Anna Feliu

Perception of healthcare providers versus patient reported incidence of chemotherapy-induced nausea and vomiting after the addition of NK-1 receptor antagonists

PurposePhysicians and nurses often underestimate the incidence of chemotherapy-induced nausea and vomiting (CINV) after both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). This study assesses physicians’ and nurses’ perceptions of CINV in their own practices after the introduction of aprepitant.MethodsA prospective observational study of patients receiving the first cycle of HEC regimens with CDDP and without CDDP or MEC was performed. Eligible patients completed a 6-day diary recording emetic episodes, nausea assessment, and antiemetic medication use. Physicians and nurses estimated the incidence of acute and delayed CINV after the first administration of HEC and MEC. The observed incidence rates of CINV were compared with the rates predicted by healthcare providers. Aprepitant was given to patients receiving HEC regimes with CDDP.ResultsTwenty-nine physicians and nurses and 95 patients (87% receiving HEC and 14% MEC) were recruited. The global control of CINV was 66.67% for all patients and 73.33%, 47.06%, and 55.56% for patients receiving HEC regimens with CDDP, HEC regimens without CDDP and MEC, respectively. Physicians and nurses underestimated the control of acute CINV in patients receiving HEC regimens with CDDP, but they accurately predicted the control of delayed CINV. All physicians and nurses predicted the control of acute CINV after HEC regiments without CDDP and after MEC quite accurately, whereas they overestimated the control of delayed CINV after both regimens.ConclusionsAprepitant allows for better control of CINV in HEC regimens with CDDP, and this control is accurately perceived by physicians and nurses. However, physicians and nurses overestimate the control of delayed CINV after HEC regimens without CDDP and after MEC. CINV is still an important target for improved therapeutic intervention and the healthcare providers must be aware of its actual incidence.

Recreational drug use among individuals living with HIV in Europe: review of the prevalence, comparison with the general population and HIV guidelines recommendations

Background: Adherence problems, interactions and higher rate of risk activities have been observed in HIV individuals using recreational drugs. Our aim was to describe recreational drug use in both HIV individuals and general population in Europe, and to assess at what extent HIV guidelines address this issue. Methods: Data on recreational drug use across Europe were obtained from the European Monitoring Centre for Drugs and Drug Addiction for the general population, and through Pubmed search. for HIV patients. We assessed the incorporation of recreational drug issues in HIV treatment guidelines for the following topics: (a) recreational drugs; (b) adherence to antiretrovirals; (c) interactions; (d) transmission risk. Guidelines included: World Health Organization; European Aids Clinical Society; U.S. Department of Health and Human Services; International Antiviral Society-USA; and seven European national guidelines. Results: 29 countries reported recreational drug use in general population. The highest prevalences were observed for Cannabis (i.e., 8–10% in Spain, France, and Czech Republic) followed by cocaine, amphetamines and ecstasy. The 13 studies selected in the systematic review showed a great variability in recreational drug use on the HIV population. Apart from classical recreational drugs, we found a relevant use of new drugs including sexual experience enhancers. Polydrug consumption was about 50% in some studies. Most guidelines included general information about recreational drugs, showing great variability on the inclusion of the evaluated topics. We found more specific, evidence-based recommendations on interactions, followed by medication adherence and transmission risk. Conclusions: Available data on the people living with HIV suggest a higher use of recreational drugs than in the general population, which is already relevant. However, recreational drug issues should be included or addressed more thoroughly in most guidelines.

Prevalence and clinical impact of recreational drug consumption in people living with HIV on treatment: a cross-sectional study

Objectives Drug interactions, poor adherence to medication and high-risk sexual behaviour may occur in individuals with HIV using recreational drugs. Thus, we aimed to assess the prevalence of recreational drugs use and to explore its clinical impact in HIV patients on treatment. Methods Observational, cross sectional, study conducted in a 700 bed university hospital, Barcelona, Spain. A total of 208 adults living with HIV on treatment were included. A questionnaire was administered by clinical pharmacists, including evaluation of sociodemographic variables, past 12-month drug consumption, adherence to antiretrovirals (Simplified Medication Adherence Questionnaire) and high-risk sexual behaviour (condomless sex/multiple partners). Additional data were obtained from clinical records. Recreational drug-antiretroviral interactions were checked in reference databases. Prevalence was calculated for 5% precision and 95% CI. Crude and adjusted binary logistic regressions were performed to identify associations between recreational drug use and adherence problems, and between recreational drug use and high-risk sexual behaviour. Results From the overall sample, 92 participants (44.2%) consumed recreational drugs over the past 1 year. Of these, 44 (48.8%) had used different types of recreational drugs in this period. We detected 11 recreational substances, including sildenafil and nitrites. The most consumed drugs were: cannabis (68.5%), cocaine (45.5%), nitrites (31.5%), sildenafil (28.3) and ecstasy (19.6%). Relevant interactions occurred in 46 (50%) of the individuals consuming drugs. Recreational drug consumption was found to be related to adherence problems with antiretrovirals (OR: 2.51 (95% CI 1.32 to 4.77) p=0.005) and high-risk sexual behaviour (OR: 2.81 (95% CI 1.47 to 5.39) p=0.002). Conclusions Recreational drugs are frequently used by HIV patients on treatment. Classical drugs and new substances consumed in sexual context are usual. Recreational drug consumption interferes with several clinical outcomes, including potentially relevant interactions between drugs and antiretrovirals, adherence problems and high-risk sexual behaviour. Thus, there is the urgent need of implementing patient-centred care involving recreational drug consumption.

Identification of Pseudomonas aeruginosa and airway bacterial colonization by an electronic nose in bronchiectasis

RATIONALE Airway colonization by Potentially Pathogenic Microorganisms (PPM) in bronchiectasis is associated with worse clinical outcomes. The electronic nose is a non-invasive technology capable of distinguishing volatile organic compounds (VOC) in exhaled breath. We aim to explore if an electronic nose can reliably discriminate airway bacterial colonization in patients with bronchiectasis. METHODS Seventy-three clinically stable bronchiectasis patients were included. PPM presence was determined using sputum culture. Exhaled breath was collected in Tedlar bags and VOC breath-prints were detected by the electronic nose Cyranose 320®. Raw data was reduced to three factors with principal component analysis. Univariate ANOVA followed by post-hoc least significant difference test was performed with these factors. Patients were then classified using linear canonical discriminant analysis. Cross-validation accuracy values were defined by the percentage of correctly classified patients. RESULTS Forty-one (56%) patients were colonized with PPM. Pseudomonas aeruginosa (n = 27, 66%) and Haemophilus influenzae (n = 7, 17%) were the most common PPM. VOC breath-prints from colonized and non-colonized patients were significantly different (accuracy of 72%, AUROC 0.75, p < 0.001). VOC breath-prints from Pseudomonas aeruginosa colonized patients were significantly different from those of patients colonized with other PPM (accuracy of 89%, AUROC 0.97, p < 0.001) and non-colonized patients (accuracy 73%, AUROC 0.83, p = 0.007). CONCLUSIONS An electronic nose can accurately identify VOC breath-prints of clinically stable bronchiectasis patients with airway bacterial colonization, especially in those with Pseudomonas aeruginosa.

Pseudomonas aeruginosa in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study

Background: Pseudomonas aeruginosa (PA) is a common microorganism related to severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD). However, their role in COPD patients with frequent hospitalized exacerbations (FHE) is not well described. Objectives: We aimed to determine prevalence, risk factors, susceptibility patterns and impact on outcomes of PA in COPD patients with FHE. Methods: Prospective observational multicentre study that included COPD patients with FHE. The cohort was stratified in 2 groups according to the presence or absence of PA isolation in sputum. Patients were followed up for 12 months. Results: We enrolled 207 COPD patients with FHE. In 119 patients (57%), a valid sputum culture was collected. Of them, PA was isolated in 21 patients (18%). The risk factors associated with PA were prior use of systemic corticosteroids (OR 3.3, 95% CI 1.2–9.7, p = 0.01) and prior isolation of PA (OR 4.36, 95% CI 1.4–13.4, p < 0.01). Patients with PA had an increased risk of having ≥3 readmissions (OR 4.1, 95% CI 1.3–12.8, p = 0.01) and higher PA isolation rate (OR 7.7, 95% CI 2.4–24.6, p < 0.001) during the follow-up period. In 14 patients (67%), PA was resistant to at least one antibiotic tested. PA persisted in the sputum in 70% of patients. Conclusions: The presence of PA was related to 3 or more readmissions during the 1-year follow-up and PA persisted in the sputum despite an appropriate antibiotic treatment. This finding suggested an important role of PA in the course of the disease of COPD patients with FHE.

Strategies for the follow-up of patients with chronic diseases and polypharmacy: development and implementation of a new health care approach based on mobile technology (DIPP-mHeart Study). (Preprint)

Authors. M. Gomis-Pastor; E. Rodriguez-Murphy; A. Feliu, PhD; G. Ontiveros, F. Garcia-Cuyàs, PhD, A. Salazar, PhD; E. Roig, PhD; M.A. Mangues, PhD. 1. Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 2. Information System Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 3. TicSalut Foundation, Barcelona, Spain. 4. Direction Management, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 5. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Characterization of the population with severe iron deficiency anemia at risk of requiring intravenous iron supplementation

Iron deficiency anemia is the most frequent cause of anemia world-wide and is a very common disorder in daily medical practice. Heavy menstrual bleeding (menorrhagia) and pregnancy and delivery can cause significant iron loss leading to severe anemia The aim of the present study was to characterize the population requiring intravenous iron and identify whether gynecological and obstetric iron loss are frequent indications for treatment. MATERIAL AND METHODS Restrospective, single center study performed in a tertiary level university hospital from January 2014 to December 2016. RESULTS During the 3-year study period, there were 4529 treatments with intravenous iron (45.98% in men vs. 54.02% in women). The population group from 10 to 54 years of age made up 19.33% of the total treatments, with 35.93% in men and 64.01% in women (Fisher exact test, p<0.001). Intravenous iron administration for gynecological and obstetric reasons was required in 20.54% and 24.82% of the total population, respectively, representing >45% of the indications for treatment in this population. CONCLUSIONS The need for intravenous iron is related to anemia refractory to oral treatment or the need for rapid iron recovery. Our results show that women of fertile age are a population at risk of requiring intravenous iron as compared to a male population of the same age. It is mainly due to blood los related to pregnancy, delivery and puerperium as well as heavy menstrual bleeding.