identify safety practices that are insufficiently implemented into emergency departments in our country and to identify critical points for improvement for which planning collaborative initiatives to reduce medication errors in these units should become a priority.

Objective: This research delves into the intricate interplay between antipsychotic medications and neuroprotection focusing on the S100B protein, a central player in the regulation of neuroapoptotic activity.

Method: Blood samples were collected to assess serum S100B protein levels using an immunoassay of immunoelectrochemiluminescence. The first two samples were collected with a 3-month interval between each, and the third sample was obtained 6 months after the previous one. Changes in S100B protein levels throughout the study were assessed using Friedman's ANOVA test. This was followed by the Wilcoxon signed-rank test with Bonferroni correction to account for multiple comparisons.

Results: This study involved 40 patients diagnosed with severe mental disorders (34 schizophrenia, 4 schizoaffective disorder, one bipolar disorder, and one borderline personality disorder). These patients had been receiving antipsychotic treatment for an average duration of 17 years. The results revealed that the S100B protein remained within physiological levels (median values 39.0 ng/L for the first sample, median values 41.0 ng/L for the second sample, and median values 40.5 ng/L for the third sample) with no significant changes (p = 0.287), with all anti-psychotic medicaments values consistently below 50 ng/L, a lower value compared to maximum range of 105 ng/L. Importantly, there were no significant differences in S100B protein levels between patients on monotherapy and those on combination antipsychotic therapy (p = 0.873), suggesting that combination therapy did not increase neuroapoptotic activity.

Conclusions: These findings provide compelling evidence for the potential neuroprotective effects of long-term antipsychotic treatment in individuals with severe mental disorders. By maintaining physiological levels of the S100B protein, antipsychotic medications may help protect against neuronal damage and dysfunction. This research contributes valuable insights into the neuroprotective mechanisms of antipsychotic drugs, enhancing our understanding of their potential benefits in the treatment of severe mental disorders.