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Larrosa-García M, Garcia-Garcia S, Louro J, Sánchez-Montalvá A, Sampol Sirvent J, Augustín Recio S, Guillén Del Castillo A, Riera-Arnau J, Gorgas MQ, Miarons M. Use of chronic medications and risk of death due to COVID-19 in hospitalised patients. Eur J Hosp Pharm 2024; 31:247-252. [PMID: 36302612 DOI: 10.1136/ejhpharm-2021-003186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 10/11/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate the potential association between chronic exposure to medication and death related to COVID-19. METHODS This is a retrospective cross-sectional study that included all patients hospitalised due to COVID-19 from 11 March to 4 June 2020 in our centre. Chronic patient medication was classified by the Anatomical Therapeutic Chemical (ATC) classification; demographic and clinical data were analysed. Multivariate logistic regression models were used to estimate the adjusted odds ratios (aOR) of death for each drug exposure; each aOR represents an independent model adjusted by clinical factors related to COVID-19 mortality. RESULTS The study included 978 patients with a mean (SD) age of 64.5 (17.7) years who were predominantly male (531, 54.3%). Of all 978 patients, 182 (18.61%) died during the follow-up of the study. The most common Charlson Comorbidity Index (CCI) was 0, 4.2% were smokers, 16.7% were obese, 47.4% had hypertension, and 19.4% were diabetic. Most patients (70.8%) were prescribed at least one treatment, 32.5% used >5 treatments, and 8.6% >10. Our data suggest that COVID-19 hospitalised patients taking trimethoprim and analogues, leukotriene receptor antagonists, calcineurin inhibitors, aldosterone antagonists, selective immunosuppressants, propulsives, insulins and analogues, and benzodiazepine derivatives have a higher risk of death. CONCLUSIONS This study investigated the association between chronic exposure to drugs and the risk of death in COVID-19 patients. Our results have shed some light on the impact of chronic drug exposure on the risk of severe COVID-19; however, further research is needed to increase the understanding about its relevance.
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Affiliation(s)
| | | | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM, Hospital del Mar INAD, Barcelona, Spain
| | | | | | | | | | - Judit Riera-Arnau
- Pharmacology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Marta Miarons
- Pharmacy Department, Vall d'Hebron University Hospital, Barcelona, Spain
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2
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Glen C, Morrow A, Roditi G, Hopkins T, Macpherson I, Stewart P, Petrie MC, Berry C, Epstein F, Lang NN, Mangion K. Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer. Heart 2024; 110:650-656. [PMID: 38103912 DOI: 10.1136/heartjnl-2023-323437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously. METHODS Participants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%. RESULTS Forty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9-10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1-Q3, 51.3-61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes. CONCLUSIONS The presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment.
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Affiliation(s)
- Claire Glen
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Giles Roditi
- Clinical Research Imaging Facility, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tracey Hopkins
- Clinical Research Imaging Facility, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Iain Macpherson
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Philip Stewart
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Fred Epstein
- School of Engineering and Applied Science, University of Virginia, Charlottesville, Virginia, USA
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
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Pinto Oliveira C, Ferreira Azevedo S, Vilafanha C, Prata AR, Barcelos A. Polymyalgia Rheumatica After COVID-19 Vaccination: Data from the EudraVigilance Database. ACTA MEDICA PORT 2024. [PMID: 38607657 DOI: 10.20344/amp.20952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Cláudia Pinto Oliveira
- Rheumatology Department. Centro Hospitalar do Baixo Vouga. Aveiro; Centro Académico Clínico Egas Moniz Health Alliance. Universidade de Aveiro. Aveiro. Portugal
| | - Sofia Ferreira Azevedo
- Rheumatology Department. Centro Hospitalar do Baixo Vouga. Aveiro; Centro Académico Clínico Egas Moniz Health Alliance. Universidade de Aveiro. Aveiro. Portugal
| | - Carolina Vilafanha
- Rheumatology Department. Centro Hospitalar do Baixo Vouga. Aveiro; Centro Académico Clínico Egas Moniz Health Alliance. Universidade de Aveiro. Aveiro. Portugal
| | - Ana Rita Prata
- Rheumatology Department. Centro Hospitalar do Baixo Vouga. Aveiro; Centro Académico Clínico Egas Moniz Health Alliance. Universidade de Aveiro. Aveiro. Portugal
| | - Anabela Barcelos
- Rheumatology Department. Centro Hospitalar do Baixo Vouga. Aveiro; Centro Académico Clínico Egas Moniz Health Alliance. Universidade de Aveiro. Aveiro. Portugal
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Kim M, Park SK, Kim WM, Kim E, Kim H, Park JM, Choi SS, Choi EJ. Updated guidelines for prescribing opioids to treat patients with chronic non-cancer pain in Korea: developed by committee on hospice and palliative care of the Korean Pain Society. Korean J Pain 2024; 37:119-131. [PMID: 38557654 PMCID: PMC10985489 DOI: 10.3344/kjp.24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.
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Affiliation(s)
- Minsoo Kim
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Cafaro A, Stella M, Mesini A, Castagnola E, Cangemi G, Mattioli F, Baiardi G. Dose optimization and target attainment of vancomycin in children. Clin Biochem 2024; 125:110728. [PMID: 38325652 DOI: 10.1016/j.clinbiochem.2024.110728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Vancomycin is a glycopeptide antibiotic that has been adopted in clinical practice to treat gram-positive infections for more than 70 years. Despite vancomycin's long history of therapeutic use, optimal dose adjustments and pharmacokinetic/pharmacodynamic (PK/PD) target attainment in children are still under debate. Therapeutic drug monitoring (TDM) has been widely integrated into pediatric clinical practice to maximize efficacy and safety of vancomycin treatment. Area under the curve (AUC)-guided TDM has been recently recommended instead of trough-only TDM to ensure PK/PD target attainment of AUC0-24h/minimal inhibitory concentration (MIC) > 400 to 600 and minimize acute kidney injury risk. Bayesian forecasting in pediatric patients allows estimation of population PK to accurately predict individual vancomycin concentrations over time, and consequently total vancomycin exposure. AUC-guided TDM for vancomycin, preferably with Bayesian forecasting, is therefore suggested for all pediatric age groups and special pediatric populations. In this review we aim to analyze the current literature on the pediatric use of vancomycin and summarize the current knowledge on dosing optimization for target attainment in special patient populations.
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Affiliation(s)
- Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy
| | - Manuela Stella
- UOC Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy.
| | - Francesca Mattioli
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy; Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Giammarco Baiardi
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy; Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genova, Italy
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Guzmán Cordero C, Saez-Torres de Vicente M. Management of nirmatrelvir/ritonavir and tacrolimus interaction in kidney transplant recipients infected by COVID-19: a three-case series. Eur J Hosp Pharm 2024; 31:175-177. [PMID: 36535689 PMCID: PMC10895186 DOI: 10.1136/ejhpharm-2022-003544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Nirmatrelvir/ritonavir may cause a clinically relevant drug-drug interaction (DDI) with immunosuppressive drugs, such as tacrolimus, which may condition the use of this antiviral in transplant patients. We aimed to describe the management of this interaction. METHODS Descriptive study in which renal transplant patients in treatment with nirmatrelvir/ritonavir and tacrolimus were included. They suspended tacrolimus the day before starting the antiviral treatment, and the decision to restart it was made based on their tacrolimus blood levels. Main variables studied to measure this DDI were tacrolimus blood concentration, dose adjustment and serum creatinine. RESULTS Three patients were included. During the study, tacrolimus levels elevation did not have repercussion in the serum creatinine, that remained stable in all patients. No patient required hospitalisation or showed signs of rejection. CONCLUSIONS Our experience provides further evidence that this interaction should not be a contraindication to treatment with nirmatrelvir/ritonavir, and can be managed with close monitoring of tacrolimus levels.
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Heinemann S, Klemperer J, Hummers E, Nau R, Himmel W. Reducing the use of sleep-inducing drugs during hospitalisation by a multi-faceted intervention: a pilot study. Eur J Hosp Pharm 2024; 31:117-123. [PMID: 35732426 PMCID: PMC10895184 DOI: 10.1136/ejhpharm-2021-003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Many patients receive benzodiazepines or Z-drugs during hospitalisation due to sleeping problems. In a pilot study, we aimed to find out whether, and to what degree, a multi-faceted intervention can reduce the use of these drugs, especially in older patients and those without a psychiatric or neurological disorder. The results of this pilot study should inform the design of a randomised controlled trial (RCT). METHODS In a quasi-experimental design, we implemented the intervention in a German hospital with the support of the hospital director, medical and nursing staff and employee representatives. We compared prescription data for sleep-inducing drugs before and after the intervention by Fisher's exact test and used odds ratios (ORs) with their 95% CIs as a measure of effect size. RESULTS The data from 960 patients aged ≥65 years before intervention and 1049 patients after intervention were analysed. Before intervention, 483 (50.3%) of the patients received sleep-inducing drugs at some time during their hospital stay. After the intervention, 381 (36.3%) patients received a sleep-inducing drug, resulting in an OR of 0.56 (95% CI 0.47 to 0.68) (p<0.001). The reduction was particularly pronounced in patients without a psychiatric or neurological disorder (from 45.0% to 28.8%). In particular, the consumption of benzodiazepines declined from 24.3% to 8.5% (OR 0.31; 95% CI 0.23 to 0.4) (p<0.001). CONCLUSIONS A multi-faceted intervention to change the practice of the use of sleep-inducing drugs in one hospital was successful in terms of drug reduction, particularly for benzodiazepines. The intervention was effective especially for target persons-that is, those without a psychiatric or neurological disease. Awareness of the magnitude of the change and the role of important stakeholders could help researchers and hospital staff to design a large RCT, including control hospitals, to evaluate the success of a multi-faceted intervention on a scientifically sound basis.
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Affiliation(s)
- Stephanie Heinemann
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Jonas Klemperer
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Nau
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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8
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Zhou XX, Ji HJ. Correspondence on 'Management of nirmatrelvir/ritonavir and tacrolimus interaction in kidney transplant recipients infected by COVID-19: a three-case series'. Eur J Hosp Pharm 2024; 31:178-179. [PMID: 36737228 PMCID: PMC10895177 DOI: 10.1136/ejhpharm-2023-003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xiaohua Xiao Zhou
- Department of Nephrology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Nephrology, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Hong Jian Ji
- School of Pharmacy, Jiangsu Vocational College of Medicine, Yancheng, China
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Zhou J, Wang F, Li S. Rare case report of moxifloxacin-induced persistent hiccups. Eur J Hosp Pharm 2024; 31:165-167. [PMID: 37369596 PMCID: PMC10895190 DOI: 10.1136/ejhpharm-2023-003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Moxifloxacin is a broad-spectrum antimicrobial agent that is commonly used in clinical practice. Here we report an unusual case of a patient with persistent hiccups caused by moxifloxacin. A man aged in his 40s was treated with moxifloxacin for tuberculous pleurisy. Hiccups occurred 2 hours after intravenous injection of moxifloxacin and lasted into evening. On the second day after injection, hiccups occurred again and made it difficult for him to fall asleep. The clinician ruled out gastrointestinal disease, nervous system disease, electrolyte disturbance and other factors. On assessing causality of the adverse drug reaction, the Naranjo scale for moxifloxacin was six, indicating a probable relationship of hiccups with moxifloxacin. Hiccups stopped 2 min after intramuscular injection of metoclopramide. To our knowledge, this is the first case report about moxifloxacin-induced persistent hiccups. Clinicians should be aware of the rare adverse reaction.
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Affiliation(s)
- Jing Zhou
- Department of Pharmacy, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Wang
- Department of Infectious Disease, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Songlong Li
- Department of Pharmacy, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Gómez-Alonso J, Martínez Martínez M, Bonilla Rojas CA, García Díaz HC, Riera Del Brio J, Gorgas Torner MQ, Doménech-Moral L. Management of heparin-induced thrombocytopenia during extracorporeal membrane oxygenation support: a case of neutropenia caused by argatroban anticoagulation. Eur J Hosp Pharm 2024:ejhpharm-2023-003914. [PMID: 38272648 DOI: 10.1136/ejhpharm-2023-003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
We present the case of a man in his 70s admitted to the intensive care unit (ICU) after mitral valve replacement and coronary artery bypass graft surgery requiring extracorporeal membrane oxygenation support due to haemodynamic instability. He received anticoagulation therapy with heparin sodium and, after 5 days, the patient presented with thrombocytopenia and deep venous thrombosis. Heparin-induced thrombocytopenia was suspected based on a positive 4T score and confirmed by antiplatelet factor 4/heparin antibodies, so argatroban was initiated as an alternative anticoagulation therapy. In the following days the patient developed severe neutropenia requiring discontinuation of argatroban and the administration of granulocyte colony-stimulating factor. According to the Naranjo Adverse Drug Reaction Probability Scale, this event would be classified as a 'probable' argatroban-related adverse event. Argatroban should be conisdered as a possible cause of neutropenia and appropriate interventions need to be implemented due to the gravity of this adverse event in the ICU.
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Tanty A, Vitale E, Lombardo-Duron D, Grevy A, Gibert P, Chapuis C, Chevallier-Brilloit C, Allenet B, Bedouch P, Chanoine S. Clinical pharmacy as a guarantee of safety in times of crisis: evolution and relevance of the continued presence of clinical pharmacists in frontline medical units during the first wave of COVID-19. Eur J Hosp Pharm 2024:ejhpharm-2023-003815. [PMID: 37875284 DOI: 10.1136/ejhpharm-2023-003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
BackgroundThe COVID-19 pandemic has had a major impact on the organisation of health services worldwide. In the first wave, many therapeutic options were explored, exposing patients to significant iatrogenic risk. In a context in which patient management was not well defined by clear recommendations and in which healthcare professionals were under great stress, was it still relevant to maintain pharmaceutical care or did it bring an additional factor of disorganisation? OBJECTIVE The aim of our study was to compare the relevance of pharmaceutical care practices before and during the COVID-19 crisis. METHODS A retrospective, comparative, observational analysis was conducted in two medical units in a French university hospital that were receiving patients with COVID-19 and benefiting from pharmaceutical care prior to the crisis. This study compared clinical pharmacy performance between two 1.5-month periods before and during the COVID-19 crisis. Performance was assessed according to the CLEO scale, rating the clinical, economic and organisational impacts of the accepted pharmaceutical interventions (PIs) performed in these units. RESULTS Of the 675 accepted PIs carried out in the two medical units over the entire study period, PIs performed during the COVID-19 period had a greater significant clinical impact (72% vs 56%, p˂0.0001), a more positive economic impact (38% vs 23%, p˂0.0001) and a more favourable organisational impact (52% vs 20%, p˂0.0001) than those performed prior to the COVID-19 period. CONCLUSIONS The health crisis generated important changes in care practices. Our study demonstrates the sustained relevance of pharmaceutical care during a health crisis. This local experience confirms the major interest in improving the integration of pharmaceutical expertise within French healthcare teams.
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Affiliation(s)
| | | | | | | | | | | | | | - Benoît Allenet
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for biomedical engineering and complexity management - informatics, mathematics and applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Université Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Pierrick Bedouch
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- Pharmacy, Université Grenoble 1, Saint-Martin-d'Heres, France
| | - Sebastien Chanoine
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- Pharmacy, Université Grenoble 1, Saint-Martin-d'Heres, France
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Memiş H, Çakır A, Ülgey A. Therapeutic drug monitoring of vancomycin in the case of augmented renal clearance: a case report of a paediatric patient. Eur J Hosp Pharm 2024:ejhpharm-2023-003982. [PMID: 38199810 DOI: 10.1136/ejhpharm-2023-003982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Augmented renal clearance (ARC) is a condition in which renal circulation increases, causing drug levels in the blood to remain at subtherapeutic levels in severe trauma patients. Vancomycin, a hydrophilic anti-Gram-positive drug, has been shown in the literature to have its levels fall below the therapeutic range in the case of ARC. However, vancomycin dosing recommendations in the case of ARC are still lacking. Here, we identify an ARC case measured with urinary creatinine clearance in a severe trauma paediatric patient, causing vancomycin blood trough levels to drop. We could not be able to increase the vancomycin trough levels with intermittent dosing; hence, we administered vancomycin with continuous infusion, and this resulted in vancomycin blood trough levels remaining in the therapeutic range. No adverse effect was seen. Continuous infusion of vancomycin can be safely administered to paediatric patients in these cases.
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Affiliation(s)
- Hasan Memiş
- Clinical Pharmacy, Inonu University Faculty of Pharmacy, Malatya, Türkiye
| | - Ahmet Çakır
- Clinical Pharmacy, Inonu University Faculty of Pharmacy, Malatya, Türkiye
| | - Ayşe Ülgey
- Anaesthesiology and Reanimation, Erciyes University Faculty of Medicine, Kayseri, Türkiye
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Cattaneo D, Pagano S, Lazzarin S, Calvagna N, Gervasoni C. No effects of nirmatrelvir/ritonavir on darunavir plasma trough concentrations: a case report. Eur J Hosp Pharm 2024:ejhpharm-2023-004015. [PMID: 38199809 DOI: 10.1136/ejhpharm-2023-004015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
COVID-19 may be associated with worst outcomes in people living with HIV compared with HIV-negative patients. Nirmatrelvir/ritonavir can be safely co-administered with all the HIV antiretroviral drugs, without considering dose adjustment. However, no studies have formally investigated the effect of a double booster (ritonavir plus cobicistat) regimen on darunavir concentrations. We presented a case describing the lack of effects of adding nirmatrelvir/ritonavir on darunavir plasma trough concentrations in a patient with HIV already on treatment with a booster-based antiretroviral regimen. We believe this could be a reassuring message for physicians, allowing them to prevent unnecessary denial of COVID-19 treatment or inappropriate discontinuation of co-medications in patients with HIV.
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Boissiere C, Francois E, Vabret E, Le Daré B, Bacle A. Spice-drug interactions: a case report on the use of turmeric, curry and ginger in a renal transplant patient on tacrolimus. Eur J Hosp Pharm 2023; 31:68-69. [PMID: 37586787 PMCID: PMC10800271 DOI: 10.1136/ejhpharm-2023-003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
Tacrolimus is a widely used immunosuppressant for the prevention of rejection after transplantation. In vitro studies suggest that interactions exist between spices and tacrolimus. We present the case of a renal transplant patient aged around 70 years who was treated with prednisone, mycophenolate-mofetil and tacrolimus. The patient had a pre-transplant dietary habit of consuming foods spiced with turmeric, curry and ginger. The following protocol was implemented in parallel with close monitoring of plasma tacrolimus concentrations: administration of 10 g/day of turmeric for 4 days, then 10 g/day of curry for 4 days and then 10 g/day of ginger for 4 days. No change in tacrolimus plasma concentrations during and after the implementation of the protocol was observed. The impact of turmeric, curry and ginger on plasma tacrolimus concentrations seems negligible in vivo although further studies are needed. A shared decision to test the impact of spice consumption in a patient with dietary habits involving these spices seems reasonable.
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Affiliation(s)
- Camille Boissiere
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
| | - Elise Francois
- Service de Néphrologie, CHU Rennes, 35000, Rennes, France
| | - Elsa Vabret
- Service de Néphrologie, CHU Rennes, 35000, Rennes, France
| | - Brendan Le Daré
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
- INSERM, INRAE, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Université de Rennes 1, 35000, Rennes, France
| | - Astrid Bacle
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France
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15
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Monti Guarnieri N, Pompilio A, Marini C, Ortenzi GB, Andresciani E, Garzone AMF, Ieracitano MC, Polidori C. A pharmacovigilance study on antiepileptic medications in a paediatric hospital in Italy. Eur J Hosp Pharm 2023; 31:46-49. [PMID: 35410875 PMCID: PMC10800265 DOI: 10.1136/ejhpharm-2021-003053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The standard treatment for epilepsy is based on the appropriate use of antiseizure medications (ASMs) to prevent the recurrence of seizures. For the newer ASMs, however, little information on their safety profile is available. This work sought to fill this gap by creating a database for ASM use in a paediatric hospital and the adverse drug reactions (ADRs) reported. METHODS This observational single-centre study was conducted from January 2018 to December 2020 and recorded the type of ASM treatment for paediatric epileptic patients cared for at the Neuropsychiatry Unit of the Salesi Paediatric Hospital in Ancona, Italy, as well as any ADRs. RESULTS In all, 519 patients were admitted to the ward with a diagnosis of epilepsy, 362 (69.7%) of whom were prescribed ASMs. Valproic acid was the most frequently prescribed drug (29.96%), followed by levetiracetam (13.97%) and carbamazepine (9.16%). We recorded 24 ADRs in 20 patients, half of which (n=12) occurred with polytherapy. Among the ADRs associated with monotherapy, 25% (n=6) were induced by carbamazepine; 12.5% (n=3) were associated with either valproic acid, clonazepam or lamotrigine; 8.3% (n=2) were associated with perampanel, clobazam or levetiracetam; while one patient experienced ADR due to vigabatrin, one due to ethosuximide and one due to cannabidiol. The median patient age was 7.5 years and most ADRs were not serious. CONCLUSION During the 3-year observation period, 6% of epileptic patients on ASMs showed one or more ADRs. Carbamazepine was responsible for about a quarter of these reactions, two of which were serious. Half of the ADRs occurred with polytherapy, which often included valproic acid and stiripentol. It is to be hoped that such active pharmacovigilance through the collaboration of hospital pharmacists and physicians will serve to improve the management of treatment.
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Affiliation(s)
| | - Adriana Pompilio
- Hospital Pharmacy, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Carla Marini
- Hospital Pharmacy, Salesi Pediatric Hospital, Ancona, Italy
| | | | | | | | | | - Carlo Polidori
- Experimental medicine and Public health, University of Camerino, Camerino, Italy
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16
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Trivellato S, Mengato D, Donà D, De Pieri M, Venturini F. Monoclonal antibodies for the early treatment of paediatric COVID-19 patients: a tangible contribution from hospital pharmacists in the lack of evidence. Eur J Hosp Pharm 2023; 30:e33. [PMID: 36202594 PMCID: PMC10647879 DOI: 10.1136/ejhpharm-2022-003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Daniele Mengato
- Hospital Pharmacy Department, Padua University Hospital, Padova, Italy
| | - Daniele Donà
- Department for Women's and Children's Health, Division of Pediatric Infectious Diseases, Padua University Hospital, Padova, Italy
| | - Marica De Pieri
- Department for Women's and Children's Health, Division of Pediatric Infectious Diseases, Padua University Hospital, Padova, Italy
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17
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Uda ME, Rivano M, Aledda L, Maioli MA, Lombardo F. Budget impact analysis: comparing the costs of nusinersen and risdiplam in the treatment of type 3 spinal muscular atrophy patients. Eur J Hosp Pharm 2023:ejhpharm-2023-003733. [PMID: 37898509 DOI: 10.1136/ejhpharm-2023-003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVES The aim of the budget impact analysis (BIA) was to determine the economic impact of introducing risdiplam in the treatment of type 3 spinal muscular atrophy (SMA) patients in a rare diseases reference centre on a 3-year time horizon, as compared with nusinersen. METHODS Public databases were used to estimate the target population. Two market scenarios were assessed over a 3-year time horizon: with nusinersen and with the introduction of risdiplam. Drug acquisition and administration costs were considered. BIA is calculated as the difference between scenarios with nusinersen - scenario with risdiplam. RESULTS The introduction of risdiplam would generate a 3-year saving of €3411.50. There could be a saving in the administration of risdiplam in the treatment of patients under the age of 2 with a weight of 5 kg (€26 382.08). CONCLUSION The BIA shows the overlapping costs of these therapies, although the oral administration of risdiplam could be a decisive factor for the therapeutical switch from nusinersen.
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Affiliation(s)
| | - Melania Rivano
- Hospital Pharmacy, Ospedale Roberto Binaghi, Cagliari, Italy
| | - Lucia Aledda
- Hospital Pharmacy, Santissima Trinità Hospital, Cagliari, Italy
| | | | - Fabio Lombardo
- Hospital Pharmacy, Ospedale Roberto Binaghi, Cagliari, Italy
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18
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Gerard D, Callies A, Simon L, Ternisien C, Prot-Labarthe S. Questions around a case of in utero thrombosis in a premature child, concerning the management of anticoagulant treatments. Eur J Hosp Pharm 2023:ejhpharm-2023-003826. [PMID: 37775260 DOI: 10.1136/ejhpharm-2023-003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
We report the case of a preterm infant presenting a thrombosis, discovered on ultrasound at 22 weeks of gestational age and confirmed at birth following additional examinations. We describe the anticoagulant treatment of this patient by intravenous enoxaparin, tinzaparin and rivaroxaban, from questioning to practice.
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Affiliation(s)
- Delphine Gerard
- Pharmacie Clinique Hôtel Dieu, CHU Nantes, Nantes, Pays de la Loire, France
| | - Arnaud Callies
- Néonatologie, CHU Nantes, Nantes, Pays de la Loire, France
| | - Laure Simon
- Néonatologie, CHU Nantes, Nantes, Pays de la Loire, France
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Abstract
The most common documented allergy is due to penicillin use, and penicillin allergy is often diagnosed early in childhood. However, fewer than 1% of the approximately 10% of the population with reported penicillin allergy have a true allergy. Antimicrobial stewardship programmes have employed pharmacist-led protocols to rechallenge patients with a documented history of penicillin allergy. There are published data to suggest that patients with a history of penicillin allergy can be successfully rechallenged and desensitised. We report a case of a 74-year-old woman with a documented childhood history of penicillin allergy who was rechallenged with amoxicillin/clavulanate (Augmentin) in the hospital during admission. She was given one trial dose of amoxicillin/clavulanate for the treatment of urinary tract infection to cover organisms detected in the urine culture. Amoxicillin/clavulanate was determined to be the most suitable antibiotic for empirical treatment. Given a documented history of penicillin allergy from over 60 years ago, the likelihood of reactivity was suspected to be low to none. The patient, however, developed an allergic reaction after the one-time oral amoxicillin/clavulanate 875/125 mg dose trial.
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Affiliation(s)
- Evon Anukam
- Clinical Pharmacy, Providence Health & Services, Milwaukie, Oregon, USA
| | - Jenny Zhu
- Pharmacy Residency, Providence Health & Services, Milwaukie, Oregon, USA
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20
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Chen C, Qi J, Li X, Yongjing W. Acute kidney injury and delayed methotrexate clearance in an adult patient with Philadelphia chromosome-positive acute lymphoblastic leukaemia treated with imatinib. Eur J Hosp Pharm 2023; 30:e28. [PMID: 36732034 PMCID: PMC10447946 DOI: 10.1136/ejhpharm-2022-003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/15/2022] [Indexed: 02/04/2023] Open
Abstract
A female patient in her early 30s was treated with imatinib and high-dose methotrexate (HD-MTX) for Philadelphia chromosome-positive acute lymphoblastic leukaemia. The patient developed delayed MTX clearance and grade 3 acute kidney injury characterised by elevated creatinine (114% increase from baseline). After intensified calcium folinate rescue therapy and hydration, the MTX serum level was appropriately decreased 72 hours after the start of MTX infusion, and renal function returned to normal. Medication analysis by a clinical pharmacist suggested that the concomitant treatment with imatinib likely contributed to the delayed MTX clearance and caused the acute kidney injury.
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Affiliation(s)
- Chen Chen
- Department of Clinical Pharmacy, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Jian Qi
- Department of Orthopedics, PLA 960th Hospital, Jinan, Shandong, China
| | - Xia Li
- Shandong Center for Adverse Drug Reaction Monitoring, Jinan, Shandong, China
| | - Wang Yongjing
- Department of Hematology, The Second Hospital of Shandong University, Jinan, Shandong, China
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21
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Huang J, Zhang M, Huang J, Deng X, Zhang X, Miao C, Weng S. Detection of Doxycycline Using Carbon Quantum dots as Probe Based on Internal Filtering Effect. J Fluoresc 2023:10.1007/s10895-023-03373-2. [PMID: 37530930 DOI: 10.1007/s10895-023-03373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
The establishment of a convenient and effective detection method for doxycycline (DC) holds significant importance in drug monitoring and drug residue assessment. In this work, carbon quantum dots (CQDs) with excellent and stable luminescence performance (the quantum yield of CQDs was 21.8%) were synthesized by the melting method and employed as probes to monitor the fluorescence intensity variations before and after the introduction of DC. A fluorescence analytical method based on the internal filtration effect (IFE) was developed for DC determination. The mechanism of DC quenching CQDs was verified using fluorescence lifetime tests, absorption spectroscopy, and evaluation of internal filtration parameters. After optimizing experimental conditions, it was found that the DC concentration (CDC) exhibited a good linear relationship with the fluorescence quenching efficiency ((F0-F)/F0) of CQDs in the range of 5-30 µM. The fitted linear equation was Y = 0.01249*CDC+0.03625, R2 = 0.9987, and the detection limit was 2.343 µM (n = 8). This developed method has been successfully applied to accurately determine DC concentrations in both doxycycline hydrochloride tablets and human serum samples. It stands out for its simplicity, rapidity, and acceptable detection performance. Due to its advantages, this method holds great promise for application in the biomedical field for monitoring DC drug concentrations and ensuring quality control.
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Affiliation(s)
- Jianhou Huang
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
| | - Menghan Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
| | - Jiyue Huang
- Department of Pharmacy, the 900th Hospital of China Joint Logistics Support Force, Fuzhou, 350025, China
| | - Xiaoqin Deng
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
| | - Xintian Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
| | - Chenfang Miao
- Department of Pharmacy, the 900th Hospital of China Joint Logistics Support Force, Fuzhou, 350025, China.
| | - Shaohuang Weng
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
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22
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Zhang Y, Yao J, Li W, Wang H. Global research trends and hotspots in pharmaceutical care: a bibliometric analysis and visualisation using CiteSpace and VOSviewer. Eur J Hosp Pharm 2023:ejhpharm-2022-003617. [PMID: 37344165 DOI: 10.1136/ejhpharm-2022-003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/02/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVE Pharmaceutical care is closely related to the outcome and prognosis of disease treatment. This study analyses the research status, hotspots, frontiers and development trends of pharmaceutical care from the perspective of bibliometrics. METHODS Related literature on pharmaceutical care published in the Web of Science Core Collection database was collected and knowledge maps were drawn by science information visualisation software Citespace 6.1 .R3 and VOSviewer 1.6.17.0. RESULTS A total of 3289 institutions from 105 countries/regions published 2906 papers in 669 academic journals, which were cited 50 027 times. The top three countries/regions by the number of publications are the USA, UK and Brazil. The top three institutions are Utrecht University and the University of Groningen in the Netherlands, and University College London in the UK. The top three journals are American Journal of Pharmaceutical Education, International Journal of Clinical Pharmacy and American Journal of Health-System Pharmacy. The top three authors are Hersberger KE, Bouvy ML and Hughes CM. The most co-cited is Hepler CD, and the most co-cited influential is Strand LM. COVID-19 pandemic, chronic obstructive pulmonary disease and pharmacy practice are the most cutting edge topics in the field of research in pharmaceutical care. Pharmaceutical service and clinical pharmacy are research hotspots in pharmaceutical care. CONCLUSION In the past 10 years, papers in the field of pharmaceutical care have shown a significant growth trend and scholars have become increasingly interested in research on related content in the field of pharmaceutical care. Our research results are of great significance for improving the connotation construction of pharmaceutical care and improving patient satisfaction and prognosis, and can also be used as an important reference for relevant scholars to select scientific research topics for subsequent research. The objective basis for relevant government departments is to modify and formulate health policies or measures.
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Affiliation(s)
- Yani Zhang
- Library, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Jie Yao
- Department of Geriatrics Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Wanni Li
- Department of Geriatrics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Hua Wang
- Department of Dermatology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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23
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Tecen-Yucel K, Bayraktar-Ekincioglu A, Yıldırım T, Demirkan K, Erdem Y. Evaluation of drug interaction between cyclosporine and lercanidipine: a descriptive study. Eur J Hosp Pharm 2023:ejhpharm-2023-003757. [PMID: 37236776 DOI: 10.1136/ejhpharm-2023-003757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Cyclosporine is an immunosuppressive drug with a high potential for drug interactions that is frequently used in renal transplant patients. The purpose of this study was to assess the change in cyclosporine concentration in patients taking cyclosporine and lercanidipine concurrently. METHODS The potential drug interactions in renal transplant patients who received lercanidipine and cyclosporine concurrently in a university hospital between January 2008 and January 2018 were evaluated retrospectively. Patients had renal transplantation from deceased donors or living related donors. The Drug Interaction Probability Scale (DIPS) criteria were used to assess the causality of cyclosporine and lercanidipine drug interaction. RESULTS The study included six renal transplant patients. The median cyclosporine concentration before lercanidipine use was 325 ng/mL (min-max 101-356) and 592.5 ng/mL (min-max 198-799) thereafter (p=0.028). Serum creatinine and proteinuria levels did not change significantly during lercanidipine treatment (p=0.686 and p=0.116, respectively). According to the DIPS evaluation, cyclosporine and lercanidipine interaction was classified as "possible (score 3)". CONCLUSIONS Concomitant use of cyclosporine and lercanidipine increases the concentration of cyclosporine, which may result in side effects during effective treatment in renal transplant patients. Therefore, cyclosporine concentrations should definitely be monitored while patients are taking lercanidipine.
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Affiliation(s)
- Kamer Tecen-Yucel
- Department of Clinical Pharmacy, Anadolu University Faculty of Pharmacy, Eskisehir, Turkey
| | | | - Tolga Yıldırım
- Department of Nephrology, Hacettepe University Hospitals, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Yunus Erdem
- Department of Nephrology, Hacettepe University Hospitals, Ankara, Turkey
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24
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Apenteng P, Virdone S, Camm J, Fox KAA, Bassand JP, Turpie AGG, Oh S, Brodmann M, Cools F, Barretto ACP, Nielsen J, Haas S, Kayani G, Pieper KS, Kakkar AK. Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry. Open Heart 2023; 10:e002275. [PMID: 37169491 PMCID: PMC10410826 DOI: 10.1136/openhrt-2023-002275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE There is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician's choice, however, a proportion of AF patients refuse anticoagulation. The aim of our study was to investigate factors associated with patient refusal of anticoagulation and the clinical outcomes in these patients. METHODS Our study population comprised patients in the Global Anticoagulant Registry in the FIELD (GARFIELD-AF) registry with CHA2DS2-VASc≥2. A logistic regression was developed with predictors of patient anticoagulation refusal identified by least absolute shrinkage and selection operator methodology. Patient demographics, medical and cardiovascular history, lifestyle factors, vital signs (body mass index, pulse, systolic and diastolic blood pressure), type of AF and care setting at diagnosis were considered as potential predictors. We also investigated 2-year outcomes of non-haemorrhagic stroke/systemic embolism (SE), major bleeding and all-cause mortality in patients who refused versus patients who received and patients who did not receive anticoagulation for other reasons. RESULTS Out of 43 154 AF patients, who were at high risk of stroke, 13 283 (30.8%) did not receive anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13 283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Diagnosis in primary care/general practitioner, Asian ethnicity and presence of vascular disease were strongly associated with a higher risk of patient refusal of anticoagulation. Patient refusal of anticoagulation was associated with a higher risk of non-haemorrhagic stroke/SE (adjusted HR (aHR) 1.16 (95% CI 0.77 to 1.76)) but lower all-cause mortality (aHR 0.59 (95% CI 0.43 to 0.80)) compared with patients who received anticoagulation. The GARFIELD-AF mortality score corroborated this result. CONCLUSION The data suggest patient refusal of anticoagulation is a missed opportunity to prevent AF-related stroke. Further research is required to understand the patient profile and mortality outcome of patients who refuse anticoagulation.
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Affiliation(s)
- Patricia Apenteng
- Institute of Applied Health Research, University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Saverio Virdone
- Department of Statistics, Thrombosis Research Institute, London, UK
| | - John Camm
- Cardiology, St Georges Hospital, London, UK
| | - Keith A A Fox
- Cardiology, University of Edinburgh and Royal Infirmary, Edinburgh, UK
| | | | | | - Seil Oh
- Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | | | - Frank Cools
- AZ Klina, General Hospital Klina, Brasschaat, Belgium
| | - Antonio C P Barretto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Jørn Nielsen
- Department of Cardiology, University of Copenhagen, Kobenhavn, Denmark
| | - Sylvia Haas
- Haemostasis and Thrombosis Research Group, Institute for Experimental Oncology and Therapy Research, Formerly Technical University, Munich, Germany
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Aguilo Lafarga I, Pérez Moreno M, Herranz Bayo E, Merchante Andreu M, Huarte Lacunza R. Recommended doses of endovenous vancomycin are insufficient to achieve therapeutic concentrations in paediatric patients. Eur J Hosp Pharm 2023:ejhpharm-2023-003694. [PMID: 37105712 DOI: 10.1136/ejhpharm-2023-003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Vancomycin therapeutic drug monitoring is challenging, especially in the paediatric population where evidence is scarce. The main objective of this study was to analyse the achievement of therapeutic concentrations of vancomycin in paediatric patients and to evaluate the current monitoring method (trough levels), doses used, and the time required to achieve target concentrations. METHODS Paediatric patients on treatment and monitored with vancomycin from November 2019 to December 2021 were included. Those with only one determination of serum vancomycin concentration were excluded. Demographic variables, analytical and microbiological parameters and toxicity data were collected. Pharmacokinetic parameters were assessed at baseline and during treatment. RESULTS 225 patients (40.9% female; 108 neonates, 49 infants and 68 children or adolescents) were included in the study. The main indications for vancomycin treatment were sepsis (33.9%) and fever of unknown origin (29.3%). Microbiological cultures were positive in 71.1%, mostly with Gram-positive bacteria (60.4%). Therapeutic levels of vancomycin were reached in only 20.1% of the participants in the first determination. After pharmacokinetic monitoring, 81.7% of patients reached therapeutic concentrations, requiring a 23% increase in the initial dose, a 2-day lag time and 1-2 dosage adjustments until the therapeutic concentration was reached. Of the total patients, 13 developed nephrotoxicity, nine neutropenia and one patient developed red man syndrome. CONCLUSIONS In our sample of paediatric patients, the recommended doses of vancomycin were insufficient to achieve therapeutic concentrations. Revision of the recommendations and/or a change in the method of pharmacokinetic monitoring is crucial to optimise treatment in this population.
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Affiliation(s)
| | - María Pérez Moreno
- Pharmacy Service, Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
| | - Elena Herranz Bayo
- Pharmacy Service, Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
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Besten-Bertholee DD, Wegner I, Touw DJ, Ter Horst PGJ. Analytical and clinical validation of an LC-MS/MS method for carbamazepine, lamotrigine and levetiracetam in dried blood spots. Eur J Hosp Pharm 2023:ejhpharm-2022-003589. [PMID: 36894298 DOI: 10.1136/ejhpharm-2022-003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Therapeutic drug monitoring is performed routinely in patients on anti-epileptic drugs (AEDs) for optimisation and individualisation of therapy. The dried blood spot (DBS) sampling technique is a suitable, more patient-friendly alternative for conventional venous sampling methods. However, before DBS can be used in routine care, data are needed to establish the correlation between standard plasma concentrations obtained from venous puncture and concentrations measured through DBS obtained by finger prick. This study aims to investigate the correlation between carbamazepine, lamotrigine and levetiracetam drug concentrations in venous blood and DBS samples in the same patients at the same time. METHODS Clinical validation was conducted by direct comparison of paired DBS and venous plasma samples. Method agreement was evaluated using Passing-Bablok regression analysis and Bland-Altman plots to provide insight into the relationship between the two analytically validated methods. For Bland-Altman analysis the acceptance limit required by both FDA and EMA guidelines is at least two-thirds (67%) of the paired samples within 80-120% of the mean of both methods. RESULTS Paired samples from 79 patients were studied. For all three AEDs, plasma and DBS concentrations correlated highly (r=0.90 for carbamazepine, r=0.93 for lamotrigine and r=0.93 for levetiracetam), indicating a linear relationship. For carbamazepine and lamotrigine, no proportional or constant bias was revealed. For levetiracetam, concentrations were higher in plasma samples than in DBS (slope 1.21), implying a conversion factor is needed. The acceptance limit was met for carbamazepine and levetiracetam with a value of 72% and 81%, respectively. For lamotrigine, this acceptance limit was not met with a value of 60%. CONCLUSIONS The method was successfully validated and will be used for therapeutic drug monitoring in patients using carbamazepine, lamotrigine and/or levetiracetam.
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Affiliation(s)
| | | | - Daan J Touw
- Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, The Netherlands
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de Godoi Rezende Costa Molino C, Rübel L, Mantegazza N, Bischoff-Ferrari HA, Freystaetter G. Association of polypharmacy with cognitive impairment in older trauma patients: a cross-sectional study. Eur J Hosp Pharm 2023:ejhpharm-2022-003645. [PMID: 36882299 DOI: 10.1136/ejhpharm-2022-003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Few if any studies have been conducted to date on the association between polypharmacy and cognitive impairment among older trauma patients. Therefore, we investigated whether polypharmacy is associated with cognitive impairment in trauma patients aged ≥70 years. METHODS This is a cross-sectional study of patients aged ≥70 years hospitalised due to a trauma-related injury. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤24 points. Medications were coded according to the Anatomical Therapeutic Chemical classification. Three exposures were examined: polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and number of medications. Separate logistic regression models adjusted for age, sex, body mass index (BMI), education, smoking, independent living, frailty, multimorbidity, depression, and type of trauma were used to test the association between the three exposures and cognitive impairment. RESULTS A total of 198 patients were included (mean age 80.2; 64.7% women and 35.4% men), of which 148 (74.8%) had polypharmacy and 63 (31.8%) had excessive polypharmacy. The prevalence of cognitive impairment was 34.3% overall, 37.2% in the polypharmacy group and 50.8% in the excessive polypharmacy group. More than 80% of participants were taking at least one analgesic. Overall, polypharmacy was not statistically significantly associated with cognitive impairment (odds ratio (OR) 1.20 [95% confidence interval (CI) 0.46 to 3.11]). However, patients in the excessive polypharmacy group were more than two times more likely to have cognitive impairment (OR 2.88 [95% CI 1.31 to 6.37]) even after adjustments for relevant confounders. Similarly, the number of medications was associated with greater odds of cognitive impairment (OR 1.15 [95% CI 1.04 to 1.28]) after adjustments for the same relevant confounders. CONCLUSION Cognitive impairment is common among older trauma patients, particularly among those in the excessive polypharmacy group. Polypharmacy was not associated with cognitive impairment. Excessive polypharmacy and number of medications, on the other hand, were associated with greater odds of cognitive impairment in older trauma patients.
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Affiliation(s)
- Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lisa Rübel
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
| | - Noemi Mantegazza
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystaetter
- Center on Aging and Mobility, University Hospital Zurich, City Hospital Zurich, Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- University Clinic for Aging Medicine, City Hospital, Zurich, Waid, Zurich, Switzerland
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Tochikura N, Matsumoto C, Iwabuchi S, Aso H, Fukushima S, Ootsuka S, Ooba N, Ishihara M, Nakajima H, Umemura H, Nakayama T. Pharmacokinetic/pharmacodynamic analysis of vancomycin in patients with Enterococcus faecium bacteraemia: a retrospective cohort study. Eur J Hosp Pharm 2023:ejhpharm-2022-003672. [PMID: 36868850 DOI: 10.1136/ejhpharm-2022-003672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES The trough concentration of vancomycin and the area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ratio are crucial in determining vancomycin efficacy against methicillin-resistant Staphylococcus aureus. However, the use of similar pharmacokinetic principles in determining antibiotic efficacy against other gram-positive cocci is lacking. We performed a pharmacokinetic/pharmacodynamic analysis (association of target trough concentration values and AUC/MIC with therapeutic outcome) of vancomycin in patients with Enterococcus faecium bacteraemia. METHODS Between January 2014 and December 2021 we performed a retrospective cohort study of patients with E. faecium bacteraemia treated with vancomycin. Patients who received renal replacement therapy or had chronic kidney disease were excluded. Clinical failure, the primary outcome, was defined as a composite of 30-day all-cause mortality, vancomycin-susceptible infection requiring change of treatment, and/or recurrence. AUC24 was estimated using a Bayesian estimation approach based on an individual vancomycin trough concentration. The MIC for vancomycin was determined using a standardised agar dilution method. Additionally, classification was used to identify the vancomycin AUC24/MIC ratio associated with clinical failure. RESULTS Of the 151 patients identified, 69 were enrolled. All MICs of vancomycin for E. faecium were ≤1.0 µg/mL. The AUC24 and AUC24/MIC ratio were not significantly different between the clinical failure group and the clinical success group (432±123 µg/mL/hour vs 488±92 µg/mL/hour; p=0.075). However, 7 of 12 patients (58.3%) in the clinical failure group and 49 of 57 patients (86.0%) in the clinical success group had a vancomycin AUC24/MIC ratio ≥389 (p=0.041). No significant association between trough concentration or AUC24 ≥600 µg/mL×hour and acute kidney injury was observed (p=0.365 and p=0.487, respectively). CONCLUSION The AUC24/MIC ratio is associated with the clinical outcome of vancomycin administration in E. faecium bacteraemia. In Japan, where vancomycin-resistant enterococcal infection is rare, empirical therapy with a target AUC24 ≥389 should be recommended.
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Affiliation(s)
- Naohiro Tochikura
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Chiaki Matsumoto
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - So Iwabuchi
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Hiroya Aso
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Sakae Fukushima
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Susumu Ootsuka
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Nobuhiro Ooba
- Department of Clinical Pharmacy, Nihon University School of Pharmacy, Funabashi, Chiba, Japan
| | - Masaki Ishihara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hiroshi Umemura
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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Edmealem A, Geleta E, Mengesha Z, Tegegne B, Ademe S, Liknaw T. Blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up at South Wollo Zone Public Hospitals, Northeast Ethiopia. Open Heart 2023; 10:openhrt-2023-002274. [PMID: 36958769 PMCID: PMC10040000 DOI: 10.1136/openhrt-2023-002274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Hypertension is a silent killer that causes serious health issues in all parts of the world. It is risk factor for cardiovascular disease, stroke and kidney disease. Self-monitoring practice has been identified as an important component of hypertension management. Hence, this study aimed to assess blood pressure (BP) self-monitoring practice and associated factors among adult hypertensive patients on follow-up in South Wollo Zone public hospitals, Northeast Ethiopia. METHODS Hospital-based cross-sectional study was conducted from 1 June 2022 to 30 June 2022, among 336 adult hypertensive patients on follow-up at selected South Wollo Zone public hospitals. Data were collected by using self-administered pretested structured questionnaires; the collected data were entered into Epi-data V.4.6 and then exported to SPSS V.25 software for analysis. Descriptive statistics such as frequency and percentage were used to describe the study participants. Tables and texts were used for data presentation. Binary logistic regression was conducted to test the association between the independent and dependent variables. Adjusted OR (AOR) with 95% CI was estimated to identify the factors associated with BP self-monitoring and the level of significance was declared at p<0.05. RESULTS The proportion (95% CI) of BP self-monitoring practice among hypertensive patients in South Wollo Zone Public Hospitals was 8.93% (95% CI 6.3% to 12.5%). In the multivariable analysis, urban residence (AOR 3.97, 95% CI (1.11 to 14.20)), comorbidity (AOR 4.80, 95% CI (1.23 to 18.69)), regular healthcare professional visit (AOR 4.64, 95% CI (1.02 to 21.14)), advice on the type of devices used for BP self-monitoring (AOR 5.26, 95% CI (1.49 to 18.58)) and knowledge on hypertension self-care (AOR 13.13, 95% CI (4.21 to 40.99)) were positively associated with BP self-monitoring practice. CONCLUSION The proportion of BP self-monitoring practice was low. Living in urban areas, comorbidity, regular healthcare professional visits, advice on the type of devices used for BP self-monitoring, and knowledge of hypertension self-care were positively associated with BP self-monitoring practice.
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Affiliation(s)
- Afework Edmealem
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Esmael Geleta
- Department of Nursing, Tropical College of Medicine, Dessie, Ethiopia
| | - Zemen Mengesha
- Department of Nursing, Wollo University, Dessie, Ethiopia
| | | | - Sewunet Ademe
- Department of Nursing, Injibara University, Injibara, Ethiopia
| | - Tiliksew Liknaw
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
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Sime FB, Wallis S, Jamieson C, Hills T, Gilchrist M, Santillo M, Seaton RA, Drummond F, Roberts J. Evaluation of the stability of temocillin in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy in accordance with the requirements of the UK NHS Yellow Cover Document. Eur J Hosp Pharm 2023; 30:e76-e81. [PMID: 35609967 PMCID: PMC10086727 DOI: 10.1136/ejhpharm-2022-003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/03/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the stability of temocillin solution in two elastomeric infusion devices - Easypump II LT 270-27- S and Dosi-Fusor L25915-250D1 for OPAT administration during 14 days of 5°C±3°C fridge storage followed by 24 hour exposure at an in-use temperature of 32°C, when reconstituted with 0.3% citrate buffer at pH7. METHODS Stability testing was conducted in accordance with standard protocols in the UK National Health Service Yellow Cover Document (YCD). A stability indicating assay method was applied using a high-performance liquid chromatography (HPLC) system with a photodiode array detector. Low (500 mg/240 mL), intermediate (4000 mg/240 mL) and high (6000 mg/240 mL) temocillin concentrations were tested in triplicate devices with duplicate samples taken at 11 time points during fridge storage and subsequent in-use temperature exposure. RESULT The percentage of temocillin remaining after 14 days of fridge storage was greater than 97% in both devices and at all concentrations tested. During subsequent in-use temperature exposure, a 95% stability limit was achieved for 12 hours except for the high concentration (25 mg/mL) in the Dosi-Fusor device. It met this criterion for only 10 hours - the percent of temocillin remaining at 12 hours was 94.5%. However, for all devices and the doses tested, the degradation of temocillin was <9% at the end of 24 hours in-use temperature exposure. CONCLUSION Temocillin reconstituted with 0.3% citrate buffer at pH7 in elastomeric infusion devices can be stored in a fridge (2°C-8°C) for 14 days meeting the YCD acceptance criteria. Considering <5% degradation, the current data supports twice daily dosing of temocillin within the OPAT setting. In jurisdictions where a <10% degradation limit is acceptable, once daily dosing with 24-hour continuous infusion may be considered. Temocillin is a useful alternative to other broad-spectrum anti-Gram-negative agents currently utilised in the OPAT setting and supports the wider antimicrobial stewardship agenda.
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Affiliation(s)
- Fekade Bruck Sime
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
| | - Steven Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
| | - Conor Jamieson
- Pharmacy Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Tim Hills
- Pharmacy Department and OPAT Service, Nottingham University Hospitals, Nottingham, UK, Bristol, UK
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Santillo
- Quality Assurance, University Hospitals Plymouth NHS Trust, Plymouth, UK and University Hospitals Bristol and Weston NHS Trust, Bristol, UK, Bristol, UK
| | | | | | - Jason Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine,the University of Queensland, Herston, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Danchin N. Missed opportunities in secondary prevention with statins. Heart 2023; 109:340-341. [PMID: 36332980 DOI: 10.1136/heartjnl-2022-321855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nicolas Danchin
- Department of Cardiology, Hôpital Paris Saint-Joseph, Paris, France
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Lhermitte R, Le Daré B, Laval F, Lemaitre F, Troussier B, Morin MP, Vigneau C, Chemouny JM, Bacle A. A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study. Eur J Hosp Pharm 2023:ejhpharm-2022-003625. [PMID: 36737230 DOI: 10.1136/ejhpharm-2022-003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Given the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist's role in the kidney transplantation team has evolved over recent decades. The primary objective of this study was to determine whether pharmacist-led intervention after kidney transplantation is associated with a lower graft rejection rate and intra-patient variation in tacrolimus trough concentrations (Cmin). The study's secondary objective was to develop a questionnaire to identify patients at risk for highly variable Cmin. METHODS We retrospectively analysed kidney transplant recipients at Rennes University Hospital (France) between January 2013 and December 2020. Patients who received pharmacist-led education (intervention group, n=139) were compared with patients who did not (control group, n=131), according to graft survival at 1 year post-transplant, coefficient of variation (%CV) for the tacrolimus Cmin, age, sex, length of hospital stay post-transplantation, body mass index, and Charlson Comorbidity Index. In the intervention group, a questionnaire assessing patient knowledge was introduced to compare scores with the %CV. RESULTS In the intervention group, 1 year post-transplant graft survival was higher (95.7% vs 88.5%, p=0.0289) and patients had fewer variabilities in Cmin. The %CV was correlated with questionnaire scores (r=-0.9758, p<0.0001). CONCLUSIONS Pharmacist-led interventions may have contributed to improved graft survival and patient management of immunosuppressants. Because %CV correlates with the patient questionnaire score, its introduction could be useful in identifying kidney transplant patients who would benefit most from a pharmacist-led patient education.
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Affiliation(s)
| | - Brendan Le Daré
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- NuMeCan, Rennes, France
| | - Florian Laval
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Clinical Investigation Center CIC-P 1414, Rennes, France
| | | | | | - Cécile Vigneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Jonathan M Chemouny
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Astrid Bacle
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
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Duval X, Franck B, Revest M, Tron C, Chemouny JM, Lalanne S, Houot R, Verdier MC, Lemaitre F. Comparison of different equations for renal function evaluation as proxies for antibiotic drug clearance: the examples of amoxicillin and cloxacillin. Clin Biochem 2022; 109-110:86-89. [PMID: 36108718 DOI: 10.1016/j.clinbiochem.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
The most appropriate renal function estimation equation to predict drug clearance is a matter of debate. In this study, we compare the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology collaboration (CKD-EPI) and the Cockroft-Gault (CG) equations to predict amoxicillin and cloxacillin clearance among hospitalized patients receiving high doses of these antibiotic treatments. This study aimed to compare different equations used to predict amoxicillin and cloxacillin clearance among hospitalized patients receiving amoxicillin or cloxacillin treatments outside the intensive care unit. Data from 128 patients contributing 268 plasma samples was analyzed, and correlations between the equations and the amoxicillin and cloxacillin antibiotic clearance rates were calculated. We found a correlation between antibiotic clearance and all the renal function estimation equations, CG being the best, with a R2 of 0.35 for amoxicillin and 0.29 for cloxacillin (compared to 0.26 and 0.21 for MDRD and 0.12 and 0.24 for CKD-EPI). CG should be preferentially used as a proxy for amoxicillin and cloxacillin drug clearance, but the use of completely different tools such as therapeutic drug monitoring could help individualize antibiotic dosage.
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Affiliation(s)
- Xavier Duval
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Bénédicte Franck
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Matthieu Revest
- Unité Inserm U1230, Université de Rennes 1, Rennes, France; Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
| | - Camille Tron
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Jonathan M Chemouny
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Sébastien Lalanne
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, Rennes, France; INSERM, U1236, Rennes, France
| | - Marie-Clémence Verdier
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Florian Lemaitre
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
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Pérez-Cordón L, Sánchez A, Marin S, Force L, Serra-Prat M, Palomera E, Campins L. Real-world effectiveness and durability of dual antiretroviral therapy in HIV-infected patients. Eur J Hosp Pharm 2022; 31:ejhpharm-2022-003277. [PMID: 35882532 PMCID: PMC10895179 DOI: 10.1136/ejhpharm-2022-003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While randomised controlled trials in HIV-infected patients have shown that certain dual antiretroviral therapy (DAT) regimens are non-inferior in terms of efficacy compared with classical triple-drug regimens, few real clinical experiences have been described. The aim of the study was to investigate, in real clinical practice, DAT effectiveness, durability, and risk factors for treatment discontinuation. METHODS This was a prospective cohort study that included HIV-infected patients treated with DAT (2015-2020). DAT was considered effective when patients achieved or maintained virological suppression and was assessed at 24 and 48 weeks. DAT durability was evaluated using the Kaplan-Meier method. Adherence and treatment cost were compared with patients' previous antiretroviral regimens. RESULTS 51 patients were included, 27.5% with HIV-1 RNA ≥50 copies/mL at baseline, treated with a wide range of dual combinations. At 48 weeks follow-up, 83.8% and 50.0% of patients who started DAT with HIV-1 RNA <50 copies/mL and ≥50 copies/mL, respectively, were suppressed. 39 out of 51 patients (76.5%) maintained DAT for a mean treatment duration of 40.5±14.8 weeks. Full adherence was observed in 78.4% of patients compared with 70.2% in the previous regimen. Mean daily cost was €18.6±4.3 compared with €16.1±7.9 in the previous regimen (p=0.008). CONCLUSION DAT effectiveness and durability were higher in patients who were virologically suppressed at baseline. DAT is a possible alternative for virologically non-suppressed patients who cannot be treated with a triple-drug regimen.
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Affiliation(s)
| | | | - Sergio Marin
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lluis Force
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
| | | | | | - Lluis Campins
- Pharmacy Department, Hospital de Mataró, Mataró, Spain
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Abdel-Tawab M, Waßmuth M, Gegenfurtner F, Hawe A, Schefe JH, Strunz AM, Wübert J. Short-term study on in-use stability of opened bevacizumab biosimilar PF-06439535 vials. Eur J Hosp Pharm 2022; 31:ejhpharm-2021-003198. [PMID: 35853692 PMCID: PMC10895173 DOI: 10.1136/ejhpharm-2021-003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Aggregation is one of the key critical points limiting the stability of monoclonal antibodies in solution. The present study aimed to investigate the in-use stability of a residual monoclonal antibody solution after withdrawal of most of the filling volume of PF-06439535 (bevacizumab biosimilar), addressing the physical and chemical stability with respect to aggregation and fragmentation. METHODS The stability of residual PF-06439535 solution (25 mg/mL) after withdrawal of 80% (12.8 mL) filling volume with a 20G needle was monitored over a light-protected storage period of 8 days at 2-8°C and 25°C with measurement time points at D0 (start of storage), D2, D4, and D8 (2, 4, and 8 days of storage after start, respectively). Unopened vials stored under the same conditions served as control. For this purpose, the analytical results from size exclusion chromatography, dynamic light scattering, and micro-flow imaging obtained after the individual measurement time points up to 8 days were compared with those obtained at D0 and with those obtained for unopened vials stored under the same conditions. RESULTS No aggregation or ongoing fragmentation due to partial withdrawal of filling volume could be observed in the residual PF-06439535 solution. Moreover, no changes in the particle size distribution at D8 compared with the D0 values were identified upon storage at either 2-8°C or 25°C (both opened and unopened vials). The total concentration of particles ≥10 µm of all samples was <100 particles/mL. In addition, no variations in the pH values or in the visual appearance were detected over the whole study period in all samples at all storage conditions. CONCLUSIONS Consequently, residual PF-06439535 solution (25 mg/mL) in opened vials may be regarded as stable when stored light-protected over a period of 8 days in the refrigerator (2-8°C) or at 25°C.
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Affiliation(s)
| | - Markus Waßmuth
- Central Laboratory of German Pharmacists, Eschborn, Germany
| | | | - Andrea Hawe
- Coriolis Pharma Research GmbH, Martinsried, Bayern, Germany
| | | | | | - Joachim Wübert
- Central Laboratory of German Pharmacists, Eschborn, Germany
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Huynh L, Agossah C, Lelong-Boulouard V, Marie J, Brossier D, Goyer I. Therapeutic drug monitoring of intravenous anti-tuberculous therapy: management of an 8-month-old child with tuberculous meningitis. Paediatr Int Child Health 2021; 41:285-290. [PMID: 33822698 DOI: 10.1080/20469047.2020.1855868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tuberculous meningitis (TBM) is now uncommon in high-income countries. It is the most severe form of extrapulmonary tuberculosis with high rates of mortality and morbidity if diagnosis and treatment are delayed. An 8-month-old girl with TBM who was treated with high-dose intravenous anti-tuberculous drugs (ATD) is reported. Therapeutic drug monitoring (TDM) of isoniazid and rifampicin was undertaken by measuring serial drug concentrations in serum and cerebrospinal fluid (CSF). There was rapid eradication of Mycobacterium tuberculosis from the CSF with a good clinical outcome and no adverse effects. Using high-dose regimens of intravenous ATD to treat TBM is an important option in order to obtain sufficient CSF diffusion. When available, TDM and a multidisciplinary approach are essential for efficient therapeutic management.
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Affiliation(s)
- Lucie Huynh
- Department of Pharmacy, Etablissement Public de Santé Mentale, Caen, France
| | - Cedric Agossah
- Department of Paediatrics, Caen University Hospital, Caen, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, France.,School of Medicine, Normandy University, Caen, France.,INSERM UMR, University of Normandy, Caen, France
| | - Julien Marie
- Department of Paediatrics, Caen University Hospital, Caen, France
| | - David Brossier
- School of Medicine, Normandy University, Caen, France.,Paediatric Intensive Care Unit, Caen University Hospital, Caen, France
| | - Isabelle Goyer
- Department of Pharmacy, Caen University Hospital, Caen, France
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37
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Ahumada-Canale A, Vargas C, Martinez-Mardones F, Plaza-Plaza JC, Benrimoj S, Garcia-Cardenas V. Cost-utility analysis of medication review with follow-up for cardiovascular outcomes: A microsimulation model. Health Policy 2021; 125:1406-1414. [PMID: 34579954 DOI: 10.1016/j.healthpol.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death. Pharmacist-led medication review with follow-up might be cost-effective preventing cardiovascular diseases. OBJECTIVE To undertake a cost-utility analysis of the addition of pharmacist-led medication review with follow-up to usual care compared to usual care alone for cardiovascular outpatients. MATERIALS AND METHODS A state-transition microsimulation model was built to project outcomes over a lifetime time horizon. Inputs from a cluster randomized controlled trial conducted in primary health care centers in Chile with full-time pharmacists were used. Probabilities were estimated using patient-level data. Utilities and costs associated with each health state were obtained from the literature, whereas the intervention costs were retrieved from the trial. The public third-party payer perspective was used. Uncertainty was evaluated through one-way and probabilistic sensitivity analyses. RESULTS For the base case analysis, an incremental cost-effectiveness ratio of $963 per quality-adjusted life-year was observed which was considered cost-effective. The results were robust to sensitivity analyses and were driven by decreased cardiovascular events resulting in lower mortality. CONCLUSIONS Medication review with follow-up was deemed a cost-effective addition to usual care with low uncertainty.
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Affiliation(s)
- Antonio Ahumada-Canale
- Graduate School of Health, University of Technology Sydney, Sydney, Australia; Centre for the Health Economy, Macquarie University, Sydney, Australia.
| | - Constanza Vargas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | | | | | - Shalom Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain
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38
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Ferreira-da-Silva R, Ribeiro-Vaz I, Morato M, Polónia JJ. Guiding axes for drug safety management of pharmacovigilance centres during the COVID-19 era. Int J Clin Pharm 2021; 43:1133-1138. [PMID: 34076805 PMCID: PMC8170628 DOI: 10.1007/s11096-021-01289-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/26/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic presents several challenges to the organisation and workflow of pharmacovigilance centres as a result of the massive increase in reports, the need for quick detection, processing and reporting of safety issues and the management of these within the context of lack of complete information on the disease. Pharmacovigilance centres permanently monitor the safety profile of medicines, ensuring risk management to evaluate the benefit-risk relationship. However, traditional pharmacovigilance approaches of spontaneous reporting, are not suitable in the context of a pandemic; the scientific community and regulators need information on a near real-time point. The aim of this commentary is to suggest six interrelated multidimensional guiding axes for drug safety management by pharmacovigilance centres during the COVID-19 pandemic. This working plan can increase knowledge on COVID-19 and associated therapeutic approaches, support decisions by the regulatory authorities, oppose fake news and promote more efficient public health protection.
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Affiliation(s)
- Renato Ferreira-da-Silva
- Porto Pharmacovigilance Centre, Rua Doutor Plácido da Costa, 4200-450, Porto, Portugal. .,Department of Community Medicine, Health Information and Decision, Porto, Portugal. .,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Rua Doutor Plácido da Costa, 4200-450, Porto, Portugal.,Department of Community Medicine, Health Information and Decision, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Manuela Morato
- Department of Drug Sciences, LAQV/REQUIMTE, Laboratory of Pharmacology, Porto, Portugal
| | - Jorge Junqueira Polónia
- Porto Pharmacovigilance Centre, Rua Doutor Plácido da Costa, 4200-450, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,Department of Medicine, University of Porto, Porto, Portugal
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39
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Ferreira-da-Silva R, Ribeiro-Vaz I, Morato M, Silva AM, Junqueira Polónia J. [The Role of Pharmacovigilance in the COVID-19 Pandemic]. ACTA MEDICA PORT 2021; 34:173-175. [PMID: 33448925 DOI: 10.20344/amp.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Renato Ferreira-da-Silva
- Unidade de Farmacovigilância do Porto. Faculdade de Medicina. Universidade do Porto. Porto; CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Saúde. Porto; Departamento Medicina da Comunidade, Informação e Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Inês Ribeiro-Vaz
- Unidade de Farmacovigilância do Porto. Faculdade de Medicina. Universidade do Porto. Porto. CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Saúde. Porto. Departamento Medicina da Comunidade, Informação e Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Manuela Morato
- LAQV/REQUIMTE - Laboratório de Farmacologia. Departamento de Ciências do Medicamento. Faculdade de Farmácia. Universidade do Porto. Porto. Portugal
| | - Ana Marta Silva
- Unidade de Farmacovigilância do Porto. Faculdade de Medicina. Universidade do Porto. Porto. CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Saúde. Porto. Departamento Medicina da Comunidade, Informação e Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Jorge Junqueira Polónia
- Unidade de Farmacovigilância do Porto. Faculdade de Medicina. Universidade do Porto. Porto. CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Saúde. Porto. Departamento de Medicina. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Almohammde S, Alhodian H, Almofareh S, Alshehri S, Almasri DM, Ghoneim RH. A survey of therapeutic drug monitoring in a teaching hospital. Saudi J Biol Sci 2020; 28:744-747. [PMID: 33424362 PMCID: PMC7783832 DOI: 10.1016/j.sjbs.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Therapeutic drug monitoring (TDM) is one of the tools that aim to improve and ensure the best therapeutic effects while avoiding drug toxicity. This study aimed to identify the clinical utilization and application of TDM at a major teaching hospital in Jeddah. Methods A cross sectional survey of the clinical utilization and application of TDM at King Abdulaziz University Teaching Hospital across nurses in medical, surgical, pediatric, and intensive care units. The sample size (n = 130) represented 30% of the nursing population. The collection of questionnaires started on the 31st of January 2019 and was completed by the 10th of March 2019. Results The indication to use TDM was well-known to respondents. However, only 64% of respondents reported collection and measuring of the correct drug levels at a precise sampling time with no specific protocols being followed for each drug. Moreover, only 53% reported that the drug levels were being re-measured and adequately monitored for the right indication and proper sampling time. Regarding the presence of clinical pharmacists, 70% of the respondents indicated that no clinical pharmacist worked in their department. Conclusion Results demonstrate that appropriate sampling time was not used for the majority of monitored drugs. In the absence of a TDM request form, this finding probably indicates the lack of national or local TDM guidelines. In conclusion, TDM services, which include standardized forms, references, and an active clinical pharmacist will likely improve the application of TDM.
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Affiliation(s)
- Shahad Almohammde
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hadil Alhodian
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Almofareh
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samah Alshehri
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Diena M Almasri
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ragia H Ghoneim
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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41
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Mcgrady KA, Benton M, Tart S, Bowers R. Evaluation of traditional initial vancomycin dosing versus utilizing an electronic AUC/MIC dosing program. Pharm Pract (Granada) 2020; 18:2024. [PMID: 33005260 PMCID: PMC7508472 DOI: 10.18549/pharmpract.2020.3.2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Area under the curve to minimum inhibitory concentration (AUC/MIC) has been
recommended by the 2020 updated vancomycin guidelines for dosing vancomycin
for both efficacy and safety. Previously, AUC/MIC has been cumbersome to
calculate so surrogate trough concentrations of 15-20 mg/dL were utilized.
However, trough-based dosing is not a sufficient surrogate as AUC/MIC
targets of 400-600 can usually be reached without achieving troughs of 15-20
mg/dL. Targeting higher trough levels may also lead to adverse events
including acute kidney injury (AKI) and nephrotoxicity. Objective: To compare the mean total first day vancomycin dose in traditional
trough-based dosing versus dosing recommended by an AUC/MIC dosing
program. Methods: Adult inpatients who received at least 24 hours of IV vancomycin treatment
were included in this single-center, retrospective cohort study. The primary
endpoint was difference in mean total first day vancomycin dose in
milligrams (mg) received between patients’ traditional trough-based
dosing and recommended dose via AUC/MIC electronic dosing calculator.
Patients served as their own control by analyzing both actual dose received
and dose recommended by the electronic AUC/MIC program. Rates of vancomycin
induced adverse events, including acute kidney injury, elevated steady-state
trough concentrations, and Red Man’s syndrome were also compared
between patients who received doses consistent with the AUC/MIC dosing
recommendation versus those who did not. Results: 264 patients were included in this study. Initial 24-hour vancomycin exposure
was significantly lower with the recommended AUC/MIC dose versus the dose
received (2380.7; SD 966.6 mg vs 2649.6; SD 831.8 mg, [95% CI
114.7:423.1] p=0.0007). Conclusions: Utilizing an electronic AUC/MIC vancomycin dosing calculator would result in
lower total first day vancomycin doses.
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Affiliation(s)
- Kerri A Mcgrady
- PharmD. College of Pharmacy and Health Sciences, Campbell University. Buies Creek, NC (United States).
| | - Makenzie Benton
- BS. College of Pharmacy and Health Sciences, Campbell University. Buies Creek, NC (United States).
| | - Serina Tart
- PharmD. Cape Fear Valley Health. Fayetteville, NC (United States).
| | - Riley Bowers
- PharmD. College of Pharmacy and Health Sciences, Campbell University. Buies Creek, NC (United States).
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42
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Jung HY, Lee S, Jeon Y, Choi JY, Cho JH, Park SH, Kim YL, Kim HK, Huh S, Won DI, Kim CD. Mycophenolic Acid Trough Concentration and Dose Are Associated with Hematologic Abnormalities but Not Rejection in Kidney Transplant Recipients. J Korean Med Sci 2020; 35:e185. [PMID: 32567256 PMCID: PMC7308135 DOI: 10.3346/jkms.2020.35.e185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known regarding the safe fixed dose of mycophenolic acid (MPA) for preventing biopsy-proven acute rejection (BPAR) in kidney transplant recipients (KTRs). We investigated the correlation of MPA trough concentration (MPA C₀) and dose with renal transplant outcomes and adverse events. METHODS This study included 79 consecutive KTRs who received MPA with tacrolimus (TAC) and corticosteroids. The MPA C₀ of all the enrolled KTRs was measured, which was determined monthly by using particle-enhanced turbidimetric inhibition immunoassay for 12 months, and clinical data were collected at each time point. The clinical endpoints included BPAR, any cytopenia, and BK or cytomegalovirus infections. RESULTS No differences in MPA C₀ and dose were observed between KTRs with or without BPAR or viral infections under statistically comparable TAC concentrations. MPA C₀ was significantly higher in patients with leukopenia (P = 0.021) and anemia (P = 0.002) compared with those without cytopenia. The MPA dose was significantly higher in patients with thrombocytopenia (P = 0.002) compared with those without thrombocytopenia. MPA C₀ ≥ 3.5 μg/mL was an independent risk factor for leukopenia (adjusted odds ratio [AOR], 3.80; 95% confidence interval [CI], 1.24-11.64; P = 0.019) and anemia (AOR, 5.90; 95% CI, 1.27-27.51; P = 0.024). An MPA dose greater than the mean value of 1,188.8 mg/day was an independent risk factor for thrombocytopenia (AOR, 3.83; 95% CI, 1.15-12.78; P = 0.029). However, an MPA dose less than the mean value of 1,137.3 mg/day did not increase the risk of BPAR. CONCLUSION Either a higher MPA C₀ or dose is associated with an increased risk of cytopenia, but neither a lower MPA C₀ nor dose is associated with BPAR within the first year of transplantation. Hence, a reduced MPA dose with TAC and corticosteroids might be safe in terms of reducing hematologic abnormalities without causing rejection.
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Affiliation(s)
- Hee Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sukyung Lee
- Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Republic of Korea
| | - Yena Jeon
- Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jang Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sun Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyung Kee Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Il Won
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chan Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
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Ilias A, Szanto K, Gonczi L, Kurti Z, Golovics PA, Farkas K, Schafer E, Szepes Z, Szalay B, Vincze A, Szamosi T, Molnar T, Lakatos PL. Outcomes of Patients With Inflammatory Bowel Diseases Switched From Maintenance Therapy With a Biosimilar to Remicade. Clin Gastroenterol Hepatol 2019; 17:2506-2513.e2. [PMID: 30630103 DOI: 10.1016/j.cgh.2018.12.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/31/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is evidence that it is safe and effective for patients with inflammatory bowel diseases (IBD) to switch from maintenance therapy with an original infliximab drug to a biosimilar, but little is known about outcomes of reverse switches and/or multiple switches. We aimed to evaluate the effects of a reverse switch (from a biosimilar to Remicade) in a real-life cohort. METHODS We performed a prospective observational study of 174 unselected and consecutive patients with IBD (136 with Crohn's disease [CD] and 38 with ulcerative colitis [UC]) who received maintenance therapy with the biosimilar in Hungary. In September 2017, patients were switched from the biosimilar (CT-P13) to Remicade, due to reimbursement policies. In our cohort, 8% (n = 14) patients had been previously exposed to the originator Remicade. We collected clinical and biochemical information from patients at baseline (time of the switch) and 16 and 24 weeks thereafter. Clinical remission was defined as a Crohn's disease activity index <150 points or no fistula drainage, or a partial Mayo score <3 points for patients with UC. Serum drug trough levels and anti-drug antibodies were measured at baseline and week 16. RESULTS There was no significant difference in the proportion of patients in clinical remission at week 8 before the switch (82.5% with CD and 82.9% with UC), at baseline (80.6% with CD and 81.6% with UC), at week 16 (77.5% with CD and 83.7% with UC), or at week 24 (CD 76.3% with CD and 84.9% with UC) (P = .60 among groups for patients with CD and P = .98 among groups for patients with UC). For all patients, mean serum trough levels of infliximab were 5.33 ± 4.70 μg/mL at baseline and 5.69 ± 4.94 μg/mL at week 16 (P = .71); we did not find significant differences in prevalence of anti-drug antibody at baseline (16.2%) compared with week 16 (16.9%) (P = .87). Four infusion reactions occurred, until week 24 of follow up. There was no difference in outcomes or trough or antidrug antibody levels between patients with or without previous exposure to Remicade. CONCLUSIONS We collected data from a real-life cohort of patients with CD or UC who were switched from maintenance therapy with a biosimilar to Remicade or were treated with only Remicade. No significant changes were observed in remission, trough levels, or antidrug antibodies in patients switched from the biosimilar to Remicade. No new safety signals were detected.
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Affiliation(s)
- Akos Ilias
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Szanto
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Anna Golovics
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Zoltan Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Balazs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Aron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Tamas Szamosi
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, Canada.
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44
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Bowers RD, Cooper AA, Wente CL, Wilson DT, Johnson SW, Drew RH. Evaluation of a vancomycin dosing nomogram in obese patients weighing at least 100 kilograms. Pharm Pract (Granada) 2018; 16:1204. [PMID: 30416622 PMCID: PMC6207350 DOI: 10.18549/pharmpract.2018.03.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background There remains variability in both practice and evidence related to optimal initial empiric dosing strategies for vancomycin. Objective Our primary objective was to describe the percentage of obese patients receiving vancomycin doses consistent with nomogram recommendations achieving targeted initial steady-state serum vancomycin concentrations. Secondary objectives were to describe the primary endpoint in subgroups based on patient weight and estimated creatinine clearance, to describe the rate of supratherapeutic vancomycin accumulation following an initial therapeutic trough concentration, and to describe the rate of vancomycin-related adverse events. Methods This single-center, IRB-approved, retrospective cohort included adult patients ≥ 100 kilograms total body weight with a body mass index (BMI) >30 kilograms/m2 who received a stable nomogram-based vancomycin regimen and had at least one steady-state vancomycin trough concentration. Data collected included vancomycin regimens and concentrations, vancomycin indication, serum creatinine, and vancomycin-related adverse events. Patients were divided into two cohorts by goal trough concentration: 10-15 mcg/mL and 15-20 mcg/mL. Results Of 325 patients screened, 85 were included. Goal steady-state concentrations were reached in 42/85 (49.4%) of total patients. Conclusions Achievement of initial steady-state vancomycin serum concentrations in the present study (approximately 50%) was consistent with the use of published vancomycin dosing nomograms.
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Affiliation(s)
- Riley D Bowers
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Cape Fear Valley Medical Center. Fayetteville, NC (United States).
| | - April A Cooper
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Duke Regional Hospital. Durham, NC (United States).
| | - Catherine L Wente
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Duke Regional Hospital. Durham, NC (United States).
| | - Dustin T Wilson
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Duke University Hospital. Durham, NC (United States).
| | - Steven W Johnson
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Novant Health - Forsyth Medical Center. Winston-Salem, NC (United States).
| | - Richard H Drew
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University. Buies Creek, NC; & Duke University School of Medicine. Durham, NC (United States).
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Sánchez-Ferro Á, Matarazzo M, Martínez-Martín P, Martínez-Ávila JC, Gómez de la Cámara A, Giancardo L, Arroyo Gallego T, Montero P, Puertas-Martín V, Obeso I, Butterworth I, Mendoza CS, Catalán MJ, Molina JA, Bermejo-Pareja F, Martínez-Castrillo JC, López-Manzanares L, Alonso-Cánovas A, Herreros Rodríguez J, Gray M. Minimal Clinically Important Difference for UPDRS-III in Daily Practice. Mov Disord Clin Pract 2018; 5:448-450. [PMID: 30838303 DOI: 10.1002/mdc3.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Álvaro Sánchez-Ferro
- HM-CINAC, Hospital Universitario HM Puerta del Sur, Móstoles and Medical School CEU-San Pablo University Madrid Spain.,Neurology Department Instituto de Investigación del Hospital 12 de Octubre Madrid Spain.,Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain.,Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge Massachusetts USA
| | - Michele Matarazzo
- HM-CINAC, Hospital Universitario HM Puerta del Sur, Móstoles and Medical School CEU-San Pablo University Madrid Spain.,Neurology Department Instituto de Investigación del Hospital 12 de Octubre Madrid Spain.,Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain.,Pacific Parkinson's Research Centre The University of British Columbia Vancouver BC Canada
| | - Pablo Martínez-Martín
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain.,Area of Applied Epidemiology, National Centre of Epidemiology Carlos III Institute of Health Madrid Spain
| | - Jose Carlos Martínez-Ávila
- Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) Hospital Universitario 12 de Octubre Madrid Spain
| | - Agustín Gómez de la Cámara
- Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) Hospital Universitario 12 de Octubre Madrid Spain
| | - Luca Giancardo
- Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge Massachusetts USA.,Center for Precision Health, School of Biomedical Informatics The University of Texas Health Science Center at Houston Houston USA
| | - Teresa Arroyo Gallego
- Biomedical Imaging Technologies ETSI Telecomunicación UPM Madrid Spain.,Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA USA.,nQ Medical Cambridge MA USA
| | - Paloma Montero
- Neurology Department Instituto de Investigación del Hospital 12 de Octubre Madrid Spain.,Movement Disorders Unit Hospital Clínico San Carlos Madrid Spain
| | | | - Ignacio Obeso
- HM-CINAC, Hospital Universitario HM Puerta del Sur, Móstoles and Medical School CEU-San Pablo University Madrid Spain
| | - Ian Butterworth
- Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge Massachusetts USA
| | - Carlos S Mendoza
- Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge Massachusetts USA
| | | | - José Antonio Molina
- Neurology Department Instituto de Investigación del Hospital 12 de Octubre Madrid Spain
| | - Félix Bermejo-Pareja
- Neurology Department Instituto de Investigación del Hospital 12 de Octubre Madrid Spain
| | | | | | | | | | - Martha Gray
- Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge Massachusetts USA.,Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA USA
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Cohen AN, Collins G, Nucifora FC, Strobel R, Wait DB, Young AS. Clinical Consensus Recommendations for Urine Testing of Adherence to Antipsychotics Among People With Serious Mental Illness. Psychiatr Serv 2018; 69:345-348. [PMID: 29241434 DOI: 10.1176/appi.ps.201700082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study developed clinical recommendations for the use of proven urine testing technologies to assess antipsychotic medication adherence among people with serious mental illness. METHODS Guided by the RAND/UCLA Appropriateness Method, researchers conducted a literature review and semistructured interviews and convened an expert panel to develop clinical consensus recommendations for the use of urine monitoring to assess antipsychotic medication adherence. RESULTS The expert panel identified six circumstances in which urine monitoring was recommended at initial evaluation and five scenarios in which monitoring was recommended after initial evaluation. Conducting monitoring at the site where psychiatric medication is prescribed and providing education prior to testing and feedback after testing were recommended. CONCLUSIONS A consensus was reached on clinical recommendations for use of urine monitoring at intake and during ongoing treatment. There was strong agreement that monitoring can be used to improve assessment and thence clinical care and outcomes.
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Affiliation(s)
- Amy N Cohen
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
| | - Gretchen Collins
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
| | - Frederick Charles Nucifora
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
| | - Roddy Strobel
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
| | - David B Wait
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
| | - Alexander S Young
- Dr. Cohen and Dr. Young are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Collins is with View Point Health, Lawrenceville, Georgia, and the Department of Psychiatry, Emory University, Atlanta. Dr. Nucifora is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore. Dr. Strobel is with the Permian Basin Community Center, Midland, Texas. Dr. Wait is with Heritage Health, Coeur d'Alene, Idaho
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47
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Cox N, Tak CR, Cochella SE, Leishman E, Gunning K. Impact of Pharmacist Previsit Input to Providers on Chronic Opioid Prescribing Safety. J Am Board Fam Med 2018; 31:105-12. [PMID: 29330245 DOI: 10.3122/jabfm.2018.01.170210] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Primary care providers (PCPs) account for half of opioid prescriptions, often feel chronic pain patients are challenging to manage, and there is wide variability in practice patterns. The purpose of this pilot study was to evaluate the impact of a previsit pharmacist review of high-risk patients treated with opioids for chronic pain on compliance to guideline recommendations at a family medicine residency clinic. METHODS All adult patients with an appointment for chronic pain who were prescribed >50 morphine milligram equivalents (MMEs)/day had charts reviewed by a pharmacist before each appointment; recommendations were sent electronically to the provider before the appointment. After 4 months of implementation, each patient's chart was manually reviewed to gather outcome variables. The primary outcomes were the mean MMEs/day and pain scores. RESULTS Pharmacist previsit recommendations were provided for 45 patients. When comparing outcomes before and after intervention, the mean MMEs/day decreased by 14% (P < .001), with no change in pain scores (P = .783). Statistically significant improvements were noted in multiple other secondary opioid safety outcomes. CONCLUSION Clinical pharmacists providing previsit recommendations was associated with decreased opioid utilization with no corresponding increase in pain scores and increased compliance to guideline recommendations.
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Hammond DA, Atkinson LN, James TB, Painter JT, Lusardi K. Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients. Pharm Pract (Granada) 2017; 15:949. [PMID: 28690700 PMCID: PMC5499355 DOI: 10.18549/pharmpract.2017.02.949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin. OBJECTIVE Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients. METHODS A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student's t-test for continuous data and chi-square test for categorical data. RESULTS Baseline characteristics were similar between the pre-intervention (n=124) and post-intervention (n=122) groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03) and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001). Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68). There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72), 60 (57% vs. 63%, p=0.35), or 75 (60% vs. 68%, p=0.22) minutes from the scheduled time of the next dose. CONCLUSION Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.
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Affiliation(s)
- Drayton A Hammond
- PharmD, MBA, BCPS, BCCCP. Assistant Professor. Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences; & Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center. Little Rock, AR (United States).
| | - Lexis N Atkinson
- Pharmacy Resident. Department of Pharmacy, Central Arkansas Veterans Healthcare System. Little Rock, AR (United States).
| | - Taylor B James
- Pharmacy Resident. Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center. Little Rock, AR (United States).
| | - Jacob T Painter
- PharmD, PhD, MBA. Assistant Professor. Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences. Little Rock, AR (United States).
| | - Katherine Lusardi
- PharmD, BCPS (AQ-Infectious Diseases). Antimicrobial Stewardship Pharmacist. Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center. Little Rock, AR (United States).
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49
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Rajon K, Vaillancourt R, Varughese N, Villarreal G. Vancomycin use, dosing and serum trough concentrations in the pediatric population: a retrospective institutional review. Pharm Pract (Granada) 2017; 15:887. [PMID: 28690689 PMCID: PMC5499344 DOI: 10.18549/pharmpract.2017.02.887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vancomycin is used primarily for Gram-positive infections. Recommended dosage regimens and targeted therapeutic levels vary between institutions. OBJECTIVES This study aims to describe therapeutic levels according to initial vancomycin doses and patient's age. A secondary objective was to evaluate appropriateness of vancomycin use in our hospital. METHODS A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario. Patients included in this study were classified by age (neonates, infants, children and adolescents) and categorized into those who received vancomycin ≤5 and >5 days. Initial vancomycin dosing regimens and corresponding initial trough levels obtained were evaluated. Initial trough levels drawn in relation to the third, fourth, or fifth doses corresponding to the first course of therapy were analyzed. Acceptable trough levels ranged from 5-20 mg/L. RESULTS One-hundred-and-sixty-four patients who received intravenous vancomycin in 2013 were included. Of the 229 courses of vancomycin, 190 (83%) were used 5 days or less (mean 4.9 days). Sixteen infants (88.9%) and 21 adolescents (100%), who received vancomycin empiric dosing of 60 mg/kg/day, had initial trough levels >5mg/L. However, in the children's group 20 (37.7%) did not reach levels >5 mg/L. None of vancomycin minimum inhibitory concentration (MIC) values were >1mg/L for the four patients who had infections due to methicillin-resistant Staphylococcus aureus strains. CONCLUSIONS In our institution, initial empiric vancomycin dosing of 60 mg/kg/day resulted in levels ≥5mg/L in most infants and adolescents. It remains unclear why some children aged 1-12 years did not achieve these levels.
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Affiliation(s)
- Kevin Rajon
- Pharmaceutical and Biological Sciences Institute, Faculty of Medicine and Pharmacy. University of Lyon. Lyon (France).
| | - Regis Vaillancourt
- Department of Clinical Pharmacy, Children's Hospital of Eastern Ontario. Ontario, Ottawa (Canada).
| | - Nisha Varughese
- Department of Clinical Pharmacy, Children's Hospital of Eastern Ontario. Ontario, Ottawa (Canada).
| | - Gilda Villarreal
- Department of Clinical Pharmacy, Children's Hospital of Eastern Ontario. Ontario, Ottawa (Canada).
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Rappelsberger A, Adlassnig KP, de Bruin JS, Plössnig M, Schuler J, Hofer-Dückelmann C. Adverse Drug Event Monitoring with Clinical and Laboratory Data Using Arden Syntax. Stud Health Technol Inform 2017; 245:1123-1127. [PMID: 29295277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In times of steadily increasing numbers of administered drugs, the detection of adverse drug events (ADEs) is an important aspect of improving patient safety. At present only about 1-13% of detected ADEs are reported. Raising the number of reported ADEs will result in greater and more efficient support of pharmacovigilance. Potential ADE's must be identified early. In the iMedication system, which is a rule-based application, triggers are used for computerized detection of possible ADEs. Creating a pilot system, we defined the relevant use cases hyperkalemia, hyponatremia, renal failure, and over-anticoagulation; knowledge bases were implemented in Arden Syntax for each use case. The objective of these knowledge bases is to interpret patient-specific clinical data and generate notifications based on a calculated ADE risk score, which may indicate possible ADEs. This will permit appropriate monitoring of potential ADE situations over time in the interest of patient care, quality assurance, and pharmacovigilance.
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Affiliation(s)
- Andrea Rappelsberger
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Klaus-Peter Adlassnig
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Jeroen S de Bruin
- Section for Artificial Intelligence and Decision Support, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Manuela Plössnig
- Salzburg Research Forschungsgesellschaft mbH, Jakob Haringer Strasse 5/3, A-5020 Salzburg, Austria
| | - Jochen Schuler
- Paracelsus Medical Private University Salzburg, Institute of General Practice, Family Medicine and Preventive Medicine, Strubergasse 21, A-5020 Salzburg, Austria
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