Background: A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. Objective: To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). Methods: This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. Results: The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (−1.28; 95% CI = −1.88 to −0.68), number of high-risk medications in chronic patients (−0.58; 95% CI = −0.9 to −0.26), and MRCI-E (−6.42; 95% CI = −8.07 to −4.76) were statistically significant ( P < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). Conclusions: The degree of polypharmacy and patients’ treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.
What is known and objective: In paediatrics, evidence regarding the treatment of viral myocarditis using interferon beta-1B is restricted to four children older than two years and there are no reported cases of infants. The objective was to describe the efficacy and safety of interferon beta-1B in two infants under one year of age with viral myocarditis. Case summary: Two infants were admitted to the hospital presenting with respiratory symptoms. Echocardiogram showed myocardial damage. Parvovirus-B19 was detected using a PCR assay, and treatment with interferon beta-1B was initiated. Six months later, the cardiac function had recovered in both cases.What is new and conclusion: This is the first published series of cases of infants less than 1 year of age with viral myocarditis treated with interferon beta-1B.
| 863CANALES SIGUERO Et AL. revealed moderate-severe left ventricular dysfunction (left ventricular ejection fraction (LVEF) Simpson BP: 39%), left ventricular dilatacion, and severe mitral insufficiency. Additionally, markers of myocardial damage were altered: troponin T 228 ng/L (≤14 ng/L) and NT-proBNP >70.000 pg/mL (≤125 pg/mL). As acute myocarditis was suspected, supportive treatment was initiated, and blood samples were drawn for aetiological study.Empirical antibiotic treatment with cefotaxime 200 mg/kg/ day and intravenous immunoglobulins was initiated. Furthermore, adrenaline (0.05 µg/kg/min), levosimendan, furosemide and spironolactone were administered as supportive treatments.
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