Health care quality is extremely variable in the three regions, requiring increased community participation to improve. Focus groups offered important, confidential and cost-effective information on quality and breadth of health care delivery and should be part of quality monitoring initiatives.

The study of the GI-tract microbiota of spondylarthritis (SpA) patients has focused on the analysis of feces samples, that picture mostly the luminal microbiota. The aim of this study was to determine the contribution of mucosal and luminal microbiome to the gut dysbiosis in SpA, using colonoscopy aspiration lavages (CAL), a recent alternative for regional studies of the GI-tract. We analyzed 59 CAL (from sigmoid colon and distal ileum), and 41 feces samples, from 32 SpA patients and 7 healthy individuals, using 16S rRNA gene-targeted metataxonomic profiling. It was found high prevalence of GI-tract manifestations among SpA patients (65.3%). Metataxonomic profiling, confirmed CAL samples from the lower GI tract (colon or ileum) presented a distinctive and undifferentiated bacteriome and separate from that found in feces’ samples or in the beginning of the GI tract (oral cavity (OC)). Lower GI-tract samples and feces of SpA patients exhibited similar behavior to the microbiota of IBD group with reduced microbial richness and diversity, comparing to the healthy controls. Interestingly, it was found increase in proinflammatory taxa in SpA patients, such as Enterobacteriaceae family (mostly in the ileum), Succinivibrio spp. and Prevotella stercorea. Conversely, SpA patients presented significant decrease in the SCFA producers Coprococcus catus and Eubacterium biforme. Our data support the value of CAL samples for the regional study of GI-tract and contribute with information of potential “disruptor taxa” involved in the GI-tract associated disorders observed in SpA patients.

Background Medicines reconciliation studies have produced estimates about rates of patients and drugs involved in unintended discrepancies along the reconciliation process, but to our knowledge no-one has worked out the reasons for these discrepancies. Purpose To determine and analyse the prevalence of unintended discrepancies in medicines reconciliation at our Emergency Department (ED), in which a Hospital Pharmacist is integrated into a multidisciplinary team. To find out the main reasons that justify intended medicines discrepancies. To analyse the ATC groups of drugs mostly involved in unintended discrepancies. Materials and methods Prospective non-interventional study conducted by a fourth-year resident pharmacist from 1–31 May 2012 at the Hospital ED. In the study we included all patients admitted to the ED from 08:00 to 11:30 am, Monday to Friday. Information regarding the patient’s previous medicines was collected from primary healthcare databases, records of previous hospital discharges and recent medical reports, followed by an interview with the patient or caregiver. All this information was compared with drug prescription in the computerised prescription order entry (CPOE) system introduced by the ED physician. No discrepancy was considered if a home drug was prescribed with same dose, frequency and route in CPOE. Medicines discrepancies were classified as intended (if the drug was tailored to the clinical situation) or otherwise unintended, after consensus with the attending ED physician. Data were analysed with SPSS v.15. Results We analysed 1,138 home drug prescriptions in 117 patients, resulting in 76.3% of discrepancies, of which 85.6% were intended and 14.4% unintended. Unintended medicines discrepancies affected 55.6% of patients. The reasons recorded for intended discrepancies were: PRN medicines (17.9%), limited oral tolerance and drug not essential in treatment of an acute pathology (15.8%), change according to clinical practice guidelines (14.8%), adaptation of dose and/or frequency to current patient situation (12.4%), oral intolerance (11.3%), medicines not indicated in the current situation (7.5%), change of drug because not available in hospital (6.1%) and others (14.2%). The ATC groups showing higher rates of unintended discrepancies were: B (22.5%), N (19.1%), C (15.7%), A (6.7%) and R (4.8%), with statistically significant differences (p < 0.001). Conclusions Most discrepancies found were intentional and justified as adaptations of previous home medicines to the acute process. The rate of unintended discrepancies found by clinical pharmacist was 14.4%. This allowed a better medicines reconciliation made by the hospital pharmacist integrated in the ED interdisciplinary team regarding unintended discrepancies.- The most frequent ATC of drugs affected by unintended discrepancies were: Blood and blood-forming organs (group B), central nervous system (group N) and cardiovascular system (group C). No conflict of interest.

BackgroundInappropriate use of antibiotics has become a serious problem in the hospital setting. We implemented a stewardship programme in order to optimise antimicrobial treatment at our hospital.PurposeTo analyse the contribution of an antibiotic pharmacist after the introduction of the antimicrobial stewardship programme.To analyse the economic impact of pharmacists’ recommendations.Material and methodsAn antibiotic pharmacist designed a protocol to optimise antibiotic treatment in agreement with infectiologists and microbiologists. The programme started running in December 2013.On a daily basis, the pharmacist obtains a list of inpatients prescribed antibiotics from the computerised prescription order entry system and recovers information from the electronic health record. The pharmacist checks the following items: (1) conformity of empirical and targeted antimicrobial treatment to clinical practice guidelines; (2) local flora and culture results; (3) dose adjustment to the clinical situation; (4) appropriate duration and (5) route of administration. If treatments are susceptible to improvement, the pharmacist contacts physicians to propose recommendations. The recommendations are recorded in a database. Additionally, the financial impact is evaluated in antimicrobial or dose changes.ResultsWe analysed 2,250 prescriptions (32% of total) over a 10-month period. Physicians were contacted on 347 occasions; 96% related to antibiotics and 4% to antifungals. In 86% of the cases they agreed with the proposals. Reasons to act were: 36% administered for too long, 20% inappropriate antibiotic selected, 18% unadjusted dose, 14% inappropriate empirical treatment, and 11% unestablished sequential treatment.Direct costs could be estimated in 32% of the antibiotic and antifungal recommendations, leading to net savings of €9,566 (49%) and €10,041 (51%).ConclusionThe contribution of an antibiotic pharmacist, as part of an antibiotic stewardship programme, resulted in a reduction of excessively prolonged antimicrobial courses and improvements in accordance with culture results, dose to patient condition, adjustment of empirical treatment to recommendations, and selection of a suitable route for administration.Interventions in antifungal treatment were associated with greater savings.References and/or AcknowledgementsNo conflict of interest.

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