The Canadian journal of hospital pharmacy最新文献

Background: Pharmaceuticals affect planetary health through environmental contamination from human excretions, improper drug disposal, and greenhouse gas emissions, derived from manufacturing as well as from use. Research suggests that patients will choose environmentally friendly options for minor ailments, but not severe conditions. To date, no Canadian research has explored patients' views on this topic.

Objectives: To characterize the views of British Columbians regarding medication-related environmental sustainability and to determine how these views relate to medication decisions.

Methods: A web-based survey was distributed across British Columbia from October 30, 2023, to February 29, 2024. Residents of British Columbia at least 18 years of age who could complete an online survey in English were eligible to participate. Descriptive statistics and thematic analysis were used.

Results: A total of 255 responses were received. When presented with a scenario related to stroke, more than half of respondents (51%) preferred the medication with higher efficacy and greater environmental harm; in contrast, for scenarios involving the common cold and asthma, more than half chose the medication with lower efficacy and lower environmental harm (54% and 59%, respectively). When cost was introduced, only 54% stated they would choose the more environmentally friendly medication if it was more expensive, whereas 97% would do so if it was less expensive. Themes from open-ended questions focused on cost, manufacturer considerations, and education.

Conclusions: Respondents were willing to choose the environmentally friendly medication for less serious conditions, but not for conditions perceived as life-threatening and/or debilitating. Cost may be a barrier to accessing environmentally friendly options. Public education opportunities may help to inform more sustainable choices. Additionally, there may be value in manufacturer regulations or policies to ensure that the environmental impact of medications is considered.

Background: Greater burdens of comorbidity and exposure to unique environmental factors predispose incarcerated individuals to polypharmacy and inappropriate prescribing. There is limited literature investigating polypharmacy within the correctional health setting.

Objectives: To determine the median number of medications prescribed per client at facilities in British Columbia, to determine the proportion of clients meeting the definition for polypharmacy, to identify the top medication categories prescribed, and to screen for potential drug therapy problems among those with polypharmacy.

Methods: An observational point prevalence study of adult clients with one or more active medications on the census date at 5 correctional health facilities in British Columbia was conducted. Clients were excluded if they had one-time or no medication orders on the census date.

Results: Of the 500 clients screened, 420 were included in the final analysis. Across the centres, the median number of medications ranged from 3 to 5 per client, and the rate of polypharmacy ranged from 23% to 41%. Of the scheduled medications, opioid agonist therapy and psychotropics were the leading categories prescribed across all facilities. Non-opioid analgesics were the top "as needed" medications prescribed at 4 of the 5 facilities. The leading potential drug therapy problem identified was drug interactions resulting in additive sedation.

Conclusions: Polypharmacy was present within all facilities in this study, with more than 25% of clients affected at 3 of the sites. The top medications prescribed aligned with those identified in the literature; however, there remain opportunities for therapy optimization.

Background: Cytomegalovirus (CMV) disease is frequent following heart transplant, especially among patients with donor-seropositive, recipient-seronegative (D+/R-) CMV status. Valganciclovir prophylaxis for 3 to 6 months is recommended, but few data support the use of 6 rather than 3 months of prophylaxis for patients who have undergone heart transplant.

Objective: To compare the risk of CMV infection and a first occurrence of CMV disease after heart transplant among CMV D+/R- patients who received 3 or 6 months of prophylaxis in the first year after transplant.

Methods: This retrospective analysis included every D+/R- heart transplant recipient at the study centre between October 2015 and October 2022. Patients had to have a minimum of 1 year of follow-up for inclusion.

Results: Thirty-five patients met the inclusion criteria. The duration of valganciclovir prophylaxis (determined by the medical team) was 3 months for 22 patients and 6 months for 13 patients. CMV infection occurred in 68.2% (15/22) and 30.8% (4/13) of the 3-month and 6-month groups, respectively (risk difference 37.4%, 95% confidence interval [CI] 1.75 to 65.8, p = 0.04). CMV disease occurred in 54.5% (12/22) of patients who received 3 months of prophylaxis and 23.1% (3/13) of those who received 6 months of prophylaxis (risk difference 31.4%, 95% CI -3.7 to 59.4, p = 0.09). Most CMV infections and diseases occurred in the 3 months after the end of prophylaxis.

Conclusions: After heart transplant, CMV D+/R- patients who received 3 months of prophylaxis had a higher risk of CMV infection and a non-statistically significant higher risk of CMV disease relative to those who received 6 months of prophylaxis.

Background: Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers' health.

Objective: To describe contamination with 11 antineoplastic drugs measured on surfaces within health care centres.

Methods: Centres sampled 12 standardized sites: 6 in oncology pharmacies and 6 in outpatient clinics. Samples were analyzed by ultra-performance liquid chromatography-tandem mass spectrometry.

Results: A total of 126 Canadian centres participated over the period January to April 2023. Cyclophosphamide (411/1476, 28%) and gemcitabine (352/1476, 24%) were frequently found on surfaces; less than 10% of samples were contaminated with the other 9 drugs. The 90th percentile of concentration was 0.0095 ng/cm² for cyclophosphamide and 0.0040 ng/cm² for gemcitabine. The armrest of a treatment chair (93/123, 76%) and the front grille inside the biological safety cabinet (61/123, 50%) were frequently contaminated with cyclophosphamide.

Conclusions: This monitoring program allowed centres to benchmark their contamination and helped increased awareness. Frequent decontamination, safe handling practices, and the use of personal protective equipment are mandatory.