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D-Penicillamine Induced Myelotoxicity: A Unique Case. d -青霉胺诱导骨髓毒性:一个独特的案例。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-11 DOI: 10.1177/08971900241308626
Aliya Abdulla, Aryan Rezvani, Christopher Nelsen, Mariah I Sigala

Purpose: A case of D-penicillamine-related myelotoxicity in a patient with Wilson's disease is reported. Summary: There is a paucity of literature regarding D-penicillamine (DPA) induced myelotoxicity in the setting of Wilson's disease (WD). A 22-year-old male presented with a 1-week history of bleeding gums and dizziness. Four months prior, he had been diagnosed with Wilson's disease and started on a regimen of DPA. His blood counts demonstrated profound pancytopenia. Due to concern for suspected drug-induced myelotoxicity, DPA was discontinued. Parvovirus B19, Epstein-Barr virus, cytomegalovirus, and varicella zoster virus polymerase chain reaction studies were negative and there was no evidence of hematological malignancy. Bone marrow biopsy demonstrated hypocellularity and trilineage hypoplasia with corresponding aspirate flow cytometry confirming the absence of acute leukemia. The patient was started on subcutaneous granulocyte-colony stimulating factor, provided transfusion support with packed red blood cells and platelets. Despite these measures, his blood count failed to recover, and he was discharged on eltrombopag 150 mg daily with plans for outpatient transfusion support. DPA was permanently discontinued, and he was prescribed trientine 750 mg daily. Unfortunately, his myelotoxicity remained consistent, requiring regular transfusions. He is currently undergoing evaluation for bone marrow transplant. Conclusion: DPA-induced myelotoxicity is a rare clinical entity. Our case demonstrates a unique clinical presentation of this phenomenon. Guidelines to mitigate the risk of and treat this toxicity remain to be determined.

目的:报告1例肝豆状核变性患者发生d -青霉胺相关髓毒性。摘要:关于威尔森氏病(WD)中d -青霉胺(DPA)诱导的骨髓毒性的文献很少。22岁男性,牙龈出血及头晕病史1周。四个月前,他被诊断出患有威尔逊氏病,并开始接受DPA治疗。他的血细胞计数显示严重的全血细胞减少症。由于担心可能引起药物性骨髓毒性,DPA已停止使用。细小病毒B19、eb病毒、巨细胞病毒和水痘带状疱疹病毒聚合酶链反应研究均为阴性,没有血液恶性肿瘤的证据。骨髓活检显示细胞增生和三期发育不全,相应的吸流式细胞术证实没有急性白血病。患者开始使用皮下粒细胞集落刺激因子,并提供红细胞和血小板填充输血支持。尽管采取了这些措施,他的血细胞计数未能恢复,他出院时每天服用150毫克的电子波巴,并计划门诊输血支持。他永久停用了DPA,并给他开了每天750毫克的曲恩汀。不幸的是,他的骨髓毒性持续存在,需要定期输血。他目前正在接受骨髓移植的评估。结论:dpa引起的骨髓毒性是一种罕见的临床疾病。我们的病例显示了这种现象的独特临床表现。减轻这种毒性的风险和治疗的指南仍有待确定。
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引用次数: 0
Real World Data of Viral Suppression With Darunavir/Cobicistat and Dolutegravir/Rilpivirine Among Treatment-Experienced Patients Living With Multidrug-Resistant HIV. 有治疗经验的耐多药 HIV 感染者使用 Darunavir/Cobicistat 和 Dolutegravir/Rilpivirine 抑制病毒的实际数据。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-04-29 DOI: 10.1177/08971900241247618
Preethi S Samuel, Folake Olaleye, Maria Longo, Leonard Berkowitz

Background: Despite the effectiveness of the TRIO regimen in maintaining viral suppression, as seen in the ANRS 139 TRIO trial, one drawback is the high pill burden. However, with the development of newer antiretrovirals, this regimen can be simplified. The combination of both co-formulated darunavir/cobicistat and dolutegravir/rilpivirine keeps the integrity of the TRIO regimen while decreasing daily pill count from 12 to 2 tablets daily. The purpose of this case series is to demonstrate the efficacy of this regimen as there is a current lack of data. Methods: This case series included patients with no resistance to dolutegravir, rilpivirine, or darunavir, who were switched to the modified TRIO regimen between June 1st 2018 to June 1st 2022. The primary outcome was the proportion of patients with plasma HIV-RNA levels <50 copies/mL by 24 weeks. Results: At week 24, all patients (n = 9) had a HIV-RNA <50 copies/mL. At week 48, one patient did not have a VL available. However, out of the remaining 8 patients, all maintained an HIV-RNA of <50 copies/mL at week 48. Conclusion: HIV-RNA levels remained suppressed when patients were switched to the modified TRIO regimen. In addition, the pill burden was reduced which can add to overall patient satisfaction.

背景:尽管从 ANRS 139 TRIO 试验中可以看出,TRIO 方案在维持病毒抑制方面非常有效,但其缺点之一是药片负担较重。不过,随着新型抗逆转录病毒药物的开发,这种治疗方案可以简化。达鲁那韦/考比司他联合制剂和多罗替韦/利匹韦林联合制剂既保持了 TRIO 方案的完整性,又将每日药片数从 12 片减少到 2 片。由于目前缺乏相关数据,本系列病例旨在证明该方案的疗效。治疗方法本病例系列包括对多罗替拉韦、利匹韦林或达鲁那韦无耐药性的患者,他们在2018年6月1日至2022年6月1日期间改用改良TRIO方案。主要研究结果是血浆 HIV-RNA 水平的患者比例:第24周时,所有患者(n = 9)的HIV-RNA均有结论:患者改用改良 TRIO 方案后,HIV-RNA 水平仍然得到抑制。此外,患者的服药负担也减轻了,从而提高了患者的整体满意度。
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引用次数: 0
Management and Pharmacological Treatment of Peripheral Arterial Disease. 外周动脉疾病的管理和药物治疗。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-01 DOI: 10.1177/08971900241250084
Samantha J Leatham, Karl R Winckel, Keshia R De Guzman

Background: Peripheral arterial disease (PAD) is a complex, heterogeneous condition that has become a leading health concern globally. Peripheral arterial disease often co-exists with other vascular disease states, including cerebrovascular and cardiovascular disease. Optimal therapy for managing symptoms and progression of disease employs non-pharmacological, pharmacological, and contemporary revascularisation techniques to improve clinical outcomes and quality of life. However, large well-designed randomised control trials (RCT) and corresponding evidence-based guidelines for management of PAD are lacking, with current practice standards often extrapolated from evidence in coronary artery disease. Purpose: This review article aims to discuss currently accepted best pharmacological practice for PAD. Method: Relevant articles were searched between May 2023 and January 2024 through PubMed, Cochrane Library, Google Scholar and international guidelines, focusing on pharmacological management for PAD. Results: This narrative review discusses holistic pharmacological treatments for PAD.

背景:外周动脉疾病(PAD)是一种复杂的异质性疾病,已成为全球关注的主要健康问题。外周动脉疾病通常与其他血管疾病并存,包括脑血管疾病和心血管疾病。控制症状和疾病进展的最佳疗法包括非药物疗法、药物疗法和现代血管重建技术,以改善临床疗效和生活质量。目的:这篇综述文章旨在讨论目前公认的 PAD 最佳药物治疗方法:方法:在 2023 年 5 月至 2024 年 1 月期间,通过 PubMed、Cochrane 图书馆、谷歌学术和国际指南检索相关文章,重点关注 PAD 的药物治疗:这篇叙述性综述讨论了 PAD 的整体药物治疗。
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引用次数: 0
Evaluation of Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitor Prescribing Patterns in Heart Failure Patients at Hospital Discharge. 评估心衰患者出院时钠糖转运蛋白 2 (SGLT2) 抑制剂的处方模式。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-27 DOI: 10.1177/08971900241256772
Emily Wo, Cara Trulli, Jessica Wilczynski, Jimmy Gonzalez

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) dapagliflozin and empagliflozin are indicated for heart failure with reduced ejection fraction (HFrEF) for cardiovascular death and heart failure hospitalization risk reduction. Due to the recent nature of these data, prescribing of SGLT2is may be suboptimal. Objective: This study sought to assess the prevalence of SGLT2i prescriptions at hospital discharge for HFrEF. Methods: A retrospective chart review was conducted on HFrEF patients discharged from April 1st to December 31st, 2021 from one academic medical center in the United States. The primary objective was to determine the percentage of eligible patients prescribed SGLT2i at discharge and the secondary objective was to characterize covariates impacting prescription. Results: Overall, 115 patients were included. The mean age was 72 ± 14.25 years. The majority were male (73.9%) and Caucasian (74.8%). At discharge, 15.7% of patients were prescribed an SGLT2i, although 94.8% were eligible. Baseline characteristics and concomitant medications did not differ significantly, although the mean number of discharge medications differed significantly between those prescribed an SGLT2i (15.78 ± 6.77) and those not (12.05 ± 5.28) (P = 0.023). Conclusions: SGLT2is are under-prescribed at discharge for HFrEF patients, despite many being eligible. Further studies should be done to elucidate factors that influence the under-prescription of SGLT2is.

背景:钠-葡萄糖共转运体-2抑制剂(SGLT2i)达帕利氟嗪(dapagliflozin)和恩帕利氟嗪(empagliflozin)适用于射血分数降低型心力衰竭(HFrEF),可降低心血管死亡和心力衰竭住院风险。由于这些数据的新近性质,SGLT2is 的处方可能并非最佳。研究目的本研究旨在评估 HFrEF 出院时 SGLT2i 处方的使用率。方法: 采用回顾性病历审查的方法,研究对象包括对美国一家学术医疗中心 2021 年 4 月 1 日至 12 月 31 日出院的 HFrEF 患者进行回顾性病历审查。主要目的是确定符合条件的患者出院时处方 SGLT2i 的比例,次要目的是描述影响处方的协变量。结果:共纳入 115 名患者。平均年龄为 72 ± 14.25 岁。大多数患者为男性(73.9%)和白种人(74.8%)。出院时,15.7% 的患者获得了 SGLT2i 处方,但 94.8% 的患者符合条件。基线特征和伴随药物无显著差异,但开具 SGLT2i 处方的患者(15.78 ± 6.77)和未开具 SGLT2i 处方的患者(12.05 ± 5.28)的平均出院药物数有显著差异(P = 0.023)。结论尽管许多 HFrEF 患者符合条件,但出院时 SGLT2i 的处方量不足。应开展进一步研究,以阐明影响 SGLT2is 处方不足的因素。
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引用次数: 0
Impact of Risk Stratification in Patients With Diabetes Mellitus in a Health System Specialty Pharmacy Setting. 医疗系统专科药房对糖尿病患者进行风险分层的影响。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-29 DOI: 10.1177/08971900241257293
Mackenzie Stout, Carly Giavatto, Nicholas McDonald, Lauren Bryant, Casey Ross, Casey Fitzpatrick, Jessica Mourani, Ana I Lopez-Medina

Background: Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. Objective: The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. Method: This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. Results: Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. Conclusion: Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population.

背景:将药剂师护理纳入医疗系统可显著降低糖尿病患者的 A1c,并改善治疗效果。然而,人们对糖尿病诊所采用医疗系统专科药房(HSSP)慢性病管理(CDM)服务的情况知之甚少。事实证明,风险分层可加强对不同患者群体的护理。研究目的本研究旨在描述在 HSSP 环境中实施风险分层如何优化糖尿病患者的治疗效果。方法:这是一项回顾性描述性研究:这是一项回顾性描述性研究,报告了扩大 HSSP 护理模式,对糖尿病患者实施风险分层 CDM 服务的结果。共有 285 名患者参加了 HSSP CDM 药房服务,并被分为高风险组和低风险组。结果:88 名患者被划分为高风险组,其平均 A1c 基线为 11.47%,最近平均值为 8.84%。其余 285 名患者被分为低风险组。他们的平均基线 A1c 为 7.48%,最近记录的平均 A1c 为 7.15%。未参加 HSSP CDM 服务的患者(N = 100)的平均 A1c 下降率低于参加该计划的患者。结论:与未使用 HSSP CDM 服务的患者相比,分为高风险组和低风险组的患者的 A1c 下降幅度更大。这些结果展示了风险分层的成功,证明了 HSSP 对需要 CDM 服务的患者产生的影响,并概述了在大量患者中产生最大影响的策略。
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引用次数: 0
The Use of Intraperitoneal Ampicillin in a Patient With Enterococcus faecalis Peritonitis. 在粪肠球菌腹膜炎患者中使用腹腔内氨苄西林
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1177/08971900241256726
Natalie Greer, Joanna Q Hudson, Anna Jacobs, Drew A Wells

Introduction: Peritoneal dialysis (PD) - associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD - associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of Enterococcus faecalis. Case Description: A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with E. faecalis. The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. Discussion: The use of IP ampicillin for E. faecalis peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with E. faecalis was not supported by this case.

导言:腹膜透析(PD)相关腹膜炎是腹膜透析(PD)的一种严重并发症。2022 年国际腹膜透析学会 (ISPD) 指南不建议使用腹膜内 (IP) 氨苄西林治疗肠球菌性腹膜透析相关性腹膜炎。迄今为止,尚无体内数据支持使用 IP 氨苄西林治疗粪肠球菌:一名 69 岁的男子因患粪肠球菌腹膜炎入院接受治疗,他既往有终末期肾病(ESKD)病史,需要连续循环腹膜透析(CCPD)。患者的 CCPD 处方为 2.5% Dianeal,共进行了 5 次交换。前 4 次换药时加入了 IP 氨苄西林,最后一次换药时又加入了氨苄西林。患者顺利完成了疗程,临床治愈:讨论:使用IP氨苄西林治疗粪肠球菌腹膜炎尚存争议,以前也没有令人信服的临床证据支持或反对使用IP氨苄西林。本病例展示了使用修改后的给药策略治疗腹膜炎,即在每次更换 CCPD 和最后一次灌注时加入氨苄西林。本病例并不支持体外报告的氨苄西林对粪肠球菌失去抗菌活性的说法。
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引用次数: 0
Navigating Glucagon-Like Peptide Receptor Agonist Reinitiation Amid Access Barriers: An Adverse Drug Event Case Report. 胰高血糖素样肽受体激动剂再启动障碍导航:药物不良事件案例报告。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-24 DOI: 10.1177/08971900241256775
Olivia Denny, Jeffrey Baron, Nicole P Albanese

Background: The expanding roles and popularity of glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists has created access barriers to medication use. We sought to describe an adverse drug event which occurred after reinitiation of a GLP-1 receptor agonist following a prolonged lapse in therapy due to poor medication access. Case Summary: Once-weekly injectable semaglutide was prescribed to an outpatient 33-year-old male for chronic weight management. After a delayed initiation due to global shortage, semaglutide was initiated and titrated over five months before a seven week lapse in therapy due to prior authorization interruption. Despite the extended treatment gap, the patient was directed to reinitiate semaglutide at the target dose rather than starting dose, which was followed by recurrent, symptomatic nausea and vomiting requiring medical intervention. Practice Implications: A prolonged lapse in GLP-1 receptor agonist therapy, typically defined as missing three or more doses of a once-weekly injectable, warrants consideration of reinitiation at a reduced dose, personalized to the patient's prior gastrointestinal tolerability, efficacy goals, and therapy lapse duration. Therapy lapses with GLP-1 receptor agonists may be prevented by utilizing a multi-modal approach including extended dosing intervals, intermediate doses, agent interchange, efficient prior authorization communication, and cautious initiation of GLP-1 recent agonists while supply cannot meet demand.

背景:胰高血糖素样肽-1(GLP-1)和 GLP-1/葡萄糖依赖性胰岛素促性多肽(GIP)受体激动剂的作用和受欢迎程度不断扩大,给药物使用造成了障碍。我们试图描述一起因药物获取途径不畅而导致长期中断治疗后重新开始使用 GLP-1 受体激动剂后发生的药物不良事件。病例摘要:一名 33 岁的男性门诊患者因长期体重控制而被处方每周注射一次的塞马鲁肽。由于全球药物短缺,患者推迟了用药时间,在五个月的时间里,患者开始使用并调整了塞马鲁肽的剂量,之后由于事先授权中断,患者中断了七周的治疗。尽管治疗间隔延长了,但患者仍被指示以目标剂量而非起始剂量重新开始服用塞马鲁肽,随后出现了反复、无症状的恶心和呕吐,需要进行医疗干预。实践意义:GLP-1受体激动剂治疗失效时间过长(通常是指每周一次的注射剂错过三次或三次以上的剂量),应根据患者之前的胃肠道耐受性、疗效目标和治疗失效时间,考虑以较小的剂量重新开始治疗。可通过多种方式防止 GLP-1 受体激动剂治疗失效,包括延长给药间隔、中间剂量、药剂互换、有效的事先授权沟通,以及在 GLP-1 近期激动剂供不应求时谨慎启动。
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引用次数: 0
Updates in Chronic Kidney Disease. 慢性肾脏病的最新进展。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-06-14 DOI: 10.1177/08971900241262381
Haley N Johnson, Lalita Prasad-Reddy

Chronic kidney disease (CKD) affects approximately 14% of adults in the United States and is present in at least 10% of the population worldwide. Blood glucose and blood pressure control are imperative to adequately manage CKD as they are the only primary prevention measures for the condition. Recent changes in CKD evaluation and medication therapies that modify disease progression and aid in managing complications such as anemia of CKD have emerged, including a newly approved mineralocorticoid receptor antagonist and hypoxia-inducible factor-prolyl hydroxylase inhibitor, respectively. This focused update on CKD evaluation and management will review the most recent evidence and approved agents to support patients with CKD, including a review of glomerular filtration rate measurement methods such as CKD-EPI 2021 and utilization of cystatin C, Kidney Disease Improving Global Outcomes (KDIGO) guidelines, American Diabetes Association (ADA) guidelines, and primary literature supporting the use of newer agents in CKD. Checklists for managing blood pressure and blood glucose, CKD-mineral bone disorder, and anemia of CKD targeted for pharmacists are also provided. Additionally, a discussion of Centers for Medicare & Medicaid (CMS) coverage of agents approved for managing complications of CKD is included.

在美国,约有 14% 的成年人患有慢性肾脏病 (CKD),全球至少有 10% 的人口患有这种疾病。控制血糖和血压是充分控制 CKD 的当务之急,因为它们是该病唯一的初级预防措施。最近,CKD 评估和药物疗法发生了一些变化,这些变化可改变疾病的进展并有助于控制 CKD 贫血等并发症,其中包括新批准的矿质皮质激素受体拮抗剂和缺氧诱导因子-脯氨酰羟化酶抑制剂。本次关于 CKD 评估和管理的重点更新将回顾支持 CKD 患者的最新证据和已批准的药物,包括回顾肾小球滤过率测量方法(如 CKD-EPI 2021 和胱抑素 C 的使用)、肾病改善全球结果 (KDIGO) 指南、美国糖尿病协会 (ADA) 指南以及支持在 CKD 中使用新型药物的主要文献。此外,还提供了针对药剂师的血压和血糖、CKD-矿物质骨紊乱和 CKD 贫血管理核对表。此外,还讨论了美国医疗保险与医疗补助中心 (CMS) 批准用于控制 CKD 并发症的药物的覆盖范围。
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引用次数: 0
Evaluation of ChatGPT as a Tool for Answering Clinical Questions in Pharmacy Practice. 将 ChatGPT 作为药学实践中回答临床问题的工具进行评估。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-22 DOI: 10.1177/08971900241256731
Faria Munir, Anna Gehres, David Wai, Leah Song

Background: In the healthcare field, there has been a growing interest in using artificial intelligence (AI)-powered tools to assist healthcare professionals, including pharmacists, in their daily tasks. Objectives: To provide commentary and insight into the potential for generative AI language models such as ChatGPT as a tool for answering practice-based, clinical questions and the challenges that need to be addressed before implementation in pharmacy practice settings. Methods: To assess ChatGPT, pharmacy-based questions were prompted to ChatGPT (Version 3.5; free version) and responses were recorded. Question types included 6 drug information questions, 6 enhanced prompt drug information questions, 5 patient case questions, 5 calculations questions, and 10 drug knowledge questions (e.g., top 200 drugs). After all responses were collected, ChatGPT responses were assessed for appropriateness. Results: ChatGPT responses were generated from 32 questions in 5 categories and evaluated on a total of 44 possible points. Among all ChatGPT responses and categories, the overall score was 21 of 44 points (47.73%). ChatGPT scored higher in pharmacy calculation (100%), drug information (83%), and top 200 drugs (80%) categories and lower in drug information enhanced prompt (33%) and patient case (20%) categories. Conclusion: This study suggests that ChatGPT has limited success as a tool to answer pharmacy-based questions. ChatGPT scored higher in calculation and multiple-choice questions but scored lower in drug information and patient case questions, generating misleading or fictional answers and citations.

背景:在医疗保健领域,人们对使用人工智能(AI)驱动的工具来协助包括药剂师在内的医疗保健专业人员完成日常工作越来越感兴趣。研究目的对生成式人工智能语言模型(如 ChatGPT)作为回答基于实践的临床问题的工具的潜力以及在药学实践环境中实施前需要应对的挑战进行评论和深入探讨。方法:为了评估 ChatGPT,我们向 ChatGPT(3.5 版;免费版)提示了基于药学的问题并记录了回复。问题类型包括 6 个药物信息问题、6 个增强型药物信息提示问题、5 个患者案例问题、5 个计算问题和 10 个药物知识问题(如前 200 种药物)。收集完所有回答后,对 ChatGPT 回答的适当性进行评估。结果:从 5 个类别的 32 个问题中生成了 ChatGPT 回答,并对总共 44 个可能的点数进行了评估。在所有 ChatGPT 回答和类别中,总分为 44 分中的 21 分(47.73%)。ChatGPT 在药房计算(100%)、药品信息(83%)和前 200 种药品(80%)类别中得分较高,而在药品信息增强提示(33%)和患者病例(20%)类别中得分较低。结论本研究表明,ChatGPT 作为回答药学问题的工具取得的成功有限。ChatGPT 在计算题和多项选择题中得分较高,但在药物信息题和病例题中得分较低,会产生误导或虚构的答案和引文。
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引用次数: 0
Changes in Time in Therapeutic Range Within a Warfarin Anticoagulation Clinic Following Introduction of Direct Oral Anticoagulants. 引入直接口服抗凝剂后,华法林抗凝门诊治疗范围内时间的变化。
IF 1 Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-05-26 DOI: 10.1177/08971900241256779
Preethi Samuel, Kaitlyn Cassidy, Pauletta Lazarevskiy, Rebecca Cope

Background: As direct oral anticoagulants (DOACs) have become widely recommended as first-line anticoagulation therapy, patients who remain on warfarin are likely those unable to afford, adhere to, or utilize DOAC therapy due to the presence of a contraindication. It is currently unknown how availability of DOACs have affected populations being managed at warfarin (VKA) anticoagulation clinics. Methods: This was a retrospective chart review assessing warfarin-treated patients at an outpatient anticoagulation clinic. The primary endpoint was the 6-month time in therapeutic range (TTR) before and after DOACs were recommended as first-line therapy by clinical guidelines. Study periods were January to June 2015, before DOACs were recommended over VKA, and January to June 2022, when DOACs were often recommended over VKA. TTR, demographic changes, and the presence of contraindications to DOAC therapy in the clinic population between the two time periods were assessed. Results: No difference in 6-month TTR was observed between study periods (59% in 2015 vs 63% in 2022; P = .45). Patient demographics did not significantly vary, which may be due to the clinic retaining 45% of patients between both time periods. Contraindications to DOAC therapy were identified in 39% of the 2015 group and 49% of the 2022 group (P = .18). The most common contraindication was indication for anticoagulation. Conclusion: Availability of DOACs did not seem to significantly affect the population or management of warfarin-treated patients at an outpatient anticoagulation clinic, however, contraindications and potential challenges to use of DOAC therapy are present in many patients.

背景:随着直接口服抗凝剂(DOAC)被广泛推荐为一线抗凝疗法,仍在使用华法林的患者很可能是那些因存在禁忌症而无法负担、坚持或使用 DOAC 治疗的患者。目前尚不清楚 DOAC 的供应对华法林(VKA)抗凝诊所管理的人群有何影响。方法:这是一项回顾性病历审查,评估了在门诊抗凝诊所接受华法林治疗的患者。主要终点是临床指南建议将 DOACs 作为一线疗法之前和之后的 6 个月治疗范围内时间(TTR)。研究时间段分别为 2015 年 1 月至 6 月(在 DOAC 被推荐为 VKA 治疗之前)和 2022 年 1 月至 6 月(DOAC 通常被推荐为 VKA 治疗之后)。评估了两个时间段之间临床人群的TTR、人口统计学变化以及是否存在DOAC治疗禁忌症。结果显示研究期间的 6 个月 TTR 无差异(2015 年为 59% vs 2022 年为 63%;P = 0.45)。患者的人口统计学特征没有明显差异,这可能是由于诊所在两个时间段之间保留了 45% 的患者。2015年和2022年分别有39%和49%的患者被确定为DOAC治疗禁忌症(P = .18)。最常见的禁忌症是抗凝适应症。结论:DOAC的可用性似乎并未对门诊抗凝门诊的华法林治疗患者的人群或管理产生重大影响,但许多患者存在使用DOAC治疗的禁忌症和潜在挑战。
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引用次数: 0
期刊
Journal of pharmacy practice
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