(1) Background: parenteral nutrition (PN) is indispensable for patients unable to receive oral or enteral feeding. However, the complexity of PN solutions presents challenges regarding stability and ...compatibility. Precipitation reactions may occur. The most frequent is the formation of calcium phosphate (Ca-P). The different factors influencing these reactions must be considered to ensure patient safety. (2) Methods: eight paediatric PN solutions were prepared, following standard protocols. Samples were stored at room temperature and in a refrigerator. Electron microscopy, coupled with energy dispersive X-ray spectroscopy (EDS), was employed. Precipitates were analysed for composition and morphology. (3) Results: precipitates were observed in all samples, even at day 0. Crystalline structures, predominantly composed of calcium or magnesium, sometimes associated with chlorine or phosphorus, were detected. Additionally, amorphous precipitates, contained heterogeneous compositions, including unexpected elements, were identified. (4) Conclusions: various precipitates, primarily calcium- or magnesium-based, can form in PN solutions, although it is not expected that they can form under the real conditions of use. Calcium oxalate precipitation has been characterised, but the use of organic calcium and phosphate salts appears to mitigate calcium phosphate precipitation. Electron microscopy provides interesting results on NP precipitation, but sample preparation may present technical limitations that affect the interpretation of the results.
(1) Background: parenteral nutrition (PN) solutions are an extremely complex mixture. It is composed of a multitude of chemical elements that can give rise to a large number of interactions that ...condition its stability and safety. The aim of this study was to evaluate the stability of PN solutions for preterm infants. (2) Methods: eight samples were prepared according to the protocol for prescribing PN in preterm infants. Samples PN1-PN7 had the normal progression of macronutrients and standard amounts of micronutrients for a 1 kg preterm infant. The PN8 sample had a high concentration of electrolytes, with the idea of forcing stability limits. Samples were stored both at room temperature and under refrigeration. Measurements of globule size, pH, density, and viscosity were performed in both storage protocols on different days after processing. (3) Results: the changes in the composition of the samples did not affect the evolution of the stability at the different measurement times and temperatures. Viscosity was affected by the compositional changes made in the PN samples, but no alterations due to time or temperature were observed. Density and pH remained stable, without significant changes due to time, storage temperature, or different composition. (4) Conclusion: all samples remained stable during the study period and did not undergo significant alterations due to compositional changes or different experimental conditions.
(1) Background: Parenteral nutrition (PN) is a technique used for the administration of nutrients to patients for whom traditional routes cannot be used. It is performed using solutions with ...extremely complex compositions, which can give rise to a large number of interactions. These interactions can impact their stability and put the patient's life at risk. The aim of this study is to determine how changes in composition and storage protocol affect the stability of NP solutions. (2) Methods: Twenty-three samples were prepared according to routine clinical practice, with modifications to the concentration of some components. The samples were stored at room temperature (RT) and refrigerated (4 °C). Measurements of the droplet diameter, pH, density and viscosity were performed for both storage protocols on days 1, 3, 10 and 14. (3) Results: The samples with the lowest concentration of lipids (PN13-17) and proteins (PN18-22) showed a larger droplet diameter than the rest of the samples throughout the experiments. The USP limits were exceeded for some of the measurements of these sample groups. The pH density and viscosity remained relatively constant under the conditions studied. (4) Conclusions: The PN samples were considered stable and safe for administration under real-world conditions, but the samples with the lowest concentrations of lipids and proteins showed a tendency towards emulsion instability.
Microcalorimetry is a highly sensitive experimental technique that determines heat changes in any process or transformation. All organisms produce heat due to their metabolism. The rate of heat flow ...is an adequate measure of metabolic activity of living beings and their component parts. Microorganisms produce small amounts of heat: 1 pW to 3 pW per cell. Although the heat produced by bacteria is very small, their exponential reproduction in a culture medium permits heat detection through microcalorimetry. A microcalorimetric growth and metabolic study was carried out for the bacteria Staphylococcus aureus and Staphylococcus epidermidis, by using heat liberated during metabolism. A thermal conductivity calorimeter of the Calvet type was used. The inside of the calorimeter contains two stainless steel cells (experimental and reference) with a screw-on Teflon cap with a hole in the center. Experiments were carried out with final concentrations of the order of (10 super(6), 10 super(5), 10 super(3), and 10) CFU upsilon . ml super(-1). These were kept at a constant temperature of 309.65 K. The plot of change in heat voltage versus time enables acquisition of the characteristic growth curve for each bacterial strain. Thermograms were analyzed mathematically and helped determine the characteristic parameters for each microorganism, and led to the identification of the bacterial species.
Enterococcus faecalis
is a Gram-positive bacteria, considered one of the most common causes of nosocomial infections. Bacterial cultures produce an exchange of energy as a result of the bacteria ...metabolisms. The rate of heat production is an adequate measure of the metabolic activity of the organisms and their constituent parts. Microorganisms produce small amounts of heat: 1–3 pW per cell. Although the heat produced by bacteria is very small, their exponential reproduction in a culture medium permits heat detection through microcalorimetry. In this study, we analyzed the microcalorimetric behavior of
Enterococcus faecalis
. A thermal Calvet microcalorimeter was used. The inside of the calorimeter contains two stainless steel cells (experimental and reference). Experiments were carried out at final concentrations of 10
6
,10
5
,10
3
, and 10 CFU/mL and a constant temperature of 309.65 K was maintained within the microcalorimeter. Recording the difference in calorific potential over time we obtained
E. faecalis
’s growth curves. Thermograms were analyzed mathematically allowing us to calculate the constant growth, generation time and the amount of heat exchanged over the culture time.
Institutionalized patients who require nutrition support regularly visit the Unit of Nutrition Support of the Hospital Pharmacy Service. During these visits, prior to establishing a nutrition regime ...and follow-up scheme, an initial nutritional status assessment is performed. Telemedicine and Telepharmacy have expanded in recent years for remote monitoring of institutionalized persons.
To evaluate the implementation of a Telemedicine informatics application for nutritional support surveillance of instutionalized persons in nursing homes from a hospital pharmacy service.
A multidisciplinary team led by the Hospital Pharmacy Service was created. Data of institutionalized persons in nursing homes needing artificial nutritional support was extracted from the SILICON prescription system and the internal ecords of the hospital pharmacy service. Nursing homes were selected on the basis of their previous experience using the Telemedicine informatics application TELEA. The following nutritional support variables were assessed: score on Mini-Nutritional Assessment questionnaire; a 24-h food record; pressure ulcer control; and laboratory parameters. The existing information flow between nursing homes and hospital specialists was analyzed. The functionalities available on TELEA were considered.
In 2021, over 300 institutionalized persons from 28 nursing homes were incluided for nutritional support surveillance program of the hospital pharmacy service. The project was implemented in two nursing homes serving 38 patients, although only 13 were involved in the nutrition surveillance program of the Nutrition Support Unit. Nutritional status assessment and nutritional support surveillance reports were adapted to the Telemedicine informatics application. Paper reports were replaced with electronic data or online questionnaires available on the informatics application. An information flow protocol was established. An instantaneous messaging and alert system was activated, which allowed continuous communication. Some Telepharmacy requests were categorized as preferential when the clinical status of the patient so required. All the information generated during the nutritional status assessment and nutritional support surveillance process was integrated into the electronic medical history of each patient.
TELEA-based nutritional support surveillance facilitates the continuum of care by enabling direct communication between nursing homes and secondary care for institutionalized persons. This model makes it possible to record nutrition-related data on the electronic medical history of patients through a Telepharmacy process. This model also eliminates paper prescriptions and medical reports, and unnecessary travels. A nutritional status profile should also be made available to facilitate nutrition surveillance in institutionalized persons with chronic diseases. That would be the first step for a new integrated healthcare informatics application for frail/polymorbid elderly patients.
Los pacientes institucionalizados que requieren soporte nutricional artificial acuden de forma periódica a las consultas de la Unidad de Soporte Nutricional del Servicio de Farmacia. En ellas se realiza una valoración nutricional inicial, a partir de la cual se establece la pauta nutricional y el plan de seguimiento. La Telemedicina y la Telefarmacia se han expandido en los últimos años para la monitorización remota de personas institucionalizadas.
Evaluar la implementación de una aplicación informática de Telemedicina para la vigilancia del soporte nutricional de personas institucionalizadas en residencias de ancianos desde un servicio de farmacia hospitalaria.
Se formó un equipo multidisciplinar liderado por el Servicio de Farmacia. Los datos de pacientes institucionalizados que requieren soporte nutricional artificial se obtuvieron del programa SILICON y de los registros internos del Servicio de Farmacia. Se eligieron las primeras residencias candidatas según la experiencia previa en el manejo de la aplicación informática de asistencia domiciliaria. Se analizaron lias variables de soporte nutricional necesarias para el seguimiento nutricional: Mini Nutritional Assessment, recordatorio de ingestas de las últimas 24 horas, control de úlceras por presión y parámetros analíticos. Se analizó el flujo de información existente entre las residencias sociosanitarias y la atención hospitalaria y se valoraron las opciones disponibles a través de la plataforma tecnológica de asistencia domiciliaria.
El Servicio de Farmacia realizó seguimiento nutricional a más de 300 pacientes institucionalizados en 28 residencias sociosanitarias en el año 2021. El proyecto se implantó en dos residencias sociosanitarias que cuentan con 38 pacientes institucionalizados, aunque solo 13 pacientes estaban en seguimiento por la Unidad de Soporte Nutricional. Todos los registros generados en la valoración y seguimiento nutricional se adecuaron a la aplicación informática de asistencia domiciliaria, se cambiaron los registros en papel por información incluida en la plataforma o cuestionarios online facilitados a través de la misma. Además, se protocolizó el flujo de información generada y se activó un sistema de mensajería con alertas que permite una comunicación continua. En caso de que la situación clínica del paciente lo requiera se puede programar una teleconsulta preferente. Toda la información generada en el proceso de valoración y seguimiento nutricional de cada paciente se integró en la historia clínica electrónica.
El seguimiento nutricional a través de la aplicación informática de asistencia domiciliaria facilita la continuidad asistencial por el establecimiento de una comunicación directa entre las residencias sociosanitarias y la atención hospitalaria, permitiendo la integración de la información nutricional de los pacientes en la historia clínica electrónica mediante un proceso de Telefarmacia. Se han eliminado las prescripciones en papel, informes clínicos impresos y los desplazamientos innecesarios. El desarrollo de este perfil podría ser extensible al seguimiento nutricional de pacientes con patologías crónicas, y ser el precedente de un nuevo programa de cuidado integral del paciente anciano frágil o pluripatológico.
Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services ...to Telepharmacy to optimize clinical outcomes and reduce the risk of contagion. The purpose of this article is to describe and analyze the experience of HPSs with outpatient Telepharmacy during the COVID-19 pandemic and expose the lessons learned. Measures have been adopted in on-site outpatient pharmacy clinics to prevent exposure of patients and professionals to the virus. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.
Describe the phases of implementation, scaling and integration of a pharmacy teleconsultation model in electronic history, to coordinate the care transition of patients.
Descriptive and ...retrospective study in a health area of 500,000 inhabitants (3 years). In the first phase, a working group was created, a communication platform was designed and a continuity program was piloted between a hospital pharmacist and the 13 primary care pharmacists. The objective was to solve problems related to medications (especially those of sanitary approval) in polymedicated patients hospitalized in the Short Stay Unit- Emergency. In a second phase, the program included all the patients in any unit and all the pharmacists in the hospital. In the third phase, the program was extended to the teleconsultation format within the corporate information systems of the Health Service. Quantitative descriptive variables were recorded (number, motives and resolution of the teleconsultations).
In total, more than 470 consultations were registered (118 in the first phase, 158 in the second and 194 in the third), which were resolved in 90% of the cases. The main reasons were discrepancies in type approval drugs, prescribed in the care transition and nutritional assessment.
Teleconsultation allows the coordination of pharmaceutical care between levels, quickly and easily. Increase the visibility and access of professionals. Problems are resolved without displacements or time delays for patients.
Microcalorimetry is a highly sensitive experimental technique that determines heat changes in any process or transformation. All organisms produce heat due to their metabolism. The rate of heat flow ...is an adequate measure of metabolic activity of living beings and their component parts. Microorganisms produce small amounts of heat: 1 pW to 3 pW per cell. Although the heat produced by bacteria is very small, their exponential reproduction in a culture medium permits heat detection through microcalorimetry. A microcalorimetric growth and metabolic study was carried out for the bacteria
Staphylococcus aureus
and
Staphylococcus epidermidis
, by using heat liberated during metabolism. A thermal conductivity calorimeter of the Calvet type was used. The inside of the calorimeter contains two stainless steel cells (experimental and reference) with a screw-on Teflon cap with a hole in the center. Experiments were carried out with final concentrations of the order of
(
10
6
,
10
5
,
10
3
, and 10) CFU
·
ml
−
1
. These were kept at a constant temperature of 309.65 K. The plot of change in heat voltage versus time enables acquisition of the characteristic growth curve for each bacterial strain. Thermograms were analyzed mathematically and helped determine the characteristic parameters for each microorganism, and led to the identification of the bacterial species.
PDF
