Hospital Pharmacy最新文献

{"title":"Idiopathic and Metabolic Triggers Leading to Recurrent Acute Pancreatitis in a 30-Year-Old Woman.","authors":"Fahamina Ahmed, Taylor Chester, Shaina Sarwar","doi":"10.1177/00185787251321072","DOIUrl":"10.1177/00185787251321072","url":null,"abstract":"<p><p><b>Background:</b> Recurrent acute pancreatitis can be influenced by a variety of factors, including metabolic and lifestyle triggers. This case report presents a 30-year-old Asian woman whose episodes of pancreatitis were complicated by hypertriglyceridemia, Type 2 diabetes mellitus (T2DM), and occasional alcohol use. Medication-related risks, such as semaglutide, were also identified as possible contributors. <b>Case Presentation:</b> The patient experienced three distinct episodes of acute pancreatitis. Initially admitted in June 2020, she presented with no prior medical history and denied alcohol use. During subsequent admissions in April 2023 and January 2024, the patient reported alcohol consumption. The second admission showed significantly elevated triglyceride (TG) levels (>5680 mg/dL), and the third occurred after New Year's Eve alcohol consumption, with TG >3000 mg/dL. Treatment across all episodes involved NPO status, IV fluids, and ICU admission with insulin therapy to lower TG levels. After the recurrence of pancreatitis, her T2DM treatment was changed from semaglutide to dapagliflozin. <b>Conclusion:</b> This case underscores the importance of comprehensive patient education on lifestyle factors, medication risks, and adherence to treatment plans to reduce the recurrence of acute pancreatitis. Tailoring interventions, such as switching diabetes medications (from semaglutide to dapagliflozin) and emphasizing TG management through gemfibrozil, atorvastatin, and icosapent ethyl, proved essential in stabilizing her condition. The patient's case serves as a reminder of the multiple potential causes of pancreatitis and the need for ongoing monitoring to prevent further complications.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251321072"},"PeriodicalIF":0.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legionnaire's Disease Beyond the Lungs: A Rare Case of Severe Rhabdomyolysis and Acute Kidney Injury from a Possible Vaping Source.","authors":"Drew A Wells, John Eick","doi":"10.1177/00185787251319309","DOIUrl":"10.1177/00185787251319309","url":null,"abstract":"<p><p>Legionnaires' disease (LD), caused by <i>Legionella pneumophila</i>, often presents with pneumonia, gastrointestinal symptoms, and confusion. Severe LD can lead to a triad of pneumonia, rhabdomyolysis, and acute kidney injury (AKI), with less common complications such as liver injury. We report a case of a 32-year-old male with no prior medical history who presented with LD complicated by severe rhabdomyolysis, AKI requiring hemodialysis (HD), and acute liver injury. The patient reported 6 days of gastrointestinal symptoms, reduced mobility, and minimal urine output. The patient also reported a history of vaping. Diagnostic imaging revealed pneumonia and enterocolitis, while laboratory findings included leukocytosis, hyponatremia, significantly elevated creatinine kinase (201 000 U/L), and acute transaminitis. A positive Legionella urine antigen confirmed the diagnosis. Initial treatment with azithromycin for 7 days showed partial improvement; however, clinical and laboratory deterioration necessitated a switch to levofloxacin for an additional 7 days. This case highlights rare, severe multi-organ involvement in LD, with rhabdomyolysis and AKI being particularly pronounced. The possible association between vaping and Legionella infection is explored, given the patient's history of vaping and limited prior documentation of such a link. Prompt recognition, accurate diagnosis, and escalation of therapy are critical in managing severe LD and reducing associated morbidity.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251319309"},"PeriodicalIF":0.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHarmacist Avoidance or Reductions in Medical Costs Considering Board of Pharmacy Specialties Certification (PHARM-BPS).","authors":"Keaton S Smetana, Edith Liang, William Adams, Payal K Gurnani, William J Peppard, Alexander H Flannery, Megan A Rech","doi":"10.1177/00185787251319311","DOIUrl":"10.1177/00185787251319311","url":null,"abstract":"<p><p><b>Introduction:</b> Clinical pharmacists bring unparalleled medication expertise, but quantifying their impact on a health system's bottom line remains unestablished. <b>Objective:</b> To classify interventions by pharmacists with and without board certification and quantify the cost avoidance (CA) from accepted interventions. <b>Methods:</b> This multicenter prospective observational study, conducted between August 2018 and January 2019, included board certified (BPS) and non-board certified (Non-BPS) emergency medicine (EM) and intensive care unit (ICU) clinical pharmacists from 89 U.S. institutions. Primary outcomes included the quantity, type, and acceptance of interventions and the CA generated by BPS pharmacists compared to Non-BPS pharmacists. <b>Results:</b> 287 pharmacists (227 BPS, 60 Non-BPS) at 89 centers provided care throughout 4184 shifts. BPS pharmacist provided more interventions (overall: 63 693 vs 8690; per shift: 18.8 vs 10.9, <i>P</i> < .001) with higher acceptance (98.2% vs 97.6%, <i>P</i> < .001). Accepted interventions per shift included adverse drug event prevention (2.0 vs 1.6, <i>P</i> = .17), resource utilization (3.6 vs 1.7, <i>P</i> = .007), individualization of patient care (9.7 vs 5.3, <i>P</i> = .05), prophylaxis (0.4 vs 0.3, <i>P</i> = .99), hands-on care (1.4 vs 0.9, <i>P</i> = .99), and administrative/supportive tasks (1.8 vs 1.1, <i>P</i> = 0.). BPS pharmacists generated greater mean CA per intervention ($873 vs $801), patient day ($961 vs $501), shift ($8112 vs $4828) and annum ($1 946 942 vs $1 158 784) (<i>P</i> < .001 for all). The CA to salary ratio was 10.5:1 for BPS and 6.3:1 for Non-BPS pharmacists. <b>Conclusion:</b> BPS pharmacists in the ED and ICU generated greater CA and a higher monetary CA to salary ratio than Non-BPS pharmacists.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251319311"},"PeriodicalIF":0.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Letter Addressing the Impact of a Flex ICU Position on Workload.","authors":"Brooke A Smith, Kelli R Henry, Kelly Nguyen, Andrea Sikora","doi":"10.1177/00185787251318287","DOIUrl":"10.1177/00185787251318287","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251318287"},"PeriodicalIF":0.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Light on Lipid Peroxidation in SMOFlipid Mixtures During Storage, Transportation and Administration.","authors":"Neeracha Phon-In, Thitima Doungngern, Krit Suknuntha","doi":"10.1177/00185787251318281","DOIUrl":"10.1177/00185787251318281","url":null,"abstract":"<p><p>Intravenous lipid mixtures were a component of 2-in-1 parenteral nutrition (PN) and were administered separately from the dextrose and amino acids mixture. SMOFlipid, the most recent composite intravenous lipid emulsion, has seen frequent use in the past decade. The SMOFlipid mixtures were prepared by mixing SMOFlipid with water-soluble and lipid-soluble vitamins. The lipid peroxidation products have been associated with serious comorbidities in premature infants. The light-exposed SMOFlipid mixtures promoted lipid peroxidation, especially administered under phototherapy, thus, the SMOFlipid mixtures were recommended to protected from light during storage, transportation, and administration. The malondialdehyde (MDA) concentration level in SMOFlipid mixtures, as a marker for lipid peroxidation, was measured up to 24 hours during storage, transport, and administration with and without light protection in simulated conditions. The MDA in SMOFlipid mixtures was chemically derivatized and analyzed using high-performance liquid chromatography. The intact SMOFlipid was used as a control. The MDA level at 24 hours in all samples exposed to ambient light was higher, up to 3.9-fold than the MDA level at initial baselines. Whereas, all samples protected from light for 24 hours showed the MDA level slightly increased up to 2.4-fold. The MDA level observed in intact SMOFlipid was higher than SMOFlipid mixtures. The aluminum foil and fabric textiles, used as light protection materials, were comparable for light protection during 24-hour administration. However, using aluminum foil as light protection material during phototherapy for 24 hours, the MDA level was slightly higher than fabric textiles. Our findings indicated that SMOFlipid and SMOFlipid mixture for 2-in-1 PN should be completely protected from light during storage, transportation and administration. The fabric textile covering was introduced and considered due to its re-usable and light protective properties for PN in transport and administration under ambient light and phototherapy.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251318281"},"PeriodicalIF":0.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enoxaparin Venous Thromboembolism Prophylaxis Dosing in Critically Ill Underweight Patients.","authors":"Elizabeth Curcio, Alyssa S Meester, Angela Harding, Marie M Lockhart, John Dillis","doi":"10.1177/00185787251313695","DOIUrl":"10.1177/00185787251313695","url":null,"abstract":"<p><p><b>Purpose:</b> Optimal dosing of VTE prophylaxis for specific patient populations remains an area of concern as insufficient evidence exists regarding dosing for underweight patients. The purpose of this study is to compare the incidence of major bleeding events in underweight patients given different prophylactic doses of enoxaparin. <b>Methods:</b> This is a retrospective analysis performed at multiple hospitals within a single health care system. Patients with a BMI < 18.5 kg/m² were divided into 2 groups depending on whether they received at least 1 prophylactic dose of enoxaparin 30 mg subcutaneously once daily or enoxaparin 40 mg subcutaneously once daily. Underweight adult patients were included if they were admitted to an ICU for at least 48 hours and received at least 1 dose of enoxaparin for VTE prophylaxis during their ICU admission. The primary aim was to compare the incidence of clinically significant bleeding between dosing strategies. Secondary aims included the incidence of VTE during admission, ICU length of stay, overall hospital length of stay, and all-cause mortality 30 days post-discharge. <b>Results:</b> A total of 310 patients met inclusion criteria for this study, with 80 patients in the 30 mg group and 230 patients in the 40 mg group. There was no significant difference in major bleeding events between the 2 groups (<i>P</i> = .61). No significant differences in incidence of VTE (<i>P</i> = .455 ), ICU length of stay (<i>P</i> = .466), overall hospital stay (<i>P</i> = .502), or all-cause mortality (<i>P</i> = .925) were found between groups. <b>Conclusions:</b> No difference was found in clinically significant bleeding between underweight critically ill patients receiving VTE prophylaxis with enoxaparin 30 mg once daily or 40 mg once daily. Further studies are needed to evaluate the optimal dosing of VTE prophylaxis with enoxaparin in underweight patients.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251313695"},"PeriodicalIF":0.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Rhizobium radiobacter</i> Prosthetic Valve Endocarditis - A Case Report and Literature Analysis.","authors":"Sunish Shah, Kavitha Ramakrishnan, Raagini Jawa","doi":"10.1177/00185787241312869","DOIUrl":"10.1177/00185787241312869","url":null,"abstract":"<p><p>We describe a case of a 67-year-old man with bioprosthetic aortic valve endocarditis secondary to <i>Rhizobium radiobacter</i>, a rare Gram-negative plant pathogen. The initial source was assumed to be due to soil exposure. The patient was successfully managed with ceftriaxone following aortic valve replacement. Upon review of the literature, failure to recover <i>R. radiobacter</i> from blood cultures occurred in 57% (4/7) of reported endocarditis cases and 86% (6/7) were managed with antimicrobial monotherapy. Notably, all the published case reports to date of <i>R. radiobacter</i> endocarditis have reported survival following treatment.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241312869"},"PeriodicalIF":0.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axatilimab.","authors":"Terri L Levien, Danial E Baker","doi":"10.1177/00185787241310874","DOIUrl":"10.1177/00185787241310874","url":null,"abstract":"<p><p>Each month, subscribers to <i>The Formulary Monograph Service</i> receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy and Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of <i>The Formulary, Hospital Pharmacy</i> publishes selected reviews in this column. For more information about <i>The Formulary Monograph Service</i>, contact Wolters Kluwer customer service at 866-397-3433.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241310874"},"PeriodicalIF":0.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cost Analysis of Opioid/Acetaminophen Therapy Versus a Multidrug, Opioid-Free Multimodal Postoperative Pain Control Regimen.","authors":"James Benjamin Jackson, Yianni Bakaes, William Kelly, Julia Bian, Paul Brandon Bookstaver, Aly York, Tyler Gonzalez","doi":"10.1177/00185787241303721","DOIUrl":"10.1177/00185787241303721","url":null,"abstract":"<p><p><b>Background:</b> Opioids are often part of the post-operative pain regimen after orthopaedic surgery. Novel multimodal post-operative pain control regimens have been developed to decrease the amount of opioid usage due to their negative side effects including nausea, constipation, and addiction. The purpose of this study was to compare the cost of postoperative pain management treatment methods after orthopaedic surgery between opioid/acetaminophen therapy and an opioid-free, multidrug, multimodal pathway. <b>Methods:</b> This is a secondary analysis of data collected from 2 IRB approved prospective studies that evaluated pain control after elective orthopaedic surgery from a single institution. The first study analyzed the use of opioid medication after hallux valgus surgery and calculated the total cost of opioid pain medication consumed. The second study assessed the pain of patients after elective foot and ankle surgery utilizing a novel opioid-free multimodal pain pathway that included 5 medications. The postoperative prescription costs of these 2 pain management groups were totaled, analyzed, and compared. A paired <i>t</i>-test was used to compare the means of these 2 groups and to evaluate whether significant differences might exist between them. <b>Results:</b> We noted that the opioid group had an average cost of $8.92 (SD $5.74), while the opioid-free multimodal group had an average total cost of $25.60 (SD $10.49), <i>P</i> < .001. The average difference in cost between the 2 regimens was $16.68. <b>Conclusion:</b> There was a statistically significant difference between the costs of an opioid-free multimodal post-operative pain regimen when compared to an opioid/acetaminophen therapy, irrespective of public vs private insurance. This 17-dollar cost difference may or may not be clinically significant depending on the financial situation of the patient, but it may be important for the clinician to consider to provide appropriate individualized patient care after orthopaedic surgery. <b>Level of Evidence:</b> II.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241303721"},"PeriodicalIF":0.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensuring the Safety of Locally Sourced Alcohols for Hand Sanitizer Production During the SARS-CoV-2 Crisis: A Comprehensive Impurity Analysis.","authors":"Camille Jurado, Zoubeir Ramjaun, Souleiman El Balkhi, Franck Saint-Marcoux, Mathieu Alonso, Anne Sophie Salabert, Fanny Durand, Laetitia Caturla, David Metsu, Emilie Gardes, Isabelle Quelven-Bertin, Philippe Cestac","doi":"10.1177/00185787241309254","DOIUrl":"10.1177/00185787241309254","url":null,"abstract":"<p><p>Amid the early 2020 SARS-CoV-2 crisis, severe hand sanitizer shortages led to OMS local production recommendations, inviting a diverse array of alcohol producers to contribute. However, not all followed mandatory controls for API-grade alcohol. We conducted a study to ensure the safety of the received alcohols, focusing on methanol and acetaldehyde levels. All samples were well below Ph. Eur guidelines, affirming their safety for use. Furthermore, no additional impurities were detected, reinforcing the quality and safety of the assessed hand sanitizers. Our findings, amidst the scarcity of the SARS-CoV-2 era, highlight the importance of rigorous safety assessments during local hand sanitizer production.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241309254"},"PeriodicalIF":0.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}