Pub Date : 2023-10-01Epub Date: 2023-08-29DOI: 10.1177/87551225231195536
Justin P Reinert, Paul Brady
Objective: Acute encephalopathy is a common symptom encountered in critically ill patients and may be associated with Wernicke's encephalopathy (WE) or serotonin syndrome (SS). We describe a patient who presented with clinical manifestations of both WE and SS and who responded to treatment for both pathologies. Case: A 56-year-old male presented after being found unresponsive and in a questionable tonic-clonic state. Past medical history was significant for depression managed with fluoxetine 20 mg by mouth daily and alcohol use disorder. A physical exam revealed severe clonus in the bilateral lower extremities; diffuse hyperreflexia along with akinesia on the left upper extremity; ophthalmoplegia; and persistent tachycardia despite pharmacologic interventions. It was learned that the patient had been taking his fluoxetine 3 times per day rather than daily as prescribed. Oral cyproheptadine was administered at a 12 mg initial dose followed by 4 mg every 6 hours. A thiamine regimen of 500 mg intravenous (IV) every 8 hours in addition to folic acid 1 mg IV every 24 hours was initiated to treat WE. Physical symptoms of both WE and SS resolved within 48 hours, and the patient was ultimately discharged to home in stable condition. Discussion/Conclusions: The clinical diagnosis of both WE and SS in this case is supported by the Caine and Hunter criteria, respectively, as well as the resolution of symptoms with accepted treatment modalities for each. It is important for clinicians to be cognizant of potential overlapping pathologies when patients present with nonspecific symptoms, especially acute encephalopathy, in the intensive care unit.
{"title":"Wernicke's Encephalopathy and Serotonin Syndrome: A Case Report of Overlapping Pathologies.","authors":"Justin P Reinert, Paul Brady","doi":"10.1177/87551225231195536","DOIUrl":"10.1177/87551225231195536","url":null,"abstract":"<p><p><b>Objective:</b> Acute encephalopathy is a common symptom encountered in critically ill patients and may be associated with Wernicke's encephalopathy (WE) or serotonin syndrome (SS). We describe a patient who presented with clinical manifestations of both WE and SS and who responded to treatment for both pathologies. <b>Case:</b> A 56-year-old male presented after being found unresponsive and in a questionable tonic-clonic state. Past medical history was significant for depression managed with fluoxetine 20 mg by mouth daily and alcohol use disorder. A physical exam revealed severe clonus in the bilateral lower extremities; diffuse hyperreflexia along with akinesia on the left upper extremity; ophthalmoplegia; and persistent tachycardia despite pharmacologic interventions. It was learned that the patient had been taking his fluoxetine 3 times per day rather than daily as prescribed. Oral cyproheptadine was administered at a 12 mg initial dose followed by 4 mg every 6 hours. A thiamine regimen of 500 mg intravenous (IV) every 8 hours in addition to folic acid 1 mg IV every 24 hours was initiated to treat WE. Physical symptoms of both WE and SS resolved within 48 hours, and the patient was ultimately discharged to home in stable condition. <b>Discussion/Conclusions:</b> The clinical diagnosis of both WE and SS in this case is supported by the Caine and Hunter criteria, respectively, as well as the resolution of symptoms with accepted treatment modalities for each. It is important for clinicians to be cognizant of potential overlapping pathologies when patients present with nonspecific symptoms, especially acute encephalopathy, in the intensive care unit.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41141856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-19DOI: 10.1177/87551225231194031
Shannon M Carabetta, Bryan Allen, Chad Cannon, Kirubel Hailu, Totty Johnson
Background: Neuromuscular blocking agents are one of the few medication classes that have demonstrated a clinical benefit in patients with severe acute respiratory distress syndrome (ARDS). However, most literature utilized cisatracurium, and utilization of atracurium is limited to 1 small study. Objective: The purpose of this study was to provide further evidence comparing the safety and efficacy of atracurium versus cisatracurium for the treatment of ARDS. Methods: This multicenter, retrospective, observational cohort noninferiority study was conducted at 3 hospitals within a tertiary health care system. We included subjects diagnosed with ARDS who received either atracurium or cisatracurium for at least 12 hours. The primary outcome measured the change in PaO2/FiO2 (P/F) ratio from baseline to 48 hours after initiation. Results: Baseline characteristics were similar between groups except for a higher median age and a higher proportion of subjects who were COVID-positive in the atracurium group. There were also some noted differences in the baseline P/F ratios. In a multivariable model adjusting for baseline characteristics, the change in the P/F ratio for atracurium was noninferior to cisatracurium at 24, 48, and 72 hours. A significant cost reduction, measured as cost per patient per day, was seen with the use of atracurium ($14.81-$25.16 vs $33.86-$41.91). Conclusion: Atracurium appears to be a safe and cheaper alternative agent in the management of ARDS.
{"title":"Atracurium Versus Cisatracurium in the Treatment of Acute Respiratory Distress Syndrome.","authors":"Shannon M Carabetta, Bryan Allen, Chad Cannon, Kirubel Hailu, Totty Johnson","doi":"10.1177/87551225231194031","DOIUrl":"10.1177/87551225231194031","url":null,"abstract":"<p><p><b>Background:</b> Neuromuscular blocking agents are one of the few medication classes that have demonstrated a clinical benefit in patients with severe acute respiratory distress syndrome (ARDS). However, most literature utilized cisatracurium, and utilization of atracurium is limited to 1 small study. <b>Objective:</b> The purpose of this study was to provide further evidence comparing the safety and efficacy of atracurium versus cisatracurium for the treatment of ARDS. <b>Methods:</b> This multicenter, retrospective, observational cohort noninferiority study was conducted at 3 hospitals within a tertiary health care system. We included subjects diagnosed with ARDS who received either atracurium or cisatracurium for at least 12 hours. The primary outcome measured the change in PaO<sub>2</sub>/FiO<sub>2</sub> (P/F) ratio from baseline to 48 hours after initiation. <b>Results:</b> Baseline characteristics were similar between groups except for a higher median age and a higher proportion of subjects who were COVID-positive in the atracurium group. There were also some noted differences in the baseline P/F ratios. In a multivariable model adjusting for baseline characteristics, the change in the P/F ratio for atracurium was noninferior to cisatracurium at 24, 48, and 72 hours. A significant cost reduction, measured as cost per patient per day, was seen with the use of atracurium ($14.81-$25.16 vs $33.86-$41.91). <b>Conclusion:</b> Atracurium appears to be a safe and cheaper alternative agent in the management of ARDS.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-09-02DOI: 10.1177/87551225231196047
Surafel G Mulugeta, Nancy C MacDonald, Caren J El-Khoury, Susan L Davis, Rachel M Kenney
Background: Inability to access and afford discharge oral antimicrobials may delay discharges or result in therapeutic failure. "Test-claims" have the potential to identify such barriers. Objective: This study evaluated discharge antimicrobial access and patient outcomes after implementation of a standardized, inpatient pharmacist-initiated antimicrobial discharge medication cost inquiry (aDMCI) process. Methods: This was an Institutional Review Board (IRB)-approved, pilot retrospective cohort study that included adults admitted for ≥72 hours from November 1, 2018, to February 28, 2019, and discharged on oral antimicrobials. Patients with a cost inquiry (aDMCI group) were compared with those without (standard-of-care, SOC, group). Primary endpoint was discharge delay. Secondary endpoints included percentage of patients discharged on suboptimal antimicrobials and medication errors from aDMCI. Results: 84 patients were included: 43 in SOC and 41 in aDMCI. Seventy-five antimicrobial cost inquiries were evaluated among 41 patients. There were no discharge delays or medication errors associated with the standardized "test-claim" (aDMCI) workflow. Patients in the SOC group had a greater Charlson Comorbidity Index (4 [2-6] vs 2 [1-4], P =0.004), were more likely to be immunosuppressed (24, 56% vs 12, 29%; P =0.014), and had longer hospitalization (8 [5-15] vs 6 [5-9] days, P =0.026). Primary access barriers were prior-authorization (8, 11%) and associated with linezolid and moxifloxacin cost inquiries. Most aDMCIs results were available in <24 hours (66, 88%). Conclusions: The aDMCI process is safe and offers an actionable transition of care tool that can identify barriers to accessing discharge medications while insulating patients from surprise out-of-pocket cost.
{"title":"Impact of a Standardized, Pharmacist-Initiated \"Test-Claim\" Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials.","authors":"Surafel G Mulugeta, Nancy C MacDonald, Caren J El-Khoury, Susan L Davis, Rachel M Kenney","doi":"10.1177/87551225231196047","DOIUrl":"10.1177/87551225231196047","url":null,"abstract":"<p><p><b>Background:</b> Inability to access and afford discharge oral antimicrobials may delay discharges or result in therapeutic failure. \"Test-claims\" have the potential to identify such barriers. <b>Objective:</b> This study evaluated discharge antimicrobial access and patient outcomes after implementation of a standardized, inpatient pharmacist-initiated antimicrobial discharge medication cost inquiry (aDMCI) process. <b>Methods:</b> This was an Institutional Review Board (IRB)-approved, pilot retrospective cohort study that included adults admitted for ≥72 hours from November 1, 2018, to February 28, 2019, and discharged on oral antimicrobials. Patients with a cost inquiry (aDMCI group) were compared with those without (standard-of-care, SOC, group). Primary endpoint was discharge delay. Secondary endpoints included percentage of patients discharged on suboptimal antimicrobials and medication errors from aDMCI. <b>Results:</b> 84 patients were included: 43 in SOC and 41 in aDMCI. Seventy-five antimicrobial cost inquiries were evaluated among 41 patients. There were no discharge delays or medication errors associated with the standardized \"test-claim\" (aDMCI) workflow. Patients in the SOC group had a greater Charlson Comorbidity Index (4 [2-6] vs 2 [1-4], <i>P =</i>0.004), were more likely to be immunosuppressed (24, 56% vs 12, 29%; <i>P =</i>0.014), and had longer hospitalization (8 [5-15] vs 6 [5-9] days, <i>P =</i>0.026). Primary access barriers were prior-authorization (8, 11%) and associated with linezolid and moxifloxacin cost inquiries. Most aDMCIs results were available in <24 hours (66, 88%). <b>Conclusions:</b> The aDMCI process is safe and offers an actionable transition of care tool that can identify barriers to accessing discharge medications while insulating patients from surprise out-of-pocket cost.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-29DOI: 10.1177/87551225231195216
Anna Barraquer Comes, Pedro Roy Millán
Background: The increasing utilization of proton pump inhibitors (PPIs) in patients without clear medical indications has raised concerns regarding potential risks, highlighting the importance of deprescription. However, comparative analyses of withdrawal strategies (abrupt vs gradual) in this context remain scarce or of low quality. Aim: This study aimed to evaluate the success rate of deprescribing PPIs in hospitalized patients without a documented indication and compare the proportion of treatment restarts based on withdrawal strategy. Method: An uncontrolled, open-label prospective observational study was conducted on patients receiving PPI treatment during hospital admission between May 2017 and July 2018. Deprescription was recommended for patients without a clear indication. Follow-up continued until discharge, with monitoring for rebound symptoms. The percentage of restarts based on the withdrawal strategy was compared using the chi-square test. Results: A total of 402 patients were reviewed, among whom 27% lacked a medical indication (mean age > 60 years, polymedicated), while 70% were prescribed PPIs electronically. Deprescription was performed in 49% of patients, with 64% undergoing abrupt withdrawal. Rebound symptoms led to treatment restart in 15% of cases. However, the chi-square test revealed no significant differences in restart proportions between the abrupt and gradual withdrawal groups (P = 0.365). Conclusion: Deprescribing PPIs is deemed safe, particularly for polymedicated geriatric patients, as it leads to a low percentage of restarts regardless of the chosen withdrawal strategy. However, the high percentage of PPI prescription without a clear indication underlines the need for periodic reassessment to avoid unnecessary risks and overuse.
{"title":"Proton Pump Inhibitor Deprescription Prospective Study in Patients Without Indication: Are There Differences in Proportion of Restarts According to Withdrawal Strategy?","authors":"Anna Barraquer Comes, Pedro Roy Millán","doi":"10.1177/87551225231195216","DOIUrl":"10.1177/87551225231195216","url":null,"abstract":"<p><p><b>Background:</b> The increasing utilization of proton pump inhibitors (PPIs) in patients without clear medical indications has raised concerns regarding potential risks, highlighting the importance of deprescription. However, comparative analyses of withdrawal strategies (abrupt vs gradual) in this context remain scarce or of low quality. <b>Aim:</b> This study aimed to evaluate the success rate of deprescribing PPIs in hospitalized patients without a documented indication and compare the proportion of treatment restarts based on withdrawal strategy. <b>Method:</b> An uncontrolled, open-label prospective observational study was conducted on patients receiving PPI treatment during hospital admission between May 2017 and July 2018. Deprescription was recommended for patients without a clear indication. Follow-up continued until discharge, with monitoring for rebound symptoms. The percentage of restarts based on the withdrawal strategy was compared using the chi-square test. <b>Results:</b> A total of 402 patients were reviewed, among whom 27% lacked a medical indication (mean age > 60 years, polymedicated), while 70% were prescribed PPIs electronically. Deprescription was performed in 49% of patients, with 64% undergoing abrupt withdrawal. Rebound symptoms led to treatment restart in 15% of cases. However, the chi-square test revealed no significant differences in restart proportions between the abrupt and gradual withdrawal groups (<i>P</i> = 0.365). <b>Conclusion:</b> Deprescribing PPIs is deemed safe, particularly for polymedicated geriatric patients, as it leads to a low percentage of restarts regardless of the chosen withdrawal strategy. However, the high percentage of PPI prescription without a clear indication underlines the need for periodic reassessment to avoid unnecessary risks and overuse.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-17DOI: 10.1177/87551225231190567
Chukwuemeka Augustine Nwachuya, Anthony Uche Umeh, Jennifer Chinaza Ogwurumba, Ifunanya Ngozi Chinedu-Eze, Chukwunenye Christopher Azubuike, AbdulMuminu Isah
Objectives: This review examined the effectiveness of telepharmacy in rural communities in Africa to identify the barriers that hinder its implementation and integration as well as highlight the gaps in the existing research on telepharmacy. Data Source: PubMed and Google Scholar search (2008-2023) was conducted using keywords related to telepharmacy, telemedicine, telehealth, and rural communities. Study Selection and Data Extraction: The inclusion criteria for the review include peer-reviewed articles published in English language and studies that focus on the implementation and evaluation of telepharmacy in rural communities. Data Synthesis: In all articles used, access to quality health care in rural communities has been a persistent challenge in Africa. Digital technologies such as telemedicine, telepharmacy, and artificial intelligence were reported to have emerged as promising solutions to improve health care access and outcomes in rural communities. Telepharmacy, in particular, has the potential to provide medication-related services to patients irrespective of one's location. However, the implementation of telepharmacy in Africa has been slow, and there are several barriers affecting its integration and adoption in rural communities that include access to technology, limited infrastructure, and regulatory challenges. Gaps and limitations in the existing research on telepharmacy in rural communities were highlighted from the articles. Conclusion: Telepharmacy can improve health care access and outcomes in rural communities by bridging the gap between pharmacists and patients. However, the lack of infrastructure, inadequate funding, and regulatory challenges pose significant barriers to its implementation. Future research should focus on addressing these challenges and exploring the potential of telepharmacy to improve health care in rural communities in Africa.
{"title":"Effectiveness of Telepharmacy in Rural Communities in Africa: A Scoping Review.","authors":"Chukwuemeka Augustine Nwachuya, Anthony Uche Umeh, Jennifer Chinaza Ogwurumba, Ifunanya Ngozi Chinedu-Eze, Chukwunenye Christopher Azubuike, AbdulMuminu Isah","doi":"10.1177/87551225231190567","DOIUrl":"10.1177/87551225231190567","url":null,"abstract":"<p><p><b>Objectives:</b> This review examined the effectiveness of telepharmacy in rural communities in Africa to identify the barriers that hinder its implementation and integration as well as highlight the gaps in the existing research on telepharmacy. <b>Data Source:</b> PubMed and Google Scholar search (2008-2023) was conducted using keywords related to telepharmacy, telemedicine, telehealth, and rural communities. <b>Study Selection and Data Extraction:</b> The inclusion criteria for the review include peer-reviewed articles published in English language and studies that focus on the implementation and evaluation of telepharmacy in rural communities. <b>Data Synthesis:</b> In all articles used, access to quality health care in rural communities has been a persistent challenge in Africa. Digital technologies such as telemedicine, telepharmacy, and artificial intelligence were reported to have emerged as promising solutions to improve health care access and outcomes in rural communities. Telepharmacy, in particular, has the potential to provide medication-related services to patients irrespective of one's location. However, the implementation of telepharmacy in Africa has been slow, and there are several barriers affecting its integration and adoption in rural communities that include access to technology, limited infrastructure, and regulatory challenges. Gaps and limitations in the existing research on telepharmacy in rural communities were highlighted from the articles. <b>Conclusion:</b> Telepharmacy can improve health care access and outcomes in rural communities by bridging the gap between pharmacists and patients. However, the lack of infrastructure, inadequate funding, and regulatory challenges pose significant barriers to its implementation. Future research should focus on addressing these challenges and exploring the potential of telepharmacy to improve health care in rural communities in Africa.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-19DOI: 10.1177/87551225231193057
Rithi J Chandy, Diem-Phuong D Dao, Cristian C Rivis, Divya M Shan, Steven R Feldman
Objective: The objective was to compare the safety and efficacy of noncorticosteroid topical treatments for plaque psoriasis. Data Sources: A literature search of the PubMed database was performed (January 1978 to May 2023) using the keywords plaque psoriasis, tapinarof, benvitimod, Vtama, roflumilast, Zoryve, pimecrolimus, tacrolimus, tazarotene, tacalcitol, calcitriol, Vectical, calcipotriene, Dovonex, tacalcitol, vitamin D analogs, salicylic acid, non-corticosteroid topical, Investigator's Global Assessment, and Physician's Global Assessment. Study Selection and Data Extraction: Relevant English-language articles and clinical trial data were considered. Data Synthesis: Six noncorticosteroid topical classes for the treatment of plaque psoriasis were selected. The percentage of patients with plaque psoriasis who achieved Investigator's Global Assessment (IGA) success after 8 weeks of treatment with tacalcitol, calcipotriene/betamethasone dipropionate compound, tazarotene/halobetasol propionate, and roflumilast was 17.9%, 39.9%, 40.7%, and 42.4%, respectively. For 12-week trials of tapinarof and coal tar, 37.4% and 58.2% of patients achieved IGA success, respectively. There were 48% and 71.4% reductions in IGA scores with salicylic acid (12 weeks) and pimecrolimus (4 weeks), respectively. Finally, 66.7% of patients achieved Physician's Global Assessment success with 8 weeks of tacrolimus. There were no serious adverse events for the noncorticosteroid topicals. Conclusion: Noncorticosteroid topicals are suitable options for patients with plaque psoriasis who would like to avoid topical corticosteroids or have experienced adverse effects from chronic corticosteroid use. Due to treatment duration differences and varied outcome measures, it is unclear which noncorticosteroid topical is most efficacious; however, calcineurin inhibitors appear to exhibit the greatest efficacy. Each topical was efficacious in treating plaque psoriasis and had an adequate safety profile. Despite several treatment options for plaque psoriasis, medication adherence is a limiting factor.
{"title":"Noncorticosteroid Topical Therapies for the Treatment of Plaque Psoriasis: A Narrative Review.","authors":"Rithi J Chandy, Diem-Phuong D Dao, Cristian C Rivis, Divya M Shan, Steven R Feldman","doi":"10.1177/87551225231193057","DOIUrl":"10.1177/87551225231193057","url":null,"abstract":"<p><p><b>Objective:</b> The objective was to compare the safety and efficacy of noncorticosteroid topical treatments for plaque psoriasis. <b>Data Sources:</b> A literature search of the PubMed database was performed (January 1978 to May 2023) using the keywords <i>plaque psoriasis</i>, <i>tapinarof, benvitimod, Vtama, roflumilast, Zoryve, pimecrolimus, tacrolimus, tazarotene, tacalcitol, calcitriol, Vectical, calcipotriene, Dovonex, tacalcitol, vitamin D analogs, salicylic acid, non-corticosteroid topical, Investigator's Global Assessment</i>, and <i>Physician's Global Assessment</i>. <b>Study Selection and Data Extraction:</b> Relevant English-language articles and clinical trial data were considered. <b>Data Synthesis:</b> Six noncorticosteroid topical classes for the treatment of plaque psoriasis were selected. The percentage of patients with plaque psoriasis who achieved Investigator's Global Assessment (IGA) success after 8 weeks of treatment with tacalcitol, calcipotriene/betamethasone dipropionate compound, tazarotene/halobetasol propionate, and roflumilast was 17.9%, 39.9%, 40.7%, and 42.4%, respectively. For 12-week trials of tapinarof and coal tar, 37.4% and 58.2% of patients achieved IGA success, respectively. There were 48% and 71.4% reductions in IGA scores with salicylic acid (12 weeks) and pimecrolimus (4 weeks), respectively. Finally, 66.7% of patients achieved Physician's Global Assessment success with 8 weeks of tacrolimus. There were no serious adverse events for the noncorticosteroid topicals. <b>Conclusion:</b> Noncorticosteroid topicals are suitable options for patients with plaque psoriasis who would like to avoid topical corticosteroids or have experienced adverse effects from chronic corticosteroid use. Due to treatment duration differences and varied outcome measures, it is unclear which noncorticosteroid topical is most efficacious; however, calcineurin inhibitors appear to exhibit the greatest efficacy. Each topical was efficacious in treating plaque psoriasis and had an adequate safety profile. Despite several treatment options for plaque psoriasis, medication adherence is a limiting factor.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41124344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-08-29DOI: 10.1177/87551225231194027
Riley J Larson, Ann M Philbrick, Caroline S Carlin, Ila M Harris
Objective: To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). Research Design and Methods: A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An "index date" was identified as the start of CGM. The closest hemoglobin A1c (A1c) 6 months or more after the index date was identified as the "follow-up date." The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. Results: Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference -1.4%; p < 0.001), with 41.7% of the population meeting goal (mean difference +25%; p < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. Conclusion: A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.
目的:确定个人连续血糖监测(CGM)在不同2型糖尿病(T2D)人群中的临床效果。研究设计和方法:根据2019年1月1日至2022年2月23日期间在城市家庭医学诊所开具CGM处方的成年人的电子健康记录创建了一份报告。一个“索引日期”被确定为CGM的开始。最接近的血红蛋白A1c(A1c)6 本研究的主要结果是比较符合MN社区测量(MNCM)D5 HbA1c目标的个体百分比。结果:应用排除标准后,确定了72名患者。大约三分之一的患者需要使用口译员,76%的患者是少数种族或族裔。使用CGM前的平均HbA1c为9.8%,16.7%的人群达到了MNCM D5 A1c的目标 p 结论:T2D的不同人群A1c显著降低,更有可能达到MNCM D5 A1c的目标
{"title":"Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes.","authors":"Riley J Larson, Ann M Philbrick, Caroline S Carlin, Ila M Harris","doi":"10.1177/87551225231194027","DOIUrl":"10.1177/87551225231194027","url":null,"abstract":"<p><p><b>Objective:</b> To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). <b>Research Design and Methods:</b> A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An \"index date\" was identified as the start of CGM. The closest hemoglobin A<sub>1c</sub> (A1c) 6 months or more after the index date was identified as the \"follow-up date.\" The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. <b>Results:</b> Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference -1.4%; <i>p</i> < 0.001), with 41.7% of the population meeting goal (mean difference +25%; <i>p</i> < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. <b>Conclusion:</b> A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/87551225231179585
Dhaval Rathod, Zhengming Chen, Christine M Slover, Frank Kung, Junichi Morita, Sean T Nguyen
Background: Cost-effective and convenient modalities are required to facilitate the administration of antibiotics in hospital and outpatient settings. Objective: This study investigated the physical compatibility of the MINI-BAG Plus Container System and VIAL-MATE Adaptor with the 1 g drug product vials used for cefiderocol. Methods: Qualitative testing of the MINI-BAG Plus Container System (50 and 100 mL of 5% dextrose injection or 0.9% sodium chloride injection), using empty vials and vials containing lyophilized cefiderocol powder, was conducted in triplicate on MINI-BAGs that were hung and observed over 3 hours. Connection security between empty vials and the VIAL-MATE Adaptor was assessed in triplicate. Results: All predefined physical compatibility criteria between cefiderocol 1 g vials and the MINI-BAG Plus Container System were met, including a secure connection, successful multiple transfers of solution between vial and bag, successful reconstitution of cefiderocol, and lack of leaking into the vial or from the connections. There was no particulate matter in the prepared solution and no precipitation or discoloration. Secure connections between the VIAL-MATE Adaptor and cefiderocol vials were demonstrated. Conclusion and Relevance: Use of these systems is relevant even where resources are limited and may increase the efficiency of cefiderocol administration in hospitals, outpatient settings, or long-term healthcare facilities.
背景:需要具有成本效益和方便的方式来促进医院和门诊环境中的抗生素管理。目的:研究MINI-BAG Plus容器系统和VIAL-MATE适配器与头孢地罗1g制剂瓶的物理相容性。方法:采用MINI-BAG Plus容器系统(50、100 mL 5%葡萄糖注射液或0.9%氯化钠注射液),用空瓶和装头孢地罗干粉的小瓶进行定性检测,一式三份,在MINI-BAG上悬挂观察3小时。空瓶与VIAL-MATE适配器之间的连接安全性进行了三次评估。结果:cefiderocol 1g瓶与MINI-BAG Plus容器系统之间的所有预先定义的物理兼容性标准均得到满足,包括安全连接、溶液在瓶和袋之间成功多次转移、cefiderocol成功重构、没有泄漏到瓶中或从连接处泄漏。制备的溶液中无颗粒物质,无沉淀、无变色。演示了VIAL-MATE适配器和cefiderocol小瓶之间的安全连接。结论和相关性:即使在资源有限的地方,使用这些系统也是相关的,并且可能提高医院、门诊机构或长期医疗机构头孢地罗给药的效率。
{"title":"Cefiderocol For Injection: Compatibility Testing Using the MINI-BAG Plus Container System and the VIAL-MATE Adaptor.","authors":"Dhaval Rathod, Zhengming Chen, Christine M Slover, Frank Kung, Junichi Morita, Sean T Nguyen","doi":"10.1177/87551225231179585","DOIUrl":"https://doi.org/10.1177/87551225231179585","url":null,"abstract":"<p><p><b>Background:</b> Cost-effective and convenient modalities are required to facilitate the administration of antibiotics in hospital and outpatient settings. <b>Objective:</b> This study investigated the physical compatibility of the MINI-BAG Plus Container System and VIAL-MATE Adaptor with the 1 g drug product vials used for cefiderocol. <b>Methods:</b> Qualitative testing of the MINI-BAG Plus Container System (50 and 100 mL of 5% dextrose injection or 0.9% sodium chloride injection), using empty vials and vials containing lyophilized cefiderocol powder, was conducted in triplicate on MINI-BAGs that were hung and observed over 3 hours. Connection security between empty vials and the VIAL-MATE Adaptor was assessed in triplicate. <b>Results:</b> All predefined physical compatibility criteria between cefiderocol 1 g vials and the MINI-BAG Plus Container System were met, including a secure connection, successful multiple transfers of solution between vial and bag, successful reconstitution of cefiderocol, and lack of leaking into the vial or from the connections. There was no particulate matter in the prepared solution and no precipitation or discoloration. Secure connections between the VIAL-MATE Adaptor and cefiderocol vials were demonstrated. <b>Conclusion and Relevance:</b> Use of these systems is relevant even where resources are limited and may increase the efficiency of cefiderocol administration in hospitals, outpatient settings, or long-term healthcare facilities.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/f4/10.1177_87551225231179585.PMC10387812.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01Epub Date: 2023-06-19DOI: 10.1177/87551225231179327
Apryl N Peddi, Heidi N Eukel, Brittney A Meyer, Lauren M Caldas
Background: Drug utilization review (DUR) skills are important for pharmacists across all settings. Computer-based DUR simulations to teach student pharmacists are currently scarce. This article describes a computer-based DUR simulation that required limited faculty and financial resources and was implemented in collaboration among 3 institutions. Objective: To describe the innovation of a computer-based DUR simulation and its impact on pharmacy students' knowledge and confidence of DUR skills. Methods: This pre-post educational study assessed a computer-based DUR simulation that replicated the DUR process in dispensing systems. First- and third-year pharmacy students at 3 institutions were guided through simulated patient cases with various medication-related problems. The self-paced activity provided students with immediate, formative feedback and rationale for each option after an attempt was made in lieu of faculty intervention. Students completed pre-and post-assessments to evaluate changes in knowledge and confidence. Knowledge was assessed by comparing results of multiple choice and matching questions on the pre- and post-assessments. Confidence was assessed by the change in self-reported confidence scale measurements. Results: Students at all institutions (N = 405) had nonsignificant changes in knowledge scores from the pre-assessment to the post-assessment, with the exception of 1 question. All confidence survey questions significantly improved from pre- to post-assessment. Conclusion: The DUR educational innovation had a nonsignificant overall impact on students' knowledge but significantly improved confidence in their abilities. Skills-based instruction provides additional practice to increase student confidence.
{"title":"Teaching Independent Decision-Making Through a Computer-Based Drug Utilization Review Simulation.","authors":"Apryl N Peddi, Heidi N Eukel, Brittney A Meyer, Lauren M Caldas","doi":"10.1177/87551225231179327","DOIUrl":"10.1177/87551225231179327","url":null,"abstract":"<p><p><b>Background:</b> Drug utilization review (DUR) skills are important for pharmacists across all settings. Computer-based DUR simulations to teach student pharmacists are currently scarce. This article describes a computer-based DUR simulation that required limited faculty and financial resources and was implemented in collaboration among 3 institutions. <b>Objective:</b> To describe the innovation of a computer-based DUR simulation and its impact on pharmacy students' knowledge and confidence of DUR skills. <b>Methods:</b> This pre-post educational study assessed a computer-based DUR simulation that replicated the DUR process in dispensing systems. First- and third-year pharmacy students at 3 institutions were guided through simulated patient cases with various medication-related problems. The self-paced activity provided students with immediate, formative feedback and rationale for each option after an attempt was made in lieu of faculty intervention. Students completed pre-and post-assessments to evaluate changes in knowledge and confidence. Knowledge was assessed by comparing results of multiple choice and matching questions on the pre- and post-assessments. Confidence was assessed by the change in self-reported confidence scale measurements. <b>Results:</b> Students at all institutions (N = 405) had nonsignificant changes in knowledge scores from the pre-assessment to the post-assessment, with the exception of 1 question. All confidence survey questions significantly improved from pre- to post-assessment. <b>Conclusion:</b> The DUR educational innovation had a nonsignificant overall impact on students' knowledge but significantly improved confidence in their abilities. Skills-based instruction provides additional practice to increase student confidence.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9926268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01Epub Date: 2023-06-28DOI: 10.1177/87551225231182543
Abigail L Hulsizer, Sondra Davis, Caitlin M Gibson
Background: Ischemic stroke is the leading cause of long-term disability in the United States. To reduce the likelihood of debilitating outcomes, early treatment with fibrinolytics is necessary; however, many struggle to identify strategies that limit time to treatment. The purpose of this study is to identify if implementing a process for obtaining laboratory blood draws by emergency medical services (EMS) prior to patient arrival at the hospital will reduce the door-to-needle time for patients arriving with acute ischemic stroke. Objectives: To compare the door-to-needle time for patients with acute ischemic stroke who had blood drawn via EMS versus in hospital. Methods: This single-center, retrospective cohort study was conducted from 2015 to 2017 at a 433-bed designated Level II Trauma Center and Comprehensive Stroke Center community hospital. A comprehensive chart review was done via stroke coordinator binders and electronic medical record. Adult patients ≥18 years of age with an acute ischemic stroke diagnosis who met criteria for and received alteplase were included in the study. Patients were excluded if they did not arrive via EMS. The primary end point assessed time to fibrinolytic treatment via door-to-needle times. Results: A total of 66 patients were included with 28 in the EMS laboratory drawn group and 38 in the usual group. Median door-to-needle time was 57.5 ± 19.0 minutes in the EMS group and 55.0 ± 31.9 minutes in the usual care group (p = 0.818). Conclusions: Collection of blood for laboratories by EMS personnel did not significantly shorten door-to-needle time.
{"title":"Does Emergency Medical Services Blood Collection Shorten Time to Tissue Plasminogen Activator in Ischemic Stroke?","authors":"Abigail L Hulsizer, Sondra Davis, Caitlin M Gibson","doi":"10.1177/87551225231182543","DOIUrl":"10.1177/87551225231182543","url":null,"abstract":"<p><p><b>Background:</b> Ischemic stroke is the leading cause of long-term disability in the United States. To reduce the likelihood of debilitating outcomes, early treatment with fibrinolytics is necessary; however, many struggle to identify strategies that limit time to treatment. The purpose of this study is to identify if implementing a process for obtaining laboratory blood draws by emergency medical services (EMS) prior to patient arrival at the hospital will reduce the door-to-needle time for patients arriving with acute ischemic stroke. <b>Objectives:</b> To compare the door-to-needle time for patients with acute ischemic stroke who had blood drawn via EMS versus in hospital. <b>Methods:</b> This single-center, retrospective cohort study was conducted from 2015 to 2017 at a 433-bed designated Level II Trauma Center and Comprehensive Stroke Center community hospital. A comprehensive chart review was done via stroke coordinator binders and electronic medical record. Adult patients ≥18 years of age with an acute ischemic stroke diagnosis who met criteria for and received alteplase were included in the study. Patients were excluded if they did not arrive via EMS. The primary end point assessed time to fibrinolytic treatment via door-to-needle times. <b>Results:</b> A total of 66 patients were included with 28 in the EMS laboratory drawn group and 38 in the usual group. Median door-to-needle time was 57.5 ± 19.0 minutes in the EMS group and 55.0 ± 31.9 minutes in the usual care group (<i>p</i> = 0.818). <b>Conclusions:</b> Collection of blood for laboratories by EMS personnel did not significantly shorten door-to-needle time.</p>","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10666602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}