Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria最新文献

Objective: To evaluate the importance and need for pharmacists to expand  their role to new activities and to promote and maintain others they already  carried out prior to the implementation of a new Immunemediated Inflammatory Diseases Unit to be created in our hospital; to prioritize the new activities incorporated based on the results obtained.

Method: This was a single center cross-sectional based on a survey  administered during January 2020 to all clinical healthcare providers due to be part of the new unit, as well as to a sample of patients. It was structured into two categories: actions related to patients' pharmaceutical  care, and actions related to practitioners of the Immune-mediated  Inflammatory Diseases Unit. Each item was assigned a score from 0 to 10,  where 10 indicated maximum interest or need. A prioritization template was  applied to quantify and evaluate each activity and implement the new ones in  order of priority.

Results: A total of 90 responses were obtained (30 from patients and 60 from  healthcare workers). An analysis was performed of the median scores of each  of the 20 activities proposed, which ranged between 8 and 10 points. When  comparing the scores obtained, it was observed that more statistically  significant differences were obtained in the pharmacists vs doctors group than  in the pharmacists vs nurses group, or the pharmacists vs patients one. After  prioritization, the first action taken was to implement electronic prescriptions  for outpatients with immune-mediated inflammatory diseases.

Conclusions: The survey revealed the expectations of healthcare providers and patients regarding the role pharmacists should play in the newly created unit and provided an insight into the most valued activities. This information will be useful in prioritizing the implementation of the new activities to be carried out by the unit.

Objective: To provide new insight into the training needs and resources required by hospital pharmacy resident tutors in Spain, as well as  into their level of motivation and satisfaction with their teaching. Method: Google Forms® was used to design a survey addressed to hospital pharmacy resident tutors between January and March 2019. They survey consisted of generic (tutor, hospital, service) and specific  questions (available resources, teaching activities, teaching satisfaction,  training needs). A univariate exploratory analysis was conducted to study  possible factors related to teaching satisfaction and motivation. Results: Replies were received from 83 tutors (rate of response: 52.8%), from  15/17 Spanish regions. The annual resident/tutor ratio was 4 (IQR = 2- 4). A total of 96.4% of tutors conducted interviews, of whom 65.1% did so  quarterly. Other activities included the management of external training  rotations (97.6%), planning of rotations (97.6%) and annual  appraisals  (96.4%). Only 17.1% of respondents were given time off their regular duties  for their tutorship work, with 71.4% stating that the time they were allowed  was insufficient. A total of 70.7% of tutors from eight Spanish regions where  the granting of protected time was regulated said were not given any time off  for their teaching endeavors. Most tutors declared to be satisfied (66.7%) and  motivated (63%) with their teaching work. Motivation appeared to fall with  age, and both motivation and satisfaction decreased as a function of the tutors'  years of professional experience and when they were given no time off  for their tutorship work or when the remuneration was low, without any  relationship being identified between these factors. Tutors pointed out that work should be done to increase the number of hours assigned to tutorships  (78%), preparing SEFH-validated training plans (76.8%), improving teaching  techniques (65.9%), and decreasing the clinical workload (62.2%). Over the  past 3 years, 69.1% of tutors had received training. This training was arranged  by educational committees (63.3%), the Spanish regional authorities  (42.4%) and SEFH (13.6%). All the training in clinical, teaching, and communicative competencies enjoyed wide acceptance (> 90%). The  preferred delivery method was hybrid (partly on-line and partly onsite)  (64.6%).

Conclusions: SEFH's tutors' group conducted its first national survey  addressed to hospital pharmacy resident tutors. The survey showed that, although tutors are highly satisfied with their teaching activities, they  ould like more training and to be able to devote more time to their tutorship work. It was also shown that a regulatory framework needs to be  implemented in various Spanish regions and that compliance with existing  regional regulations must be improved.

Objective: The literature has described the interaction between valproic acid  and carbapenems. This interaction leads to decreases in plasma concentrations  of valproic acid. The main objectives of this study were  to assess its relevance in clinical practice, to identify variables associated with  increased seizure episode rates, and to analyse the impact of pharmaceutical intervention on avoiding the effects of this interaction.

Method: An observational retrospective study of inpatients with epilepsy  admitted between 2016 and 2020. Their pharmacological treatment throughout  admission was recorded, and the presence of other interactions  leading to decreased plasma concentrations of valproic acid was reviewed. The  seizure rate during the year prior to admission was compared to that during  the interaction period. For every episode in which the interaction was detected, an intervention was conducted by providing the prescriber with information on  the interaction and suggesting a change of antibiotherapy as well as the  pharmacokinetic monitoring of valproic acid.

Results: 37 episodes were included. 58.1% of the patients were male and  median age was 70 years. In total, 56.8% of the patients received meropenem  and 43.2% received ertapenem. The median duration of  concomitant treatment with valproic acid and carbapenem was 4 days. The  incidence rate ratio was 2.60 (95% confidence interval: 1.61-4.21). Thus, this  interaction was associated with a higher seizure rate. A statistically significant  association was found between higher seizure rates and patients treated with  more than one anti-epileptic drug. Hospital pharmacists detected 24 episodes  (64.9%). In total, 17 interventions (70.8%) were accepted and 13  combinations were discontinued. Pharmacokinetic monitoring was conducted in  13 episodes (35.1%) and infratherapeutic levels were found in all of them.

Conclusions: The interaction between valproic acid and meropenem or ertapenem is clinically relevant. It is recommended that this combination should be avoided provided that a viable alternative is available.  Pharmaceutical intervention may contribute to preventing seizures associated with this combination.

Objective: To improve the quality of the dispensing process and  pharmaceutical care in the Outpatient Pharmacy through patient participation and Lean methodology, and to analyse the results obtained in  terms of efficiency and patient satisfaction.

Method: Prospective observational single-centre study. A working group was  organized with the health care staff involved in outpatient care to apply Lean  methodology and detect improvement opportunities. We used a focus group  technique to understand the patients' experience. The impact on patient  satisfaction was measured through a mass survey mailed out in December  2019 (before introducing the main measures) and in December 2020.

Results: More than 30 improvement actions were identified after surveying the opinions of the patients and health care staff involved. Nine actions were prioritized, which were mainly related to structural and circuit changes. Waiting times significantly improved (35% of patients waited for more than 30 minutes before the improvement actions vs 4.5% afterward). The results showed that waiting times and overall  satisfaction significantly improved in the period between the two surveys. In both cases, the degree of satisfaction was higher after introducing the improvement actions.

Conclusions: We analysed the situation of our Outpatient Service and designed the most appropriate improvement actions according to the resources available. This initiative was achieved through patient  participation (via a focus group and mass surveys), the participation of health  care staff, and the application of Lean methodology.

Objective: Cyclin-dependent kinase 4/6 inhibitors have a synergistic effect  in combination with endocrine therapy. This combination is used as first and  subsequent-line treatment for advanced luminal breast carcinoma because it  increases progression-free survival. We analysed clinical course and toxicity  in patients treated with palbociclib in our hospital and determined potential  associations between these variables and clinicopathological variables.

Method: Observational retrospective study including patients with advanced  or metastatic breast cancer treated with palbociclib plus endocrine therapy at  the Hospital Universitario de Cabueñes between 2017 and 2020. We  analysed clinicopathological variables, toxicity, and survival. Results: In total, 72 women and 1 man (median age: 63 years) received palbociclib plus an  aromatase inhibitor or fulvestrant. When used as firstline treatment,  progression-free survival was 22 months, and as second and subsequent-line treatment, progression-free survival was 13 months. Adverse effects (mainly haematological) were experienced by nearly all any patient, although delays  and dose adjustments were common (61.7% and 42.7%, respectively).  Performance status alone had a significant impact on progression-free  survival (22 months in patients with ECOG 0 vs 12 months in patients with  ECOG ≥ 1; P = 0.021).

Conclusions: Disease stage, age, and performance status do not limit the  use of treatment with palbociclib, nor its combination with aromatase inhibitors or fulvestrant for first or subsequent-line treatment.  Toxicity is easily managed. Real-world results are equivalent to those  published to date.