Journal of Pharmacy Practice and Research最新文献

Aim

The aim of this study was to undertake a systematic review and meta-analysis to determine the effectiveness of oral and sublingual ketamine in pain management.

Data Sources

A systematic search was conducted utilising four databases: MEDLINE, CINAHL, Embase, and Web of Science.

Study Selection

The study included randomised controlled trials investigating the use of oral or sublingual ketamine in the management of pain in inpatient or outpatient settings compared to any alternative oral or sublingual comparator, including placebo.

Results

Twenty-one studies were included for systematic review, all assessing oral ketamine, including one comparing oral to sublingual ketamine. Of these, 12 studies evaluated oral ketamine in procedural pain, with 10 studies finding oral ketamine significantly better than the comparator at reducing procedural pain. Two studies focused on oral ketamine in postoperative pain, both finding oral ketamine reduced the requirement for additional analgesia compared to placebo. Five studies investigated oral ketamine in chronic pain with heterogenous results. Of the remaining two studies, one compared various doses of oral ketamine and the other compared oral to sublingual ketamine.

Fifteen studies were included for meta-analysis. Among them, seven studies compared oral ketamine to placebo and found oral ketamine was superior to placebo in reducing pain (p < 0.01). Eight studies compared oral ketamine to other oral medications such as methadone, codeine, midazolam, and dexmedetomidine and showed no significant benefit of oral ketamine in reducing pain (p = 0.18).

Conclusion

The results suggest oral ketamine is an effective analgesic in the procedural setting.

Background

Recent studies produced conflicting results on the suitability of repackaging dabigatran etexilate (Pradaxa) capsules in dose administration aids (DAAs).

Aim

To determine the stability of Pradaxa capsules in climate zones II (25°C and 60% relative humidity [RH]) and IVa (30°C and 65% RH).

Method

Pradaxa 110 mg capsules were subjected to two storage conditions (25°C/60% RH and 30°C/65% RH) in both the original packaging and after repackaging into Webster packs. Content assay, appearance, pH, and dissolution profile of capsules were determined at baseline, and 2 and 4 weeks after storage. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.

Results

Dabigatran etexilate content (± standard deviation) decreased significantly after 4 weeks of storage in DAAs at 30°C/65% RH (87.7% ± 4.4%). In addition, the amount of dabigatran etexilate released from the capsules at 45 min was significantly lower for capsules repackaged in DAAs and stored at 30°C/65% RH at both time points. Considerable changes in the appearance of capsule content were also observed following storage at 30°C/65% RH for 4 weeks in DAAs. There were no significant changes to dissolution profile or drug content of capsules repackaged and stored at 25°C/60% RH. No significant changes in the pH of dabigatran etexilate solutions were observed.

Conclusion

Repackaging impacts the chemical stability of dabigatran etexilate if the DAAs are exposed to climate zone IVa conditions. Although repackaged dabigatran etexilate stored at 25°C/60% RH appears to be stable, caution should be exercised if these DAAs are to be stored at ambient room conditions due to the inability to guarantee humidity levels.

Background

Unit-dosing medications can improve time to drug administration and patient safety in inpatient settings. No available information supports the practice of unit-dosing for prasugrel.

Aim

The stability of unit-dosed prasugrel tablets was evaluated against tablets maintained in the manufacturer container.

Method

Three lots of 10 mg prasugrel tablets were packaged as individual unit-doses and stored at room temperature. Tablets were analysed for prasugrel concentration over a 90-day period and compared against control tablets retained in the manufacturer's container. Prasugrel was quantified using a previously validated stability-indicating high-performance liquid chromatography method with ultraviolet detection. Experimental lots were monitored for >10% loss of potency. A non-linear one-phase decay curve was used to describe drug potency changes in experimental versus control tablets. Ethics approval was not required for this research article as it was a stability study and did not involve human subjects.

Results

Average potency in all groups remained above 90% for the duration of the study; however, some individual experimental samples dropped below 90% at 7 days. Control tablets did not show a statistically significant potency change until 90 days. Modelling data indicated the ending average potencies in the experimental versus control tablets were 9.083 mg and 9.736 mg, respectively.

Conclusion

Unit-dosing 10 mg prasugrel tablets has a negative effect on potency, which was most pronounced by day 7. The average potency remained above 9.00 mg over the 90-day period. Conservative interpretation of these data may allow institutions to unit-dose prasugrel tablets and discard after 72 h, when individual data points showed <90% potency. The decision to unit-dose prasugrel must consider several factors surrounding patient care and individual institutional standards.

Background

Practice-integrated residency programs are one of the most recognised training platforms for early career development across settings, including hospital pharmacy. They embed a structured education and competency framework and preceptor mentoring systems in the workplace.

Aim

This review aimed to map the global literature on practice-integrated education and professional development programs for early career hospital pharmacists, with a focus on how the programs were implemented and structured.

Design

A search was applied to electronic databases MEDLINE, Ovid Emcare, Embase, ERIC, Scopus, PsycINFO, Cochrane Library, Google Scholar and grey literature sources until 31 December 2023. Search terms were developed in consultation with an academic librarian and using the population, concept and context mnemonic. The scoping review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute scoping review manual.

Results

Forty-seven papers were included from seven countries, with the majority (n = 33) being from the United States of America. Residency program details were mapped against jurisdictions and associated assessment processes, competency training areas, and focused training elements. Findings report similarities and differences of structural, competency frameworks, and locally driven context and requirements.

Conclusion

The demand from early career pharmacists for residency programs remains high, with professional pharmacy organisations providing leadership to grow training positions. The global pharmacy development goals appear to be embedded within the residency programs, but gaps include training in non-direct patient care competencies and research that demonstrates the outcomes from residency training.

Background

The use of a closed system transfer device (CSTD) is recommended when compounding hazardous cytotoxic medicines for operator and environmental protection. The hospital pharmacy compounding unit has used the CSTD PhaSeal since 2014. Recent evidence suggests an alternative CSTD, Equashield, may be a suitable alternative.

Aim

To determine if Equashield provides any advantages financially, in compounding time, rubber bung contamination, cytotoxic medicine surface contamination, staff satisfaction, and work health and safety benefits when compared to PhaSeal.

Method

CSTD PhaSeal was compared to Equashield by performing a financial cost comparison, time in motion study to compare compounding time, evaluation of product contamination rates and cytotoxic surface contamination levels, work health and safety (WH&S) review and staff satisfaction survey. This project was exempt due to the local policy requirements that constitute research by the Children's Health Queensland Research Ethics Committee (Reference no: EX/23/QCHQ/97690). The justification for this ethics exemption was as follows: the study conformed with the Ethical considerations in quality assurance and evaluation activities and met local requirements for a quality assurance activity and did not involve any assessment of staff. Informed consent was obtained from all staff via verbal explanation of the project and their voluntary participation. Staff consented via completion of the voluntary survey.

Results

The cost to compound using Equashield instead of PhaSeal was increased by AUD $4684 over a 6-month period, with a compounding time saving benefit of approximately 1 min per product. Product contamination by rubber stopper core was 16 per 100,000 products using Equashield. Surface cytotoxic contamination levels remained undetectable before and after the comparison. Staff preferred Equashield and a WH&S product review determined Equashield required less torque and force during use and may reduce repetitive strain injury.

Conclusion

Equashield performed better in time to compound, rate of product contamination, staff satisfaction and WH&S assessment. The cost of Equashield was greater; however, Equashield demonstrated benefits over Phaseal in other areas of comparison, which could potentially offset the cost increase. The pharmacy demonstrated Equashield may be a suitable alternative to PhaSea