Protocolo del estudio: Demanda y práctica farmacéutica en afección bucofaríngea en España. Estudio ACTUA

Introducción y justificación: La afección bucofaríngea, y más concretamente el dolor de garganta, por su prevalencia y relación con el uso inadecuado de medicamentos tiene una alta importancia en salud, el farmacéutico contribuye a que el usuario alcance una automedicación adecuada a través de los servicios de atención farmacéutica. Sin embargo, se conoce poco en el ámbito de la farmacia comunitaria sobre los usuarios que demandan esta atención, así como las consultas e intervenciones de los farmacéuticos.Aplicabilidad de los resultados: Conocer las características de la demanda y la práctica farmacéutica en afección bucofaríngea permitirá establecer estrategias sanitarias destinadas a optimizar la asistencia sanitaria.Objetivos: Caracterizar la práctica farmacéutica en afección bucofaríngea realizada en farmacias comunitarias españolas.Material y métodos: Estudio observacional descriptivo transversal. En farmacias comunitarias voluntarias del territorio español. La población de estudio serán los usuarios que acudan a las farmacias por una afección bucofaríngea. La duración del trabajo de campo será de tres meses. Las variables contempladas en el estudio serán aquellas que caracterizan al usuario, a la consulta realizada, y a la intervención del farmacéutico. Se realizará un análisis estadístico descriptivo de los datos (univariante y multivariante por la técnica de correspondencias múltiples). Se garantizará la confidencialidad y el consentimiento informado de los participantes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Satisfacción de los usuarios de Farmacia comunitaria con un servicio de dispensación pilotado

Objetivo: Valorar la satisfacción de los pacientes con el servicio de dispensación durante la realización del pilotaje del protocolo de dispensación en farmacia comunitaria. Material y métodos: Estudio observacional descriptivo transversal. Se midió la satisfacción con un cuestionario validado en farmacias comunitarias de las Provincias de Murcia y Málaga, España. El cuestionario auto administrado y anónimo midió dos áreas de satisfacción global del paciente: Referente al trato personal recibido y referente al servicio recibido. Resultados: De 60 farmacias participantes, se obtuvieron 335 cuestionarios, siendo válidos 329. El 71,2% de los pacientes se mostraron “muy satisfechos” respecto al trato del personal y respecto al servicio realizado se obtuvo un 59,1% “muy satisfecho”. Discusión: El estudio refleja una gran aceptación y satisfacción de los pacientes con el servicio recibido, sin embargo, la mayoría de participantes son usuarios habituales de la farmacia, lo que puede sobreestimar los resultados obtenidos. Resultaría interesante valorar los cambios de satisfacción con el tiempo, siendo recomendable buscar nuevos enfoques que determinen las expectativas y preferencias de los pacientes, mostrando posibles causas de insatisfacción. Conclusión: La satisfacción de los pacientes con el trato personal y el servicio de dispensación recibido resultó muy elevadaAim: To assess patient satisfaction with the service of dispensing during the pilot implementation of the protocol in community pharmacy dispensing. Methods: Made in community pharmacies of Murcia and Malaga provinces in Spain. Satisfaction was measured with a validated 10-item questionnaire, structured, multidimensional, with Likert scale of five continuous categories.The validated questionnaire measures two areas of overall patient satisfaction: 1. Concerning the personal treatment received. 2 .- Regarding the service received. Results: Of 60 participating community pharmacies, we obtained 335 questionnaires, from which 329 were valid. The results obtained were 71.2% very satisfied about the treatment of staff and a 59.1% very satisfied with the dispensation service. Discussion: The study shows a wide acceptance of patient satisfaction with the service, although mostly are frequent patients of participating pharmacies, which may overestimate the results. It would be interesting to evaluate changes in satisfaction over time and it is recommended to explore new approaches to determine the expectations and preferences of patients, showing possible causes of dissatisfaction. Further studies should be conducted in the future. Conclusions: The satisfaction of personal treatment received and the dispensing service was very high.Este estudio ha sido financiado por el laboratorio STADA, la Sociedad Española de Farmacia comunitaria ( SEFAC) y la fundación HEFAME

Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Background: The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. Methods: We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. Results: 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). Conclusion: Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases