Hospital Pharmacy最新文献

Background: The study aimed to assess pharmacy professionals' attitudes, perceptions, practices, and concerns about using ChatGPT in routine clinical duties in Pakistan.

Methods: A descriptive cross-sectional study was conducted from 1 September 2024 to 1 April 2025. A self-administered questionnaire was distributed among pharmacy professionals employed in hospitals, communities, academic institutes, industries and other healthcare settings. A convenience sampling technique was utilized to recruit 405 participants. Data was analyzed using IBM SPSS statistics version 30, employing descriptive and inferential statistics, including Spearman's rank correlation, chi-square test, and binary logistic regression analysis.

Results: Among 405 participants, the majority were male (210, 51.9%), 230 (56.8%) participants were aged between 23 and 33 years, 196 (48.4%) participants identified as single. Regarding pharmacy positions, 115 participants (28.4%) were hospital pharmacists, and the majority, 145 participants (35.8%), possessed professional experience ranging from 1 to 5 years. Furthermore, 271 participants (67.0%) reported familiarity with AI technology in pharmacy practice. Majority of participants (n = 228, 56.3%) demonstrated a positive attitude, while (n = 222, 54.8%) exhibited a positive perception, and (n = 232, 57.3%) reported good practice toward ChatGPT integration. Additionally, 56.0% (n = 227) of participants exhibited higher concerns regarding the integration of ChatGPT.

Conclusion: The study findings indicate that more than half of the pharmacists demonstrated positive attitudes, perceptions, and good practices regarding using ChatGPT in pharmacy practice. Key concerns about its use include ethical considerations, privacy issues, data accuracy, and potential for bias. This highlights the necessity for extensive instructional programs to encourage educated and responsible use of ChatGPT in pharmacy practice. Future research should investigate developing and implementing customized training programs and protocols to guarantee ChatGPT's secure and efficient incorporation into pharmacy processes for enhanced patient care.

Background: We sought to mine the respiratory system toxicity risk signals associated with fulvestrant, with the aim to enhance clinical awareness of its respiratory toxicity.

Research design and methods: The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were employed to mine respiratory system toxicity risk signals of fulvestrant from the Tianjin Adverse Drug Reaction Monitoring Center (Tianjin Center) database and the FDA Adverse Event Reporting System (FAERS) database between January 2004 and July 2025. The mined risk signals were statistically classified and described using the Medical Dictionary for Regulatory Activities (23.1 edition).

Results: The Tianjin Center database contained 233 adverse drug event (ADE) reports in which fulvestrant was the primary suspected drug, with 156 reports involving respiratory, thoracic, and mediastinal disorders. Cough was the most frequently reported ADE, with the strongest signals detected for throat irritation, throat tightness, and cough. The FAERS database contained 12 364 ADE reports with fulvestrant as the primary suspected drug, with 818 reports involving respiratory, thoracic, and mediastinal disorders. Cough was the most frequently reported ADE, with the strongest signals detected for mediastinal fibrosis, pulmonary septal thickening, and pleural thickening.

Conclusions: Clinical use of fulvestrant should include careful monitoring for respiratory adverse events.

As individuals age, age-related biologic and physiologic changes, alterations to pharmacokinetic and pharmacodynamic variables, and multimorbidity place geriatric patients at high risk for drug-related problems. Drug therapy problems in these patients include polypharmacy, inappropriate medication use, and poor medication adherence often due to complex regimens and medication costs. Pharmacists, physicians, and advanced practice providers (APPs) are uniquely positioned to tackle drug therapy problems and must work in tandem to do so. For maximal success, routine drug assessment within the multidisciplinary team should occur across the care continuum from the intensive care unit to the general floor to the outpatient setting. Pharmacists must identify drug therapy problems through medication reconciliations performed at admission, discharge, and during transitions of care, assist with adherence strategies, and address barriers to medication access. Physicians and APPs must routinely review medication lists, deprescribe and taper pharmacotherapy when able, identify medications to avoid and their appropriate alternatives, and prevent the prescribing cascade. To do this, a variety of tools can be deployed such as the Fit for the Aged criteria, Medication Appropriateness Index, American Geriatric Society Beers Criteria, and Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria, to aid in medication selection in older adults. This review aims to describe key geriatric physiological changes, highlight the role of the inpatient pharmacist, physician, and APP and discuss methods for assessment and optimization of drug therapy regimens in geriatric patients.

Background: Doxorubicin, as part of the chemotherapy regimen for breast cancer, has long been associated with cardiotoxicity, primarily manifested by a reduction in left ventricular ejection fraction (LVEF). Early detection of cardiac dysfunction is essential to prevent the progression of heart failure and ensure patient safety. This study aimed to analyze trends in LVEF reduction, the incidence of cardiotoxicity, and associated risk factors in breast cancer patients receiving doxorubicin-based chemotherapy at Dr. Hasan Sadikin General Hospital, Bandung.

Methods: We conducted a retrospective cohort study of 130 patients and further reviewed the medical records. The LVEF values were obtained from echocardiographic assessments performed before and after each chemotherapy cycle. The Mann-Whitney U test and Wilcoxon Signed Rank test were used to assess LVEF trends, while bivariate analysis was applied to evaluate the association between clinical variables and cardiotoxicity.

Results: The results showed a statistically significant reduction in LVEF beginning after the third chemotherapy cycle and continuing through the sixth (P < .05), with a median decline of approximately 4% to 5%. The incidence of cardiotoxicity was 4.62%, with an additional 3.85% of patients classified as having borderline low LVEF. The age factor (P = .047) and a history of hypertensive heart disease (HHD) (P = .034) showed a statistically significant association with the incidence of left ventricular dysfunction, but no factors showed a statistically significant association with the incidence of cardiotoxicity.

Conclusions: The early onset of LVEF reduction highlights the critical role of routine cardiac monitoring during chemotherapy as a preventive strategy against cardiotoxicity progression. Identification of risk factors such as older age and preexisting cardiovascular conditions is essential for risk stratification and the implementation of safer and individualized treatment approaches.

Background: Typical strategies for obtaining medication lists may be suboptimal for incarcerated individuals due to unavailability of electronic transmission and verification methods, leading to potential delays and inaccuracies during care transitions. This study reviews disease states and medication lists at admission and discharge for incarcerated patients at a large academic medical center, hypothesizing that discrepancies in chronic disease diagnoses and medication lists exist during these care transitions.

Methods: A retrospective, single-cohort analysis from January 1, 2017 to December 31, 2020, evaluated medication lists in incarcerated adults. Medication lists and chronic disease states, as defined by the Charlson comorbidity index, were assessed at 2 critical care transitions: on admission and at discharge. Pre-specified co-morbidities were selected to identify discrepancies involving missing or duplicate medications.

Results: Of 557 eligible patients, 417 (75%) had active prescriptions on admission, averaging 8 medications per patient. Diagnostic discrepancies were infrequent upon admission and at discharge (3.9%), with conditions more often noted for the first time at discharge. In reviewing 309 patients with pre-specified co-morbidities, 55% exhibited at least 1 medication discrepancy, with an average of 1.65 co-morbidities reviewed per patient.

Conclusion: The healthcare teams caring for incarcerated patients face unique challenges in medication management during hospital transitions. These medication lists are characterized by a high incidence of medication discrepancies despite a low incidence of diagnostic differences. To enhance care continuity and minimize risks, healthcare systems need to implement streamlined, standardized medication reconciliation processes and improve institutional policies to better support this vulnerable population.

Background: The optimal timing of initiating direct oral anticoagulants (DOACs) after ischemic stroke in patients with atrial fibrillation (AF) remains uncertain. Early initiation may reduce recurrent stroke risk but raise concerns about hemorrhagic complications. This study aimed to evaluate the efficacy and safety of early versus later anticoagulation after ischemic stroke in AF.

Methods: We systematically searched PubMed, EMBASE, CENTRAL, and Scopus from inception to May 22, 2025, for randomized controlled trials (RCTs) comparing early (≤4 days) versus later (5-14 days) DOAC initiation post-stroke in AF. Primary outcomes were recurrent ischemic stroke, symptomatic intracerebral hemorrhage (sICH), and all-cause mortality. Data were pooled using MetaXL (version 5.3) with a random-effects model. Heterogeneity was assessed using the Chi-square test and I ² statistic.

Results: Five RCTs (n = 6810) were included. Early anticoagulation showed a non-significant reduction in recurrent ischemic stroke (OR 0.80, 95% CI: 0.59-1.09; I ² = 1%) and no significant difference in sICH (OR 0.92, 95% CI: 0.45-1.85; I ² = 0%) or all-cause mortality (OR 0.94, 95% CI: 0.78-1.14; I ² = 0%). Across all outcomes, heterogeneity was low and findings were consistent.

Conclusion: Early initiation of DOACs after ischemic stroke in AF appears safe and may modestly reduce stroke recurrence without increasing hemorrhagic or mortality risk. These findings support individualized decision-making and suggest that early anticoagulation is a reasonable strategy in appropriately selected patients.

Hospitalized patients with asthma or COPD typically receive respiratory medications via inhalers (pressurized metered dose inhalers, dry powder inhalers, or soft mist inhalers) or nebulizers. Because in-hospital use of inhalers may be complicated by required interchanges from nonformulary home inhalers to inpatient formulary inhalers, clinician or patient errors in administration, unclear dosage received, wasted drug, misplaced devices, and increased costs, switching from the use of inhalers to an all-nebulization strategy may streamline processes and improve outcomes. As respiratory therapists and hospital pharmacists, we have had experience with making this switch in different types and sizes of hospital systems. Despite the challenges we encountered, each of our approaches to implement an all-nebulization protocol was ultimately successful. In this article, we summarize our learnings during the operationalization of all-nebulization protocols, describe the benefits we observed post-implementation, and provide recommendations including detailed guidance for how to implement this type of switch successfully.

A patient at our institution was admitted to Labor & Delivery at 41-weeks' gestation for augmentation of early labor for spontaneous rupture of membranes. The anesthesia team placed an epidural catheter and initiated an infusion of bupivacaine with fentanyl for pain management. During nursing shift change several hours later, staff found oxytocin connected to the patient's epidural catheter. A root cause analysis identified that a combination of human error, workflow inefficiencies, and technology challenges contributed to this error. Because the neuraxial and oxytocin infusion bags were the same size, the Department of Pharmacy recommended switching oxytocin infusion bags to a more distinct size. We summarize the literature on inadvertent neuraxial medication infusions, which can lead to devastating consequences. While this patient experienced no adverse effects, we present this case as a cautionary case study to highlight the need for system-level interventions to enhance patient safety.