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Introduction: Medication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised., Objectives: To describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated., Methodology: Prospective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver., Results: 1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance., Conclusions: The findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population., (Copyright © 2023 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them., Methods: A 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur., Results: Medication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE., Conclusions: In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the prevalence of reconciliation errors on admission to hospital in the pediatric onco-hematological population in order to check whether they are similarly susceptible to these reconciliation errors as adults and to describe the characteristics of the patients who suffer them., Methods: A 12-month prospective, multicentre study of medication reconciliation on admission in the pediatric onco-hematological population to assess the incidence of reconciliation errors and to describe the characteristics of the patients., Results: Medication reconciliation was performed in 157 patients. At least a medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were related to patient's new clinical situation or by the physician, while 48.9% were determined to be reconciliation errors. The most frequent type of reconciliation error was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a reconciliation error., Conclusions: In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic pediatric patients, such as onco-hematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication reconciliation errors on admission to hospital, and the omission of some medication was the main cause of these errors., Competing Interests: Conflict of interest This study was conducted with the support of a scholarship under the 2019–2020 scholarship program of the Spanish Foundation of Hospital Pharmacists., (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objetivo: Determinar la incidencia, gravedad y evitabilidad de los  incidentes por medicamentos detectados en los pacientes que acuden a los servicios de urgencias pediátricas, e identificar los grupos de edad de mayor riesgo y los medicamentos implicados.Método: Estudio multicéntrico observacional prospectivo, realizado entre  marzo y junio de 2017, en pacientes entre 0 y 16 años que acudieron a los servicios de urgencias pediátricas de ocho hospitales públicos españoles. Se recogieron tres tipos de incidentes: eventos adversos por medicamentos, errores de medicación e intoxicaciones accidentales. Los incidentes se caracterizaron atendiendo a su gravedad, evitabilidad, grupos de edad afectados y medicamentos implicados.Resultados: Durante el periodo de estudio se registraron 99.797 visitas a los servicios de urgencias pediátricas y se recogieron 334 incidentes por medicamentos en 334 pacientes, de los cuales el 52,4% fueron varones, con una media de edad de 47,1 ± 44,4 meses. La incidencia de pacientes  con incidentes fue del 0,3%. Del total de incidentes, 264 (79%) fueron considerados prevenibles y 158 (47,3%) produjeron daño a los pacientes. Los incidentes detectados fueron 144 (43,1%) eventos adversos por medicamentos, 218 (65,2%) errores de medicación (74 de ellos errores con daño, que se incluyen asimismo como eventos adversos prevenibles) y 46 (13,7%) intoxicaciones accidentales. Los preescolares (edad: 1-5 años) presentaron el 60,8% de los incidentes, siendo también el grupo de edad con un mayor porcentaje de incidentes prevenibles (64%). Un total de 351 medicamentos estuvieron implicados en los incidentes y pertenecieron mayoritariamente a tres grupos terapéuticos: antiinfecciosos de uso sistémico (171; 48,7%), sistema nervioso (66; 18,8%) y sistema respiratorio (41; 11,7%).Conclusiones: La incidencia de incidentes por medicamentos en los pacientes pediátricos que acudieron a servicios de urgencias fue inferior a la referida en pacientes adultos, si bien prácticamente la mitad de los incidentes detectados causaron daños a los pacientes. Los niños preescolares (1-5 años) fueron identificados como el grupo de edad con mayor riesgo. Los incidentes registrados estuvieron causados por un número reducido de medicamentos. Un elevado porcentaje de los incidentes fueron prevenibles, lo que confirma la imperiosa necesidad de implementar medidas de prevención de incidentes en esta población., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Electroanatomical mapping systems (EMS) reduce fluoroscopy dose for the ablation. Higher costs and longer procedure times are the drawbacks associated with EMS. Our objective was to validate the efficiency of the EMS., Objective: To demonstrate that using EMS is more efficient and as secure as the traditional system of ablation., Methods: From April 2013 to June 2018, all patients were included into two groups, according to the intention of ablation with or without fluoroscopy. Right, left, supraventricular and ventricular ablation were included. We compared procedure variables (fluoroscopy, radiofrequency and procedure times, ablation results, complication rates and costs of the procedure) that included material and detrimental effect of fluoroscopy., Results: A total of 105 were included in the fluoroscopy group and 287 in the without fluoroscopy group. We found an important reduction in time and radiation dose in all the ablation procedures studied, without increasing the procedure time. No differences in ablation results nor complications rate were found. We found lower costs in the flutter ablation without fluoroscopy, similar costs in the right focal tachycardia ablation group and higher costs in the without fluoroscopy group for the AVNRT and left accessory pathway. When detrimental effect of fluoroscopy was added, all procedures without fluoroscopy were significantly more efficient than the ones performed with it., Conclusions: Ablation without fluoroscopy is a technique as safe and effective as the conventional technique. Our study suggests that the radiation dose delivered to the patient and staff might be reduced, without increasing the total procedure time, being even more efficient.

Objetive: To describe off-label and unlicensed drugs in clinical practice in a Neonatal Intensive Care Unit (NICU)., Method: The design of the study was a descriptive and retrospective three months research in a NICU of a Spanish University Hospital. All prescriptions were classified as approved, off-label and unlicensed drug used, according to the information available on the Summary of Product Characteristics. Off-label drugs prescriptions were divided into four groups (dose, frecuency, age and indication of use) depending on the reason of disconformity., Results: Forty-one neonates were included (46.3% premature patients) and a total of 273 drug prescriptions were evaluated. Of them, 53.1% (145) were classified as an approved drug prescriptions, 41.4% (113) were off-label use and 5.5% (15) were unlicensed drugs. 90.2% of the patients (37/41) received at least one off label prescription, with a median of 3 (range 1-7). Age was the foremost reason for off-label use (42.5%), followed by dose (31.0%), frecuency (16.8%) and dose-frecuency off-label drug use (8.8%). The last place was reserved for off-label drug use by indication (0.9%). Group J (corresponding with antiinfectives for systemic use) was the most frecuently prescribed, with ampicillin (18.6%) and gentamicin (16.8%) as the drugs most commonly use as off-label prescriptions. Finally, caffeine citrate was the unlicensed drug most frecuently prescribed., Conclusion: Off-label and unlicensed drug use prescriptions in our NICU clinical practice are highly frecuent as other authors have previously published in other countries where they were studied. Although there are few studies in newborn patients, both off-label and unlicensed drug prescriptions are commonly recomended in Paediatrics Guidelines., (Copyright AULA MEDICA EDICIONES 2017. Published by AULA MEDICA. All rights reserved.)

Background: Acquired haemophilia is an uncommon condition caused by the development of clotting factor inhibitors. To eliminate them, immunosuppressive therapy with corticosteroids and cytotoxic drugs is required., Methods: We describe a case of rituximab use in acquired haemophilia refractory to conventional therapy in a 63 year old male patient with chronic hepatitis C virus infection who was receiving treatment with pegylated-interferon-a-2a plus ribavirin., Results: After 21 weeks of antiviral therapy, the patient was admitted to hospital with a large haematoma in the abdominal muscles. Factor VIII level was zero and inhibitor titer was 345 Bethesda units. Oral immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered for 1 month, with limited improvement. Therefore, cyclophosphamide was replaced by a four once-weekly dose of intravenous rituximab. Two months later, factor VIII level was normal and inhibitor titer was undetectable., Conclusion: Rituximab may be useful for the treatment of acquired haemophilia resistant to standard therapy., (Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.)

We present the case of a patient with syncope with repetition over 12 years, with a clinical profile not clearly related with a cardiogenic origin, who was studied by several medical specialties without any accurate diagnosis. After subcutaneous loop recorder implantation, we were able to demonstrate how seizures acted as a trigger in the genesis of an exaggerated cardio inhibitory reflex. A new entity has been described, known as "ictal asystole", in patients with focal epilepsy mostly from the temporal lobes and has been implicated as a cardiac cause of sudden unexplained death in epilepsy. We think this case could add new information about some patients who are at high risk of death but they are misdiagnosed.

Background and Objective: To determine the incidence of adverse drug events (ADE) in hospitalized patients, identify those that were potentially preventable, and asses the drug classes involved, the clinical symptoms and the type of medication errors that led to the preventable ADE., Patients and Method: An observational study of ADE prevalence in hospitalized patients in internal medicine, pneumology, gastroenterology, nephrology and neurology wards, over a six-month period, at a tertiary university hospital. ADE were prospectively detected through physician and nurses reporting fostered by daily visits of a clinical research and retrospectively through review of medical records using event codes as defined by the IDC-9-CM system., Results: In a total of 2,643 hospitalized patients, 191 (7.2%) ADE were detected. Of these, 38 cases (19.9%) were classified as preventable, of which 21.1% were mild; 60.5% moderate and 18.4% serious or life-threatening. Preventable ADE were frequently associated with anti-infective drugs (22.9%), diuretics (18.8%) and digoxin (16.7%). Inadequate therapy monitoring (28.3%), excessive dosage (21.7%), selection of an inappropriate drug according to patient characteristics and/or to diagnosis (15.0%), lack of prescription of a necessary drug (15.0%) and drug-drug interactions (11.7%) were the most common identified type of errors leading to preventable ADE., Conclusions: 1.4% of hospitalized patients in medical wards experienced potentially preventable ADE. Healthcare professionals and administrators must be made aware of the scope of this problem so that they will implement effective safety practices directed to reduce the incidence of medication errors, particularly prescription and monitoring errors.