Hospital Pharmacy最新文献

Background: Artificial intelligence (AI) helps to develop personalized medication therapy and regimens. It improves the patient care system. A cross-sectional study used and included pharmacy students, using validated survey questions. Objective: This study aimed to evaluate awareness, perception and opinion toward AI among pharmacy students. Design: This is a cross-sectional study (survey-based). Methods: A cross-sectional survey distribution among students in different levels of the college of pharmacy at National University (NU). The questions were classified to measure the variation of demographics, awareness, perceptions and opinions toward Artificial Intelligence (AI). Results: The results showed that more than 50% of pharmacy students are familiar with the uses of AI and know it's important in scientific research, 46.4% have a basic understanding of AI technologies. However more than 75% don't know the applications of AI used in pharmacy practice, 50.6 % don't know AI can support therapeutic diagnosis and 57 % don't know its importance in pharmacy education. A high perception was shown toward AI in facilitating pharmacy access to information (84.2%) and patients' access to the service (80.8%). In addition, 92% suggested that AI training is needed and 86.1 % recommended using AI in scientific research. The conclusion of this study identified the needs for awareness toward AI, and the important role of AI for education in pharmacy and health communities.

This chart is an update to the 2019 article published in Hospital Pharmacy on injectable drugs to be used with a filter. To update the chart, drugs approved from January 2019 to December 2024 were reviewed to determine if they require filtration and drugs included in the 2019 table were reviewed for accuracy. Readers are urged to review national standards of practice for information about clinical situations that warrant the use of a filter for medication preparation or administration, independent of the drug being given, and the reader should consult the prescribing information for the most up-to-date information.

Objectives: Sleep in the hospital is often disrupted by modifiable factors. When addressing poor sleep in the hospital, non-pharmacologic strategies should be utilized initially; however, pharmacologic therapies are often prescribed first. The objective of this initiative was to determine if pharmacist-led initiation of a sleep promotion order set improved quality of inpatient sleep. Methods: This was a prospective, single-center, before-and-after quality improvement project. Patients admitted to the adult internal medicine service with a pharmacologic sleep aid ordered were considered for inclusion. Pharmacists conducted baseline sleep assessments using the Modified Richards Campbell Sleep Questionnaire (mRCSQ), then recommended initiation of the sleep promotion order set. A second mRCSQ was conducted 2 to 5 nights after order set initiation. The mean difference in mRCSQ for individual patients before and after sleep promotion were compared. Results: Fifty-three patients completed both baseline and follow-up mRCSQ surveys. The average mRCSQ score before sleep promotion was 55.8 and the average score after sleep promotion was 56.8 with a subject paired difference of 1.0; P = .8. Individual components of the mRCSQ survey were compared and not found to have significant differences. Conclusions: Implementation of the sleep promotion order set did not result in a significant improvement in patient-reported sleep. This study was marked by significant limitations including difficulty with patient comprehension of the mRCSQ sleep assessment tool, lack of assessment of adherence to the order set, and variability in where in patient clinical course sleep assessments were performed. Despite the findings of this project, further evaluation should be made into the ideal sleep assessment tool for an internal medicine patient population. Medical teams should continue to make an interdisciplinary effort to address modifiable risk factors to optimize sleep in the hospital and limit prescribing of pharmacologic sleep aids.

Purpose: ASHP Residency Standards consider research an important component of residency training. Publication of these projects is considered the gold standard for high quality research; however, residency research publication rates are low, with most reports suggesting less than 12% of projects are successfully published. This study reviewed post-graduate year one (PGY1) research projects to evaluate the role of mentorship in successful publication in peer-reviewed journals. Summary: This was a single-center, observational study of PGY1 research projects between 2010 and 2022 to assess mentorship's association with publication rate. Successful publication was confirmed via a PubMed search conducted through October 2022. Of 53 included PGY1 research projects, 18 projects (34%) were published, with 12 as manuscript publications and 6 as published abstracts. Projects with mentors with ≥3 publications and with mentors with ≥1 first author publications were associated with higher rates of full publications (excluding projects that were published in abstract form only) (50.0% vs 8.6%, p < 0.001; 37% vs 7.7%, p = 0.001). Faculty member participation also increased manuscript publication (63.6% vs 11.9%, p = 0.008). Publication of PGY1 projects was associated with higher rates of future publications (median 5 vs 1, p < .001). Conclusions: The presence of experienced mentors was associated with successful publication, and publishing a residency project was associated with future publications. New practitioners interested in precepting research projects may benefit from the inclusion of mentors with previous publication experience to support resident research projects.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

Medication management in hospitals is a complex process that encompasses every step from prescription to administration, involving multiple healthcare professionals. This process is prone to various errors that can compromise patient safety and generate significant human and financial costs. Automation in hospital pharmacies represents a major advancement, enhancing patient safety, optimizing professional practices, and reducing hospital expenses. This study aims to analyze the different types of automation systems used in hospital pharmacies, assess the impact of automation, and explore its benefits as well as the challenges and limitations associated with its implementation. A literature search was conducted using the ScienceDirect, PubMed, and Scopus databases, covering the period from 1992 to 2024. A total of 129 relevant articles related to the automation of medication preparation and distribution, as well as its challenges and perspectives were included in this study. Automated technologies significantly contribute to reducing medication errors, strengthening traceability, optimizing inventory management, and alleviating the workload of healthcare professionals. However, challenges persist, particularly in terms of costs, integration with existing processes, and staff training. The use of artificial intelligence offers promising prospects for improving the accuracy and operational efficiency of automation systems.

Background: Data comparing the efficacy of alfacalcidol to that of calcitriol in managing secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is scarce. We sought to compare the efficacy of both drugs in managing hyperparathyroidism in patients with CKD. Methods: A retrospective observational cohort study conducted from January 2022 to March 2023 included adults with CKD stages 3 to 5 (non-dialysis) who received alfacalcidol for 3 months followed by calcitriol for another 3 months. Assessments were done at baseline and after 3 months of each treatment. The primary outcome was iPTH suppression, and the secondary outcome was total serum calcium levels. Results: A total of 70 patients were included, with 34 (48.6%) being male. The cohort's mean age was 65.5 ± 15 years. CKD stage 3 comprised 47.1% of the sample. The median dose of alfacalcidol was 0.5 (0.25-0.8) µg compared to 0.5 (0.25-0.5) µg for calcitriol (P = .001). Alfacalcidol did not significantly suppress iPTH levels, with median values of 13.31 (8.23-24.4) pg/mL at baseline and 12.5 (8.86-24.7) pg/mL after 3 months (P = .937). In contrast, calcitriol significantly reduced iPTH levels from 12.5 (8.86-24.7) pg/mL to 10.7 (5.7-19) pg/mL (P = .017). Additionally, alfacalcidol did not significantly increase calcium levels, while calcitriol did. Throughout the study period, albumin values, the follow-up times, and the use of phosphate binders or non-active vitamin D remained consistent for each drug. The multivariate Generalized Estimating Equations indicated that baseline iPTH [B = 0.041, 95% CI (0.03- 0.05); P < .001], calcitriol [B = -0.278, 95% CI (-0.5 to -0.06); P = .014], daily dose of the study drug [B = -0.45, 95% CI (-0.7 to -0.2); P < .001], and baseline phosphorus level [B = 0.354, 95% CI (0.004-0.7); P = .047] were independent factors associated with iPTH suppression. Conclusion: Calcitriol, at significantly lower doses, was more effective than alfacalcidol in suppressing iPTH levels and increasing calcium levels over 3 months. A randomized controlled study is needed to confirm these findings.

Purpose: One option recommended by expert guidelines for prompt reversal of anticoagulation-induced hemorrhage is four-factor prothrombin complex concentrate (4F-PCC). Pharmacist presence has been shown to reduce order entry to administration and door-to-needle (DTN) times. However, how pharmacist preparation of 4F-PCC at the bedside in the Emergency Department (ED) can affect times to administration has not been thoroughly studied. The purpose of this study was to assess if pharmacist presence along with preparation of 4F-PCC at the bedside could improve administration times. Methods: This retrospective cohort study included anticoagulated patients requiring emergent reversal with 4F-PCC in the ED from January 2019 to April 2020 (pre-group) to March 2022 to March 2023 (post-group). Patients in the post-intervention group who had 4F-PCC prepared at the bedside were compared to a historical group without bedside 4F-PCC preparation. The primary outcome was time from 4F-PCC order entry to administration. Results: Of 193 patients evaluated, 99 (51.3%) were included (N = 41 pre-group; N = 58 post-group). There was a significant 11 minute difference in median time from order entry to administration favoring the post-group (31 vs 20 minutes, P < .001). The subset of patients with intracranial hemorrhage (ICH) in the post-group also had a significantly shorter order to administration time of 14 minutes (31 vs 17 minutes, P < .001). There was no difference in overall DTN times, in-hospital mortality, or length of stay (LOS) between groups, including in the subset of patients with ICH. Conclusion: 4F-PCC preparation at the bedside by the ED pharmacist significantly reduced 4F-PCC order entry to administration time. However, this intervention did not reduce overall DTN times.

Background: Recurrent acute pancreatitis can be influenced by a variety of factors, including metabolic and lifestyle triggers. This case report presents a 30-year-old Asian woman whose episodes of pancreatitis were complicated by hypertriglyceridemia, Type 2 diabetes mellitus (T2DM), and occasional alcohol use. Medication-related risks, such as semaglutide, were also identified as possible contributors. Case Presentation: The patient experienced three distinct episodes of acute pancreatitis. Initially admitted in June 2020, she presented with no prior medical history and denied alcohol use. During subsequent admissions in April 2023 and January 2024, the patient reported alcohol consumption. The second admission showed significantly elevated triglyceride (TG) levels (>5680 mg/dL), and the third occurred after New Year's Eve alcohol consumption, with TG >3000 mg/dL. Treatment across all episodes involved NPO status, IV fluids, and ICU admission with insulin therapy to lower TG levels. After the recurrence of pancreatitis, her T2DM treatment was changed from semaglutide to dapagliflozin. Conclusion: This case underscores the importance of comprehensive patient education on lifestyle factors, medication risks, and adherence to treatment plans to reduce the recurrence of acute pancreatitis. Tailoring interventions, such as switching diabetes medications (from semaglutide to dapagliflozin) and emphasizing TG management through gemfibrozil, atorvastatin, and icosapent ethyl, proved essential in stabilizing her condition. The patient's case serves as a reminder of the multiple potential causes of pancreatitis and the need for ongoing monitoring to prevent further complications.

Legionnaires' disease (LD), caused by Legionella pneumophila, often presents with pneumonia, gastrointestinal symptoms, and confusion. Severe LD can lead to a triad of pneumonia, rhabdomyolysis, and acute kidney injury (AKI), with less common complications such as liver injury. We report a case of a 32-year-old male with no prior medical history who presented with LD complicated by severe rhabdomyolysis, AKI requiring hemodialysis (HD), and acute liver injury. The patient reported 6 days of gastrointestinal symptoms, reduced mobility, and minimal urine output. The patient also reported a history of vaping. Diagnostic imaging revealed pneumonia and enterocolitis, while laboratory findings included leukocytosis, hyponatremia, significantly elevated creatinine kinase (201 000 U/L), and acute transaminitis. A positive Legionella urine antigen confirmed the diagnosis. Initial treatment with azithromycin for 7 days showed partial improvement; however, clinical and laboratory deterioration necessitated a switch to levofloxacin for an additional 7 days. This case highlights rare, severe multi-organ involvement in LD, with rhabdomyolysis and AKI being particularly pronounced. The possible association between vaping and Legionella infection is explored, given the patient's history of vaping and limited prior documentation of such a link. Prompt recognition, accurate diagnosis, and escalation of therapy are critical in managing severe LD and reducing associated morbidity.