medicines for an untreated condition, 3-to modify a dose regimen, 4-to substitute one medicine for another). Data extracted were: daily dose, price per unit (for drug substitutions we calculated the difference between the prices of the drugs) and average length of stay. We hypothesised that our interventions had a cost impact for half of the inpatient's stay. Cost impact was calculated as follows: (Added or avoided daily dose) X (price per unit) X (half of the average length of stay). Results 1706 prescriptions were analysed and 340 pharmacist recommendations were accepted by physicians (20%). 238 of these recommendations were among the four types listed above. 155 interventions had an impact on cost: 83% led to a cost reduction (total reduction of Euros 1949) and 17% led to an increased cost (total Euros 571). The 1378 Euros saved represent an economy of 3.6% on the total cost of medicines for these two wards between April and June 2012. Extrapolated to the entire hospital, this saving could add up to Euro 2.5 million each year. Conclusions Medicines costs can be reduced by pharmaceutical interventions. The financial evaluation of Clinical Pharmacy practise is necessary and further studies are needed to calculate avoidable indirect costs. No conflict of interest. Drug-relateD Problems in a CarDiology DePartment-iDentifying trenDs
BackgroundAutologous serum eye drops (ASED) have been reported to be effective in the management of ocular surface disorders, such as dry eye syndrome and following ocular surface reconstruction. Under Spanish law, ASED are considered a drug, and in our hospital the pharmacy service is responsible for their preparation.PurposeTo describe the use, preparation and clinical effectiveness of ASED prepared by a hospital pharmacy service.Material and methodsRetrospective observational study. Sample: 100% patients. Data sources: electronic medical records (IANUS application) and pharmaceutical records.Analysed data: number of patients, age, sex, diagnosis, ASED concentration, treatment time, microbiological controls of the final product, serological controls (HBV, HCV, HIV, syphilis) and clinical evolution.Preparation protocol: sterile phlebotomy of patient blood, allow clotting for 2 h at room temperature, centrifuge for 10 mi at 2000 rpm, dilute from 20% to 50% with normal saline using a sterilising filter (0.2 μm) and divide into 5–7 mL portions in sterile bottles. Check for microbiological contamination: if negative, hand out to patient and if positive do not give to patient. Check for serological controls: if positive, prevent patient from using ASED. Store frozen ASED for 3 months at -20°C. Use new bottle weekly and store at 2–8°C.Results70 patients. Age 65 (29–93) years, 46 women (65.7%). Diagnosis (number of patients): persistent epithelial defects (26); severe dry eye (24); neurotrophic keratopathy (6); Sjögren syndrome (4); superior limbic keratoconjunctivitis (1); and amniotic membrane transplantation (1). ASED prescribed concentration (number of patients): 20% (49); 30% (10); 40% (1); and 50% (10). Treatment time (number of patients): 1 year or more (28); 6 months to 1 year (26); and <6 months (16). Microbiological controls: 121 (0 samples positive). Serological controls: 86 (1 patient positive for syphilis). This positive patient was excluded and treated with doxicicline.Usual doses: 3–4 times/day. Clinical evolution (number of patients): improvement (29); stabilisation (2); no improvement detected (38).ConclusionASED are useful for the treatment of severe dry eye pathologies but in these patients clinical improvement was only registered in 42%. We believe it is necessary to do intensive and long term patient follow-up. When ASED were compounded using an aseptic technique, no microbial contamination was detected.References and/or AcknowledgementsReed, Kane Carlson, et al. Int J Pharm Comp 2009;13:540-3No conflict of interest.
Background Strongiloides stercolaris can produce a life threatening illness in inmunosuppressed hosts. Treatment options are limited to oral formulations and there are few data on alternative therapies.PurposeTo describe the preparation of ivermectin enema and evaluate its effectiveness in the treatment of Strongyloides hyperinfection.Material and methodsBibliographic search in Medline (keywords: ivermectin, rectal, Strongyloides) to determine the main characteristics of ivermectin enema: concentration, composition, elaboration method, packaging material, stability and storage conditions. Review of the electronic medical records and follow-up of the patient during hospitalisation.ResultsA 57-year-old man of Brazilian origin, presnted to the emergency department with nauseas, vomiting and dizziness. Imaging tests show lesions in his brain, and consequently he underwent neurosurgery. After a month the patient has haemodynamic instability and was transferred to intensive care where he was diagnosed with Strongyloides hyperinfection by wet prep of bronchial suction on 18 August 2014. Treatment was initiated with ivermectin 200 µg/kg/24 h by nasogastric tube. On 19 August, Strongyloides was isolated in faecal cultures and ivermectin enema 200 µg/kg/24 h was added to the treatment on 22 August. Since the beginning of the treatment, several microbiological controls have been done: on 25 August Strongyloides larvas were observed in bronchial suction and on 27 August in faecal cultures but with no movement capacity in both samples. On 3 and 5 September, bronchial suction and faecal cultures were done and the results were negative. Treatment by nasogastric tube and rectal ivermectin finished on 5 September.Elaboration of ivermectin enema was required by the pharmacy service because it does not exist as a commercial presentation appropriate for rectal administration. A standardised protocol was made.Elaboration process: crush ivermectin 12 mg in a mortar until it is a fine powder. Wet the powder with a small quantity of carboxymethylcellulose 1.5% until a homogeneous mixture is achieved. Add small porportions of carboxymethylcellulose up to 30 ml. Concerning stability, the enema has to be used immediately.ConclusionA protocol for the elaboration of Ivermectin enema was stablished. Treatment with rectal ivermectin added to ivermectin oral administration is an effective therapeutic option for the treatment of Strongyloides hyperinfection.References and/or AcknowledgementsTarr PE, Miele PS, Peregoid KS, et al. Case report: Rectal administration of ivermectin. Am J Trop Med Hyg 2003;68:453-5No conflict of interest.
Background and importance Digital health is the concept that incorporates information and communication technologies into healthcare services. Nowadays, and favoured by the SARS-CoV-2 pandemic, hospital pharmacy has been forced to adopt digital technologies and tools to improve patient care. Aim and objectives If any area of hospital pharmacy has gained prominence in recent years, it is the area of digital health. Therefore, it was decided to analyse current clinical trials in relation to technological devices or wearables. Material and methods Descriptive study of current clinical trials on technological devices from the pharmacological aspect. The following filters were applied: active trials, devices in digital pharmacy, all phases, all ages and both sexes. The type of device was analysed as intervention, pathology, location, and study topic. Both observational and interventional studies were included. The tool used for evaluation was the ClinicalTrials. gov clinical trials registry. Results Nineteen current active phase clinical trials were analysed. The phases of the projects were: phase I-7, phase II-3, phase III-2 and phase IV-7. The main pathologies of the clinical trials were: musculoskeletal disorders ( 6), chronic obstructive pulmonary disease (3), Parkinson's neurodegenerative diseases (3), oncology (2), autism (1), renal system (1), cardiac system (1) and self-injection devices (1). The main countries conducting clinical trials were: United States (13), Europe (4), Asia (1) and Oceania (1). Seven projects were detected in the patient recruitment phase. Conclusion and relevanceAlthough the use of wearables in the field of hospital pharmacy is a little known topic, it is increasingly gaining prominence in the literature and in scientific research. Digital health is the driver of change towards new models of care between patients and healthcare professionals. Therefore, it is necessary to continue with research and clinical trials to promote digitisation in hospital pharmacy.
Background Ketamine has been shown to be effective not only for its anaesthetic properties but also for the analgesic and opiate-sparing effects. Purpose To describe the use of ketamine as an adjuvant in the treatment of malignant neuropathic pain. To analyse its effectiveness and safety, and to determine whether its use reduces the required doses of opioids. Materials and methods A retrospective study based on the review of clinical records, computerised nursing care records (GACELA) and pharmacotherapeutic records (SILICON) for patients hospitalised in a Palliative Care Unit who were treated with ketamine for malignant neuropathic pain that could not be controlled with opioids and adjuvants. A 5 mg/ml oral solution of ketamine is prepared in the clinical unit using a vial of Ketolar. The pharmacy service prepares 10 mg/ml syringes of ketamine for parenteral administration. Data were gathered on demographic factors, pain location, previous analgesia, ketamine dose, effectiveness and side effects. A numerical scale 0–3 points was used to evaluate the effectiveness: 0 = no pain relief, 1 = partial effectiveness (depending on the need for analgesics/adjuvants and rescue treatment ≥2 per day), 2 = moderate efficiency (depending on the need for analgesics/adjuvants and rescue treatment ≥1 per day), 3 = full effectiveness (no pain). Results Twelve patients (6 male), age 60 ± 15 years (32–81). Pain location: lumbar (5 patients), bones (2), lower limb (2), inguinoscrotal (1), mouth (1) and facial (1). The opioids previously used as analgesics were morphine (5), fentanyl (5) and oxycodone (2). 50% of patients used at least 3 adjuvants (benzodiazepines, antidepressants and antiepileptic drugs). 100% of patients needed to continue using strong opioids until death: fentanyl IV (4), morphine IV (4), methadone IV/SC (2), oxycodone IV (1) and intrathecal morphine (1). From the time at which ketamine was introduced, 33% of the patients required an increase in the doses of opioids, while 67% did not require changes in the basal analgesia. The previous opioid dose was reduced in three patients on using ketamine, with a 50, 12 and 8% reduction in the morphine dose respectively. The daily oral doses of ketamine were 131 ± 148 mg (15–390) and intravenously 239 ± 183 mg (60–600). The overall mean effectiveness of ketamine in addition to IV opioids was evaluated as 1.6 ± 0.7 points, which means that 50% of patients experienced a partial improvement in the control of their pain, 42% moderate improvement, and 8% became pain-free while receiving ketamine. 58% of patients experienced at least one adverse effect (drowsiness 71%, delirium 43%, restlessness/nervousness 29%). Conclusions As an adjuvant, ketamine can be a useful alternative to normal analgesic treatment in controlling refractory neuropathic pain. While using ketamine, 25% of the patients required less opioids. There was a high incidence of adverse effects, although none of them were serious. It is important to use pain assessment scales that make it possible to preci...
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