European journal of hospital pharmacy : science and practice最新文献

Objective: To use the Raman scattering technique to identify precipitating drug substance(s) in situ.

Background: The case originated when a combination of midazolam hydrochloride, clonidine hydrochloride and fentanyl citrate with Numeta G16E was administered in a central venous catheter line. Following an alarm from the syringe pump, a precipitate in the catheter line was visually observed.

Method: The actual catheter line, with the precipitate still inside, was removed from the clinic and brought to the laboratory. Raman spectra of the precipitate, both when still inside the catheter line (in situ) and after removal, were recorded and analysed for similarity using our in-house database. Additionally, to validate the method, dry powders of midazolam, clonidine and fentanyl were mixed in the ratio of ~300:1:1. This tailor-made mixture was subjected to Raman analysis with the aim of validating the ability of the method to identify all components in a mixture, even if some of the components were present only in small amounts.

Results: The precipitate was successfully identified as midazolam. Measuring in situ caused some additional peaks in the Raman spectra, attributed to the plastic of the catheter line. The influence of these additional peaks was eliminated by a two-component search or by demixing the spectra. The spectra of the precipitate indicated no traces of either clonidine or fentanyl. The experimental results were in line with the results from the theoretical calculations. The ability of Raman spectroscopy to identify both midazolam and small amounts of clonidine and fentanyl in a powder mixture was successfully demonstrated by scanning the tailor-made mixture.

Conclusion: Raman spectroscopy in combination with a database was used for rapid and non-invasive bulk identification in situ. However, to confirm or refute small amounts of a second drug substance in the precipitate, a large area scan of the particle on a flat surface is recommended.

Objectives: Unplanned hospital revisits (UHR) among older adults are common and contribute to adverse clinical outcomes, caregiver burden and increased healthcare costs. We aimed to develop and validate a risk prediction model for UHR in older adults to support early identification.

Methods: We conducted a retrospective cohort study, following the TRIPOD statement, using a Flemish linked database combining primary care and national health insurance data. Adults aged ≥75 years with an all-cause hospital admission in 2014 were included. The primary outcome was UHR, defined as emergency department visits or unplanned hospital admissions within 6 months post-discharge. We used multivariable logistic regression to identify predictors for UHR and develop a risk prediction model. Model performance was assessed using balanced accuracy. Missing data were handled using multiple imputation by chained equations. The model was validated on a held-out test set and a k-nearest neighbour classifier was used to cross-validate risk categories.

Results: Among 3133 patients, 309 (10%) experienced UHR. The best-performing model had a balanced accuracy of 0.56, with a sensitivity of 58% and a specificity of 54%. Predictors were polypharmacy, male sex, haemoglobin level, number of general practitioner contacts and multimorbidity. Excessive polypharmacy (>9 medications) was associated with a 55% increase in UHR odds. Three UHR risk groups were identified: low-risk (5.1%), medium-risk (8.8%) and high-risk (11.6%).

Conclusions: UHR are common in older adults, with excessive polypharmacy emerging as a key predictor. The pragmatic model described here provides a valuable tool to stratify older adults into distinct risk groups, identifying a high-risk group that may benefit from targeted interventions.

The management of oncological treatment has evolved substantially with the increasing use of oral antineoplastic agents, which are self-administered by patients or caregivers at home, and require careful monitoring and support. The aim of this study was to evaluate the impact of pharmaceutical consultations on oncology patients undergoing therapy with oral antineoplastic agents. A systematic literature review was conducted using the PubMed, Scopus and Web of Science databases with the last search on 5 June 2025. Primary observational or experimental studies were sought for inclusion. Eligible studies assessed the outcomes of pharmaceutical consultations for oncology patients receiving oral antineoplastic therapy in a hospital setting, compared with a conventional medication dispensing model. The risk of bias in the included studies was evaluated using the Cochrane risk-of-bias tools, RoB-2 and ROBINS-I. The review was developed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 Statement, and the protocol for the systematic literature review was registered with PROSPERO under the reference CRD42024533367. From the 881 records initially identified, 16 studies were included. A backward reference search led to the inclusion of two additional publications, bringing the total to 18 studies in this systematic review. The main interventions performed by pharmacists during pharmaceutical consultations included patient education on their treatment, management of adverse reactions and drug interactions, and monitoring of adherence to therapy. The studies evaluated a total of 10 variables, demonstrating the benefits of pharmaceutical consultation in all of them. Significant benefits were observed in terms of progression-free survival and quality of life, both of which are crucial in cancer treatment. However, further research is required, particularly involving larger patient samples and studies spanning multiple institutions and countries. To facilitate a comprehensive and comparative evaluation of different pharmaceutical consultation models in oncology, it would be advantageous to standardise methods for assessing their impact.

Objectives: Caffeine citrate, a methylxanthine derivative, is commonly used in the management of apnoea of prematurity. In clinical settings, particularly in neonatal intensive care units, various dilutions of caffeine citrate in intravenous fluids are required to ensure precise and individualised dosing for extremely low birth weight infants. This study aimed to assess the stability of caffeine citrate solutions at concentrations of 1 mg/mL and 12.5 mg/mL in 0.9% w/v sodium chloride and 5% w/v glucose, stored at room temperature and under refrigeration up to 48 hours.

Methods: Caffeine citrate concentrations were measured using a high-performance liquid chromatography method with ultraviolet detection (HPLC-UV). Solutions were stored at room temperature (22°C) and at 8°C for up to 48 hours. Two solvents for caffeine citrate were studied: normal saline (0.9% w/v sodium chloride), and 5% w/v glucose. The calibration curves of the HPLC-UV method were linear over the range of 0.1-12.5 mg/mL for both types of intravenous fluid. The stability criterion was defined according to International Council for Harmonisation (ICH) M10 (±15% of nominal concentration), and compliance with the stricter United States Pharmacopeia (USP) criterion (±10%) was also assessed.

Results: All samples remained within the ICH M10 acceptance limits. Most results also complied with the USP±10% threshold; however, three values (12.5 mg/mL in 0.9% w/v sodium chloride at 24 hours refrigerated, and 1 mg/mL in 5% w/v glucose at 24 hours and 48 hours refrigerated) exceeded 110% (112.9%, 111.3%, and 111.4%, respectively).

Conclusions: Caffeine citrate diluted in 0.9% w/v sodium chloride or 5% w/v glucose is chemically stable at concentrations of 1 mg/mL and 12.5 mg/mL for up to 48 hours when stored at room temperature, meeting ICH and USP acceptance criteria in all cases. Caffeine citrate solutions did not meet the USP±10% criterion if stored at 8°C for 24 hours.

Introduction: Nefopam is a non-opioid analgesic used for postoperative pain control. For intravenous home use, a portable elastomeric device is often preferred for administration. The nefopam in the device must be stable at 32°C because this device is positioned close to the patient.

Objectives: This study aimed to evaluate the physicochemical stability of nefopam solutions at 0.2 and 3.33 mg/mL diluted in 0.9% NaCl in silicone portable elastomeric devices at 32°C in the dark.

Methods: Three portable elastomeric devices were prepared for each condition. Chemical stability was assessed by pH measurement and high-performance liquid chromatography (HPLC). The method was validated according to the International Conference on Harmonisation Q2(R1). Stability was tested after preparation and after 6 and 24 hours of storage. At each time of analysis, the pH values were measured, and three samples from each device were analysed via HPLC. The solution is chemically stable if it retains more than 90% of its initial concentration, with the appearance of any degradation products monitored, and if the pH variation is less than one unit. Physical stability was evaluated by visual and subvisual inspection using a particle counter following the European Pharmacopoeia guidelines.

Results: Nefopam solutions at both concentrations maintained more than 93% of their initial concentration after 6 and 24 hours at 32°C, with no pH variation exceeding one unit, demonstrating chemical stability. For both concentrations, visual inspection was compliant at each analysis time, and subvisual inspection was consistent at 24 hours. Physical stability was therefore demonstrated for both concentrations after 24 hours.

Conclusions: The physicochemical stability of nefopam solutions at 0.2 and 3.33 mg/mL was demonstrated for 24 hours at 32°C in portable elastomeric infusion devices. This attribute allows continuous administration at home, particularly in cases of difficulty with oral administration, or minimises the side effects of discontinuous administration.

Introduction: Clinical guidelines recommend switching from intravenous to oral antibiotics in community-acquired pneumonia (CAP) once patients are clinically stable because it is safe and cost-effective. However, studies have reported low switching rates in clinical practice. This study aimed to assess current switch practices in the real-world setting.

Methods: The switch from intravenous to oral antibiotic therapy was evaluated in adults (≥18 years) admitted to hospital with CAP. The primary outcome was a switch within 72 hours (early switch). Secondary outcomes included duration of hospital stays, readmissions, changes in inflammatory markers and mortality within 30 days after discharge. Furthermore, information on healthcare providers' decisions was gathered.

Results: The cohort comprised 214 patients with CAP, of which 187 (87.4%) underwent a switch and 146 (68.2%) of these had an early switch. Early switching was frequent in younger patients (18-49 years) and those with low Pneumonia Severity Index (PSI I and II). Hospital stay was longer in the late and non-switch groups compared with the early switch group, and the total duration of antibiotic therapy was the highest in the late switch group. No reasons were documented for 76.5% (n=52) of the patients who did not undergo an early switch. Almost no early switches were advised during the weekends.

Conclusion: A high overall switch rate of 87.4% was observed with a 68.2% early switch rate. Early switch was associated with shorter duration of hospital stay and antibiotic therapy. Reasons for not applying an early switch were underreported, and weekends served as significant barriers to an early switch.

Background: The healthcare sector produces significant amounts of waste and harmful substances and consumes large amounts of energy; hence, it is also involved in the move towards sustainability. Plastics are everywhere in hospitals (especially in medical devices used for infusion) and contribute significantly to greenhouse gas emissions. The objective was to review the scientific literature on ways of making in-hospital infusion practices more environmentally friendly.

Methods: The literature data were reviewed systematically and independently by two investigators and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Any differences of opinion were resolved by a third investigator. Four online databases (PubMed, Embase, ScienceDirect and Web of Science) were searched for articles published in English or French between 1 January 2004 and 31 December 2024. Only publications that address sustainable development and infusion medical devices were included. The following data were extracted: country, hospital department(s), and the study's objectives, methods, main results and conclusions. The robustness of the selected studies was assessed using the Mixed Methods Appraisal Tool.

Results: In all, 1938 publications were screened, and eight were included. Four publications concerned overconsumption and/or waste analysis, one compared single-use devices with reusable devices, and three were concerned with intravenous drug administration and wastage. The topics addressed in life cycle assessments were procurement, supply, storage, overconsumption of medical devices, the wastage of intravenous drugs and waste management.

Conclusion: The results highlighted some areas for improvement at various points in the medical device life cycle-from manufacturing to recycling. Collaboration between hospital stakeholders is essential for the promotion of environmentally friendly infusion practices.

Objectives: To evaluate the physicochemical and microbiological stability of preservative-free losartan potassium (LP) eye drops (0.8 mg/mL) prepared using balanced salt solution (BSS), normal saline (NS) or glucose saline (GS) and stored in sterile polypropylene eye drop bottles under different temperature conditions for 30 days.

Methods: Three independent batches of each formulation (BSS, NS and GS) were aseptically prepared in a laminar flow cabinet and stored under three conditions: room temperature (25±4°C), refrigeration (4±3°C) and freezing (-20±5°C). Three samples from each batch were analysed for each condition and time point. LP concentrations were measured on days 0, 7, 15, 22 and 30 using high-performance liquid chromatography with photodiode-array detection (HPLC-DAD) and ultraviolet (UV) - visible spectrophotometry. Visual inspection was performed to identify macroscopic changes and physicochemical parameters - including pH, osmolality and refractive index - were evaluated. Microbiological quality was assessed on days 0, 10, 20 and 30.

Results: BSS and NS formulations maintained 90-110% of their initial LP concentration under all storage conditions. The GS formulation remained stable when refrigerated or frozen but showed a marked decline at 25°C, with turbidity and concentrations falling below 50% by day 20. pH, osmolality and refractive index remained within acceptable physiological ranges for ophthalmic solutions. All samples tested negative for microbial growth.

Conclusions: LP eye drops prepared with BSS or NS were stable in closed sterile eye drop bottles for at least 30 days under all tested conditions. Frozen and refrigerated conditions are preferred for storage. Because the formulation does not contain preservatives, its use is recommended for no longer than 7 days after opening. GS-based formulations are not recommended for ophthalmic use. The conducted stability study provides hospital pharmacies with data supporting the safe preparation, storage and use of non-commercial ophthalmic formulations.