Pharmaceutical care at discharge for patients with feeding tubes.

Objective: to assess and analyse a medication adaptation pathway for feeding tube administration followed by clinical pharmacists for patients at discharge, and to analyse the level of physician acceptance of the recommendations issued by pharmacists in pharmaceutical care reports to improve patient therapy. Methods: a multidisciplinary protocol for treatment adaptation to feeding tube administration at discharge was implemented in a 350-bed hospital during 2019, in which pharmacists prepared feeding tube medication-adaptation reports during pharmaceutical care visits. The number of recommendations related to adaptation of a drug to route of administration was recorded and classified as need for change of active substance or change of pharmaceutical form.

Impact of a nutrition consultation on the rate of high output stoma-related readmission: an ambispective cohort study.

The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. A single-centre ambispective cohort study was conducted in which all adult patients undergoing intestinal resection and stoma creation were recruited. Two nutrition consultations were established for early follow-up after hospital discharge and patients were prospectively included.

Systematic review of drug bioavailability following gastrointestinal surgery.

Purpose: Inter- and intraindividual pharmacokinetics variability in humans affects the way in which drugs act on the body. Gastrointestinal surgery has an impact on this variability and significantly alters the kinetics of drugs in post-surgical patients. The way in which pharmacokinetic profiles are modified depends on the type of operative procedure performed.

An admission medication reconciliation programme carried out by pharmacists: impact on surgeons' prescriptions.

Objectives: To describe a medication reconciliation (MR) procedure prepared by the pharmacist for patients admitted for elective surgery and to assess the surgeon's degree of acceptance.

Methods: A 1-year retrospective observational study was conducted. The patient population consisted of patients aged ≥18 years admitted during 2016 for elective surgery and whose planned length of hospital stay was >24 hours.

The role of clinical pharmacists in the optimisation of medication prescription and reconciliation on admission in an emergency department.

Objectives: To describe a clinical pharmacist's (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission.

Methods: A 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected.

Effects of cyclic parenteral nutrition on parenteral-associated liver dysfunction parameters.

Introduction: One of the most common complications of parenteral nutrition (PN) is liver dysfunction (LD). Therapeutic approaches for LD include, among others, administering cyclic parenteral nutrition (cPN), allowing some hours for metabolic rest. The purpose of this study was to evaluate the effectiveness of cPN in treating PN-associated LD.