Introduction Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients.

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BackgroundCinacalcet is approved for the treatment of hypercalcaemia in patients with primary hyperparathyroidism for which parathyroidectomy is contraindicated. At present, there is little information available on the administration of cinacalcet via percutaneous endoscopic gastrostomy (PEG).PurposeTo describe the impact of administration of crushed film coated cinacalcet tablets via a PEG catheter on reduction of corrected serum calcium values in a patient with hypercalcaemia due to primary hyperparathyroidism.Material and methodsA case of hypercalcaemia in a 72-year-old man with a PEG tube, diagnosed with spinal cord injury was reported to our pharmacy department. Pharmacotherapeutic information was required by physicians since the oral route was not possible. He was unsuccessfully treated with hydration, alendronate 70 mg/weekly and intravenous zoledronic acid (4 mg) in a single dose. A systematic review of the literature was performed by searching Medline and Micromedex databases for studies about cinacalcet crushed tablets via PEG but no references were found in the published literature. According to product information, dividing tablets is not recommended. Nevertheless, it was decided to administer cinacalcet through the PEG catheter due to the ineffectiveness of other treatments previously used.ResultsCinacalcet tablets were crushed and given through the PEG tube. Dietary calcium was controlled during hospitalisation. The starting cinacalcet dose was 30 mg/day (day 1). Dosage was increased to 30 mg twice daily (day 14) and a clear variation in calcaemia values was observed over time (day 1: 11.86 mg/dL; day 7: 11.35 mg/dL; day 11: 11.40 mg/dL; day 20: 10.10 mg/dL; day 30: 9.76 mg/dL; day 60: 9.58 mg/dL). After 3 weeks, serum calcium levels declined and returned to the normal range (8.7–10.4 mg/dL) and remained stable during follow-up.ConclusionCinacalcet given as crushed tablets via a PEG effectively decreased serum calcium levels and normalised calcium levels in a patient with primary hyperparathyroidism not eligible for surgical treatment, although further pharmacokinetic/pharmacodynamic studies are required.References and/or acknowledgementsArranz Martín A, et al. Endocrinol Nutr2011;58:24–31.No conflict of interest

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The purpose of this integrated review was to examine research on the relationships between immigration and health. The review was limited to studies of immigration into North America published since 1994. The results suggested that, although recent research has furthered the understanding of immigration and health, the multiple health effects of the various social and cultural processes immigrants undergo are still not clearly understood. In addition, research on acculturation has not clarified the positive or negative effects of acculturation on health. The incorporation of transnational perspectives and contemporary concepts and frameworks such as biculturalism, undocumentedness, and transitions was noted as a significant contribution from recent research. The results of this integrative review indicate that interdisciplinary research on immigration and health is moving in new directions. The reviewers provide suggestions for future research on health disparities as well as on possible health protective factors among diverse immigrant populations.

BackgroundAutomated dispensing cabinets (ADC) allow medications to be stored and dispensed near the point of care, improving efficiency in drug distribution. Nevertheless, new technologies are not exempt from errors.PurposeTo analyse if there are stock discrepancies (SD) in drugs included in ADC.Material and methodsA descriptive observational prospective study was conducted during October 2014. Medicines contained in three ADC were inventoried. ADC were placed in internal medicine/haematology departments, digestive/oncology/cardiology departments and urgency service.We evaluated: global rate of SD; global rate of SD by drawer type; rate of SD per ADC; and rate of SD by drawer type per ADC.Three drawer types were defined: multiple drug access drawers (MDAD), single drug access drawers (SDAD) and single dose dispensing pockets (SDDP).Results1082 drugs were inventoried. 395 presented SD (36.5%): 279 (25.8%) in MDAD, 115 (10.6%) in SDAD and only 1 (0.1%) in SDDP. SD distribution by ADC is shown in table 1.Abstract DD-022 Table 1Total No of drugs by ADCTotal SD by ADC (%)Multiple drug access drawers SD (%)Single drug access drawers SD (%)Single dose dispensing pockets SD (%)Internal medicine/haematology departments393146 (37.2%)115 (29.3%) (261 drugs)31 (7.9%) (116 drugs)0 (0%) (16 drugs)Digestive/oncology/cardiology departments416169 (40.6%)103 (24.7%) (209 drugs)66 (15.9%) (166 drugs)0 (0%) (41 drugs)Urgency service27380 (29.3%)61 (22.3%) (178 drugs)18 (6.6%) (78 drugs)1 (0.4%) (17 drugs)ConclusionThe more drug storage is in an ADC, the more SD are found. Discrepancies were more common with MDAD because users could remove more doses and different drugs than requested. Therefore, although new technologies are designed to improve both safety and efficiency in medicine management in  hospitals, the use of ADC should include an evaluation of possible error opportunities, to implement strategies focused on preventing or minimising these errors. taking more care with those drawers where you can access the whole medication. Appropriate ADC handling is crucial to guarantee fast and safe access to medications in clinical units.No conflict of interest.