Hospital Pharmacy最新文献

Background: Postoperative sore throat (POST) is a common complication following endotracheal intubation. Various pharmacological interventions have been explored for POST prevention, with budesonide emerging as a promising option due to its anti-inflammatory properties. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched following PRISMA guidelines. The primary outcomes were POST incidence and severity. Incidence data were pooled using random- or fixed-effects models. Severity analysis focused on budesonide versus saline studies, applying an ordinal logistic regression (mild, moderate, severe) with group assignment as the predictor, and predicted probabilities were computed in R. Results: Budesonide significantly reduced the incidence of POST compared to placebo (OR 0.28, 95% CI: 0.18-0.41, P < .001, I ² = 52%) and no intervention (OR 0.09, 95% CI: 0.05-0.14, P < .001, I ² = 0%). It demonstrated similar efficacy to magnesium sulfate and ketamine (P > .05). Budesonide also reduced POST severity, increasing the likelihood of mild symptoms while decreasing moderate and severe cases (OR 0.46, 95% CI: 0.26-0.81). Additionally, budesonide combined with dexamethasone was more effective than budesonide alone in reducing POST incidence and severity. Conclusion: Preoperative budesonide is an effective prophylactic agent for reducing the incidence and severity of POST. Its localized anti-inflammatory action, cost-effectiveness, and minimal systemic side effects make it a viable option for clinical use. However, variations in dosing and administration require further high quality RCTs to establish standardized guidelines.

Background: The Pharmacist Workload Prioritisation Work Instruction (PWPWI) was developed to optimise clinical pharmacy services, such as best possible medication history (BPMH) completion. Inpatients are assigned a risk category and associated BPMH completion timeframe.

Aim: To determine the proportion of inpatients who met criteria for urgent, high, moderate, and low risk, and the proportion in each category who were reviewed within 24 hours of admission, to inform PWPWI updates.

Method: Clinical, pathologic, medication data, and whether or not the BPMH was completed within 24-hours, was retrospectively collected for inpatients from a single institution and the PWPWI was used to assign risk category.

Results: Data was collected for 280 patients. Prioritisation risk categories were assigned as 3% urgent and requiring immediate review, 61% high risk requiring review within 24-hours, 2% moderate risk requiring review within 48-hours, and 34% low risk. Overall, BPMHs were completed within 24-hours for 54% patients; 50% of the urgent risk individuals, 57% of the high risk, 100% of the moderate risk, and 46% of the low risk.

Conclusion: This study found that nearly two-thirds of patients were urgent or high risk, affecting the completion timeframes. The study's findings, including four key recommendations, will update the PWPWI. Regular evaluations of such tools are suggested to adapt to changes in clinical care and local context. Following the update, the pharmacy department will receive training to optimise BPMH prioritisation.

The Director's Forum Series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. As burnout and workforce turnover continues to rise, pharmacy leaders find themselves in high-stakes interviews that are part performance, part investigation. This article reframes the interview process as an opportunity for candidates to assess the institutional culture, leadership expectations, and long-term alignment. It explores the structure and intent of stakeholder interviews, emphasizes the importance of emotional intelligence and curiosity, and provides a framework for asking strategic questions. A curated appendix offers strategic sample questions tailored to pharmacy leadership roles. Pharmacy administration candidates are encouraged to approach interviews as meaningful opportunities to gather insight and determine whether a role aligns with their values, goals, and leadership vision.

Scleroderma, or systemic sclerosis, is a rare and multifaceted autoimmune disorder characterized by fibrosis of connective tissues, vasculopathy, and autoimmune dysfunction, which often leads to debilitating cutaneous manifestations and digital ulcers. This disease poses significant challenges in both clinical management and patient care, particularly regarding the treatment of associated skin lesions. The pathogenesis of scleroderma involves endothelial damage, impaired vascular function, and the secretion of inflammatory mediators like endothelin-1 (ET1), leading to vasoconstriction and fibrosis. Approximately 30% to 50% of patients experience digital ulcers, which are resistant to healing and have a high risk of infection. The management of these ulcers has evolved with the introduction of advanced wound dressings, which now play a pivotal role in promoting healing and reducing complications. These dressings, such as hydrocolloids, polyurethane foams, charcoal, antimicrobial, collagen, and alginate-based products, are designed to manage various stages of wound healing-from debridement in the inflammatory phase to promoting granulation and epithelialization in later stages. The selection of an appropriate dressing is influenced by factors such as lesion stage, exudate level, presence of infection, and patient comorbidities. The hospital pharmacist is integral to this process, contributing to therapeutic selection, economic evaluation, and overall cost-effectiveness. Advanced dressings, despite their higher initial cost, offer long-term savings by reducing treatment duration and the frequency of dressing changes. The multidisciplinary approach, including the expertise of rheumatologists, pharmacists, nurses, and general practitioners, is essential for providing optimal care for scleroderma patients. This review highlights the significant progress in wound care management for scleroderma and emphasizes the importance of tailored treatments to enhance healing and patient outcomes.

Dasatinib, a Tyrosine kinase inhibitor, functions by preventing an abnormal protein that instructs cancer cells to proliferate. It is used to treat chronic myeloid leukemia in adults who can no longer benefit from other leukemia medications, including imatinib, or those who cannot tolerate first-line medicines due to their side effects. Pleural effusion and pulmonary hypertension induced by the drug dasatinib are uncommon but serious complications that impact the pulmonary vasculature. Here, we describe a series of patients with chronic myeloid leukemia receiving dasatinib who subsequently experienced pleural effusion and pulmonary hypertension. In 2 of the 3 cases, dasatinib was used as first-line therapy, highlighting the importance of recognizing these adverse effects even when it is used upfront rather than solely after failure of first-generation TKIs. The patient's symptoms significantly improved after stopping dasatinib and starting supportive care. This case series emphasizes the need to raise awareness among clinicians, the importance of early recognition, and the timely initiation of alternative treatment to enhance patient outcomes.

Introduction: Stress dose hydrocortisone is recommended in septic shock. Discontinuation can lead to withdrawal after prolonged durations of therapy. There is no guidance on the use of steroid tapers. Our objective was to assess prescribing practices and evaluate stress dose hydrocortisone tapers in septic shock. Methods: Retrospective review of patients admitted to the intensive care unit (ICU), with septic shock, who received hydrocortisone for at least 24 hours from January 1, 2020 through December 31, 2023. The primary outcome was the percentage of patients who received a hydrocortisone taper. Secondary outcomes included duration of stress dose hydrocortisone, method and duration of taper, and rate of increased vasopressors at 24 and 48 hours of hydrocortisone taper initiation or discontinuation. Results: Two hundred seventy-six patients were included. The initial duration of hydrocortisone was 2 (1.5-3) days. One hundred thirty-nine (50.4%) patients received a hydrocortisone taper, with a taper duration of 2 (1-3) days. The primary method of taper was a reduction in frequency (56.8%). Patients who received a taper required an increase in vasopressor rate at 24 (37.4% vs 21.3%, P = .004) and 48 hours (20.3% vs 12.9%; P = .14). The steroid taper group showed a decreased hospital (OR 0.55; 95% CI, 0.33-0.92) and ICU mortality rate (OR 0.47; 95% CI, 0.27-0.81), albeit an increased ICU length of stay (OR 1.04; 95% CI, 1.02-1.06), increased duration of mechanical ventilation (OR 1.08; 95% CI, 1.03-1.12), and increased vasopressor rate at 24 hours (OR 2.21; 95% CI, 1.29-3.77). Conclusions: In patients admitted to an ICU for septic shock started on stress dose hydrocortisone there was heterogeneity in the duration of stress dose hydrocortisone and the implementation, method, and length of a taper. This highlights a need for additional attention to methods of discontinuation of stress dose steroids and implications on patient centered outcomes.

Purpose: This study serves to evaluate the potential benefit of pharmacist intervention in ensuring appropriate treatment of urinary tract infections (UTI) in adult patients in a community hospital. Methods: This was a single-center, quasi-experimental design, institutional review board (IRB)-approved study comparing antimicrobial use and UTI treatment guidance adherence before (11/2021-1/2022) and after (11/2022-1/2023) pharmacist prospective audit and feedback at a community non-teaching hospital. Inpatients were included if they had a positive urine culture and no other concomitant infection or other exclusion criteria. The primary outcome was time to appropriate antibiotic therapy (as determined by the institutional treatment guidance). Overall appropriateness of empiric antimicrobials was also assessed. Results: A total of 194 patients were included in the study (101 pre-intervention group and 86 post). There was no significant difference in median time to appropriate antimicrobial therapy between groups (20.1 vs 22.6 hours, P = .907) or appropriateness of empiric therapy (50% vs 55%, P = .483). Missing indication and agent choice for higher severity infections were the two most common reasons for inappropriate empiric therapy. A total of 55 pharmacist interventions were made with an overall acceptance rate of 31%. Conclusion: In this study, pharmacist intervention did not have a significant effect on the primary outcome. Promotion of utilization of the UTI order set that aligns with the institution guideline would likely improve the appropriateness of empiric therapy. However, the institutional guidance criteria also seemed to over-recommend broad spectrum agents and may need to be revisited.