European journal of hospital pharmacy : science and practice最新文献

{"title":"Adherence and persistence rates for antidiabetic treatments in type 2 diabetes: a real-world study in an Italian region.","authors":"Alessia Romagnoli, Martina Savoia, Gloria Papini, Andrea Caprodossi, Fausto Bartolini","doi":"10.1136/ejhpharm-2024-004383","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004383","url":null,"abstract":"<p><strong>Objective: </strong>Achieving glycaemic control is essential to avoid disease progression and diabetes-related complications. Non-adherence and discontinuity in diabetic therapy are major barriers to optimal glycaemic control. The aim of this study was to evaluate adherence, persistence and therapy switching over 1 year in real-life conditions in patients with type 2 diabetes within an Italian region.</p><p><strong>Methods: </strong>A retrospective, observational, non-interventional study was conducted, analysing patients treated with Anatomical Therapeutic Chemical (ATC) Classification A10B drugs dispensed by pharmacies under the local health authority (ASL) of the Umbria region from 1 January 2022 to 31 December 2023. Adherence was measured using the Proportion of Days Covered (PDC), while persistence was calculated as the duration between the start and end of therapy.</p><p><strong>Results: </strong>A total of 6928 patients with type 2 diabetes were analysed. After 1 year, the overall adherence rate was 0.78, with 58% (4017/6928) of patients having adherence greater than 0.80. The lowest adherence was observed in patients treated with metformin +dipeptidyl peptidase 4 (DPP4) inhibitors, with a mean adherence of 0.71 and 36% (142/395) of patients achieving adherence greater than 0.80. Conversely, the highest adherence was seen in patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors, with a mean adherence of 0.91 and 97% (473/487) of patients achieving adherence greater than 0.80. Persistence data showed concerning results, with less than 10% of patients remaining on treatment for 1 year across all drug classes. Among patients initially treated with metformin (n=4427), there was a substantial loss to follow-up, with 3582 patients (81%) discontinuing treatment within the first year.</p><p><strong>Conclusions: </strong>The 1 year data on adherence and persistence for antidiabetic drugs revealed concerning trends. These findings underscore the need for targeted interventions, involving clinicians and pharmacists, to improve adherence and persistence in patients with type 2 diabetes, ultimately ensuring better disease management and reducing long-term healthcare costs.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of hospital pharmacists to sustainable healthcare: a systematic review.","authors":"Maria Pitard, Ninon Rouvière, Géraldine Leguelinel-Blache, Virginie Chasseigne","doi":"10.1136/ejhpharm-2024-004098","DOIUrl":"10.1136/ejhpharm-2024-004098","url":null,"abstract":"<p><strong>Background: </strong>With a global annual carbon footprint of the healthcare sector of 2 gigatons of CO₂e, healthcare systems must contribute to the fight against climate change. Hospital pharmacists could be key players in ecological transition due to their role in managing healthcare products. The aim of this study was to summarise the evidence on interventions implemented in healthcare facilities involving pharmacists to improve the environmental footprint of healthcare.</p><p><strong>Methods: </strong>This systematic review was conducted following PRISMA 2020 guidelines. The Medline, Web of Science and ScienceDirect databases were searched for studies published between 2013 and 2023. To be eligible for inclusion, studies had to include hospital pharmacists and present contributions aimed at reducing the environmental footprint of healthcare in healthcare facilities. Outcomes were the description of the contribution, the methods used and the stages of healthcare product lifecycle analysed. A Mixed Methods Appraisal Tool was used to assess the risk of bias for each study.</p><p><strong>Results: </strong>Seventeen studies were included. Pharmacists played a leading role in 15 (88%) and had a supporting role in the others. The healthcare products targeted were medicines (59%), medical devices (12%) or both (29%). The stages of the healthcare product cycle addressed by the contributions were elimination (71%), dispensing (35%), procurement and supply (35%), production (29%), and prescription (24%). Only two studies used life cycle assessment and only one assessed all three pillars of sustainability. Two studies had good methodological quality while the rest had at least one element of uncertainty.</p><p><strong>Conclusion: </strong>This review confirms the central role of the pharmacist and the importance of a multidisciplinary approach in implementing eco-responsible actions. It could be useful to hospitals and other teams wanting to improve sustainable actions and it emphasises the importance of collaborating with pharmacists when planning sustainable initiatives. Future eco-responsible initiatives must use robust reproducible methods.</p><p><strong>Trial registration: </strong>PROSPERO #CRD42023406835.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"100-105"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-use stability of ready-to-administer daratumumab subcutaneous injection solution in plastic syringes.","authors":"Laura Knoll, Judith Thiesen, Martin D Klassen, Lars M H Reinders, Jochen Tuerk, Irene Kraemer","doi":"10.1136/ejhpharm-2023-003928","DOIUrl":"10.1136/ejhpharm-2023-003928","url":null,"abstract":"<p><strong>Objective: </strong>In multiple myeloma patients, daratumumab is preferably injected subcutaneously. The summary of product characteristics of daratumumab subcutaneous injection solution specifies physicochemical stability for the prepared syringe for 24 hours at 2-8°C protected from light, and another 12 hours at room temperature (15-25°C) in ambient light conditions. The aim of this study was to determine the in-use stability of ready-to-administer daratumumab subcutaneous injection solution in different types of syringe and different conditions over a 28-day period.</p><p><strong>Methods: </strong>Daratumumab subcutaneous (DARZALEX 1800 mg) injection solution was withdrawn into disposable three-piece Luer-Lock syringes (20 mL, 50 mL), capped, and stored light protected at 2-8°C or at room temperature (22±2°C) over a maximum period of 28 days. Samples were taken immediately after preparation (day 0) and after 2, 7, 14, 21, and 28 days. Physicochemical stability was determined by ion-exchange high-performance liquid chromatography (IE-HPLC) and size-exclusion high-performance liquid chromatography (SE-HPLC) with ultraviolet detection, pH measurement and visual inspection for particles or colour changes.</p><p><strong>Results: </strong>In the IE-HPLC assay, peak areas and peak-to-peak area ratios remained unchanged over the whole study period, and showed no additional peaks of degraded daratumumab charge variants. In the SE-HPLC assay, neither a formation of aggregates nor of fragments was detected. Daratumumab monomer concentrations exceeded 95% of the initially measured concentrations over the entire test period. pH values remained constant. Test solutions remained clear, and no colour changes or visible particles were detected. All results were independent of storage conditions.</p><p><strong>Conclusion: </strong>Daratumumab subcutaneous injection solution proved to be physicochemically stable in capped three-piece plastic syringes for at least 28 days when stored light protected at 2-8°C or at room temperature (22±2°C). For microbiological reasons aseptic preparation and refrigerated storage are recommended. In-use stability of ready-to-administer daratumumab subcutaneous syringes prepared under appropriate aseptic conditions is given for 28 days.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"154-160"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility study of the digital tool Max for the patient-provided medication list in the medication reconciliation process prior to hospitalisation: patient willingness and usability, time saved and reliability.","authors":"Pauline Nardone, Sophie Nicolay, Alix-Marie Pouget, Elodie Civade, Mathilde Strumia, Charlotte Laborde Rouzaud","doi":"10.1136/ejhpharm-2024-004293","DOIUrl":"10.1136/ejhpharm-2024-004293","url":null,"abstract":"<p><strong>Purpose: </strong>More than 20% of prescription errors in hospitals are due to an incomplete medication history. Medication reconciliation is a solution to decrease unintentional discrepancies between medications taken at home and hospital prescriptions. It is a normalised clinical activity but it is time consuming. Medication reconciliation usually uses three sources of information for an optimised medical synthesis, one of which is the patient. A conversational robot for patients could be a solution to assist. Numerous digital applications are designed for patients and need to be tested for usability, satisfaction, reliability and time saved.</p><p><strong>Method: </strong>We analysed Max, a conversational robot for patients scheduled for surgery in Toulouse University Hospital, using routinely collected health data in three successive steps. We examined willingness, compliance and patient satisfaction of usability with a Likert questionnaire and measured the time spent with Max and without. Finally, the reliability has been explored.</p><p><strong>Results: </strong>The three successive observational steps were assessment of willingness and compliance (79 patients), time saved (61 patients) and reliability of the tool (68 patients). 71% agreed to use Max after a telephone call but only 73% of patients completed Max entirely. Max was well received and the overall satisfaction of usability was high for ease of use, readability, relevance and number of questions. Max saved a few minutes by optimised medical synthesis compared with a conventional telephone call. However, the reliability appeared to be lower than the human conventional telephone call. Randomised controlled trials are needed to confirm this feasibility study.</p><p><strong>Conclusion: </strong>Max was appreciated by patients and appeared to be suitable for assisting pharmacists in medication reconciliation. The tool established the list of treatments taken by the patient at home but reliability appeared to be lower than a conventional telephone call, recommending a 'double check' on the patient's arrival.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"132-136"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the accuracy of estimated free phenytoin concentrations in a mixed patient population.","authors":"Niamh S Horton, Sally L Hanton, Leanne Sheppard, Katherine Birch, Carrie A Chadwick","doi":"10.1136/ejhpharm-2023-003878","DOIUrl":"10.1136/ejhpharm-2023-003878","url":null,"abstract":"<p><strong>Objectives: </strong>Phenytoin is an anti-epileptic drug that has a narrow therapeutic index, and therefore requires therapeutic drug monitoring. Only the free fraction is pharmacologically active, and in some cases, accurate determination of the free phenytoin concentration may be essential to prevent phenytoin toxicity. Although it is possible to measure free phenytoin concentration, often only the total concentration is measured, with equations used to estimate the free fraction. Several equations are quoted in the literature with no overall consensus with regard to accuracy. This study aimed to assess the correlation between total and free phenytoin in a mixed patient population, and to compare the accuracy of several different equations used to estimate the free phenytoin concentration.</p><p><strong>Methods: </strong>Fifty-one serum samples were analysed for total phenytoin, free phenytoin and albumin. The measured free phenytoin concentrations were compared against those estimated using five selected equations, identified through a literature search.</p><p><strong>Results: </strong>This study showed poor correlation between the total and measured free phenytoin concentrations, and between the estimated and measured free concentrations. The overall correlation was concentration-dependent, but a correction factor could not be applied to improve the accuracy consistently. The equations assessed showed wide variability between the estimated and measured free phenytoin concentrations, with several showing a clinically significant negative bias when compared with the measured free fraction.</p><p><strong>Discussion: </strong>This study highlights the disparity of the free phenytoin concentrations generated by the equations. Underestimation of free phenytoin concentrations using these equations may result in phenytoin toxicity, bringing into question the safety of using calculated values for patient management in place of physical measurement of free phenytoin concentration by ultra-performance liquid chromatography tandem mass spectrometry.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"143-148"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41116902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk assessment of clinical trial protocols: a tool for hospital pharmacists to reduce human error in experimental drug management.","authors":"Giulia Cancellieri, Alessio Provenzani, Carlo Polidori, Piera Polidori","doi":"10.1136/ejhpharm-2024-004154","DOIUrl":"10.1136/ejhpharm-2024-004154","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hospital pharmacists collaborate in clinical trials by managing the reception, conservation, distribution, return and destruction of the investigational medical products (IMP). However, errors can happen during the simultaneous management of multiple trials because each clinical trial stipulates its own method for managing the drug under study. In order to promote optimal management by hospital pharmacists, we developed a method for calculating a risk of error index for each experimental protocol, and wrote standard procedures for managing trials assigned low, moderate and high risk levels, to provide hospital pharmacists with a systematic tool for reducing human error in the management of IMPs for multiple clinical trials.</p><p><strong>Methods: </strong>Calculation of this risk of error index (ρ) entails four factors: the pharmacological risk of error (φ) inherent in the pharmacological characteristics and route of administration of the IMP (carcinogenic, mutagenic, cytotoxic nature of the drug, parental or non-parenteral administration), the technological risk of error (α) involved should drug compounding be required, the risk of error related to the number of patients enrolled (n_p) and the risk of error intrinsic to the protocol (π) when it involves placebos, randomisation or other factors. We developed the formula [Formula: see text] to define trials as low (ρ<50), moderate (51<ρ<150) and high risk (ρ>151) for hospital pharmacist error.</p><p><strong>Results: </strong>Calculations of this formula for 60 active trials indicated that seven (11.7%) of the protocols were low risk of hospital pharmacist error, 43 (71.7%) were moderate risk and 10 (16.6%) were high risk. For each of these categories (low, moderate and high risk) we have outlined standard procedures in order to minimise the occurrence of any errors.</p><p><strong>Conclusions: </strong>Following validation of our formula and standard procedures by the ISMETT Research Institute, we are promoting the use of the tool in other clinical centres as we believe it can help hospital pharmacists minimise the risk of error in managing experimental drugs for clinical trials.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"121-125"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on: 'Patient reported medication-related problems, adherence and waste of oral anticancer medication over time' by van den Bemt <i>et al</i>.","authors":"Jinming Cao, Zhicong Chen, Feng Xu","doi":"10.1136/ejhpharm-2024-004424","DOIUrl":"10.1136/ejhpharm-2024-004424","url":null,"abstract":"","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"195-196"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of randomisation-a call to researchers.","authors":"Philip Wiffen","doi":"10.1136/ejhpharm-2025-004501","DOIUrl":"https://doi.org/10.1136/ejhpharm-2025-004501","url":null,"abstract":"","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":"32 2","pages":"99"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical compatibility of lipid emulsions and intravenous medications used in neonatal intensive care settings.","authors":"S M D K Ganga Senarathna, Tobias Strunk, Michael Petrovski, Sarah Woodland, Jorge Martinez, Victor T G Chuang, Kevin T Batty","doi":"10.1136/ejhpharm-2023-003870","DOIUrl":"10.1136/ejhpharm-2023-003870","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate the physical compatibility of intravenous lipid emulsions with parenteral medications used in neonatal intensive care.</p><p><strong>Methods: </strong>Lipid emulsion and drug solutions were combined 1:1 in glass vials, inspected for physical incompatibility at 0, 1 and 2 hours, and assessed on the basis of lipid droplet size at 0 and 2 hours after mixing. Intravenous fluid controls (Water for Injection, sodium chloride 0.9% w/v, glucose 5% w/v), positive controls (gentamicin, albumin), negative controls (metronidazole, paracetamol, vancomycin) and 21 previously untested drug combinations were evaluated.</p><p><strong>Results: </strong>No phase separation, change in colour, gas production or other visible anomaly was observed. The between-run mean droplet diameter (MDD) for SMOFlipid20% alone (0.301±0.008 µm) was comparable to the lipid emulsion/intravenous fluid and lipid emulsion/drug solution combinations. In addition to gentamicin and albumin, caffeine citrate (20 mg/mL) was shown to be incompatible with the lipid emulsion. All other lipid:drug combinations were compatible, based on the MDD data.</p><p><strong>Conclusion: </strong>Intravenous lipid emulsions were found to be compatible with 20 parenteral medications, including antimicrobial agents, inotropes, anti-inflammatory drugs and caffeine base, in simulated Y-site conditions. The lipid emulsion was incompatible with caffeine citrate injection.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"149-153"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formulation and characterisation of metyrapone suppositories for the first effective long-term use in an infant with McCune-Albright syndrome-related Cushing syndrome.","authors":"Gerda Ratzinger-Stoeger, Maria Anzengruber, Katharina Skoll, Diana-Alexandra Ertl, Gabriele Hartmann, Franz Gabor","doi":"10.1136/ejhpharm-2023-003853","DOIUrl":"10.1136/ejhpharm-2023-003853","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this project was to develop a rectal formulation of metyrapone suitable for application in an infant hospitalised with McCune-Albright syndrome (MAS)-related Cushing syndrome and to provide a detailed description of the formulation protocol including quality control parameters.</p><p><strong>Methods: </strong>Suppositories with a drug load of up to 100 mg metyrapone were prepared. Mass variation, content uniformity and drug release were analysed according to the guidelines set out by the European Pharmacopoeia. Monitoring of the drug content for 6 weeks allowed for estimation of the storage stability at 2-8°C.</p><p><strong>Results: </strong>A protocol for the reproducible preparation of suppositories with intended metyrapone content of 30-100 mg was established. The suppositories were well tolerated by the patient and the clinical outcome is promising. The suppository preparations complied with the regulations from the European Pharmacopoeia. Further, a stability of the rectal formulation of at least 1 month was confirmed, facilitating medication supply for home care.</p><p><strong>Conclusions: </strong>An adequate and easy to follow protocol for preparation of high-quality metyrapone suppositories, with sufficient stability for practical use and fulfilling major pharmaceutical quality parameters, was established. The protocol can be easily replicated by skilled personnel in a community pharmacy facilitating treatment of the infant in home care.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"161-165"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}