Hospital Pharmacy最新文献

{"title":"Purulent Sterile Wound Discharge Associated with Antibiotic Loaded Calcium Sulphate Beads: A Materiovigilance Case Report.","authors":"Kashif Akhtar Ahmed, Sankar Jyoti Bora, Phulen Sarma","doi":"10.1177/00185787261476283","DOIUrl":"https://doi.org/10.1177/00185787261476283","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic loaded calcium sulphate (CS) beads are emerging biomaterials used to provide sustained local antibiotic delivery in orthopaedic surgery. However, their use has been associated with wound discharge, which is purulent, serous, or serosanguineous in nature, although they are generally well tolerated.</p><p><strong>Case presentation: </strong>A woman approximately 50 years of age underwent implantation of gentamicin and vancomycin loaded calcium sulphate (CS) beads for the management of chronic osteomyelitis. Subsequently, she developed purulent wound discharge, which resolved following removal of the beads. Microbiological examination revealed no pathogens, acid-fast bacilli were not detected, and inflammatory cells were present.</p><p><strong>Conclusion: </strong>Clinicians should be aware of wound discharge associated with calcium sulphate beads and ensure appropriate postoperative monitoring. Further studies are needed to clarify the mechanism of culture-negative purulent wound discharge. This case underscores the importance of reporting orthopaedic implant-related adverse events to the Materiovigilance Programme of India (MvPI).</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261476283"},"PeriodicalIF":0.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792419","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":"Apixaban Lead-In Versus Lead-In Omission in Hospitalized Adults with Acute Venous Thromboembolism: A Retrospective Safety Analysis.","authors":"Kelly Rice, Abigail Hoff, Molly Droege, Timothy Rice, Christopher A Droege, Paige Bradshaw, Lindsey Federle, Savannah Ruess, Carolyn D Philpott","doi":"10.1177/00185787261476068","DOIUrl":"https://doi.org/10.1177/00185787261476068","url":null,"abstract":"<p><strong>Background: </strong>Apixaban for acute venous thromboembolism (VTE) is dosed with an intensified 7-day lead-in to decrease recurrence. The optimal initiation dosing in hospitalized patients remains unknown. This study compares the safety and efficacy of apixaban maintenance versus lead-in dose initiation in hospitalized patients with acute VTE.</p><p><strong>Methods: </strong>This IRB-approved, retrospective, single center, cohort study was conducted at a quaternary referral, academic medical center. Adult patients diagnosed with acute VTE who received ≥1 apixaban dose during hospitalization were eligible for inclusion. Patients initiated on apixaban ≥7 days from VTE or anticoagulated within 3 months prior to admission were excluded. Patients were grouped into 2 cohorts: (1) maintenance dose (MD) - no apixaban 10 mg dose and (2) lead-in dose (LD) - received ≥1 apixaban 10 mg dose. Outcomes were assessed for 3 months following apixaban initiation. The primary outcome compared a composite endpoint of major and non-major clinically relevant bleeding (NMCRB) between groups. The secondary outcome compared a composite endpoint of recurrent VTE and all-cause mortality (VTE-M) between groups.</p><p><strong>Results: </strong>A total of 200 (28 MD, 172 LD) patients were included. Patients were 61 (48-72) years old and admitted 5 (2-12) days. Baseline characteristics were similar between groups. Parenteral anticoagulation was administered in 90% (25 [89%] MD, 156 [91%] LD) of patients prior to apixaban initiation. Time on parenteral anticoagulation was longer in MD (61 [37-88] hours] compared to LD (40 [18-65] hours) patients (<i>P</i> = .02). Composite major and NMCRB occurred in 6 (21.4%) MD and 21 (12.2%) LD patients (<i>P</i> = .19). Composite VTE-M occurred in 2 (7.1%) MD and 16 (9.3%) LD patients (<i>P</i> = .71).</p><p><strong>Conclusion: </strong>This study found no difference in bleeding or VTE-M in hospitalized patients with acute VTE receiving apixaban MD versus LD. The high incidence of bleeding suggests caution is needed with apixaban initiation in this population.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261476068"},"PeriodicalIF":0.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792379","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":"Medication Burden and Clinical Outcomes in Dialysis Patients: A Systematic Review and Meta-Analysis.","authors":"Ueakan Pharadonpadjai, Talerngsak Kanjanabuch, Weerachai Chaijamorn, Nutthada Areepium","doi":"10.1177/00185787261466526","DOIUrl":"https://doi.org/10.1177/00185787261466526","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is common among dialysis patients, but its independent impact on clinical outcomes-beyond the influence of comorbidities-has not been specifically quantified in this population. This systematic review and meta-analysis aimed to determine whether a higher medication burden is associated with worse clinical and patient-reported outcomes among dialysis patients.</p><p><strong>Methods: </strong>Searches of MEDLINE, Scopus, Cochrane CENTRAL, Thai, and grey literature sources were conducted until 28 February 2026. Eligible studies enrolled adults on dialysis, assessed medication or pill burden as the exposure, and reported predefined outcomes. Two independent reviewers collected data and evaluated risk of bias with ROBINS-I, ROBINS-E, or the Modified Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted using REML estimation.</p><p><strong>Results: </strong>Sixteen studies were analyzed. Polypharmacy showed a significant association to all-cause mortality in both per-medication dose-response (HR = 1.07; 95% CI 1.03-1.10; <i>I</i> ² = 93.55%) and categorical analyses (HR = 1.10; 95% CI 1.02-1.18; <i>I</i> ² = 89.66%). Polypharmacy was associated with medication nonadherence (OR = 1.08; 95% CI 1.04-1.13) and poorer quality of life. Hospitalization data were inadequate for pooling because outcome definitions varied.</p><p><strong>Conclusion: </strong>In dialysis patients, higher medication burden is associated with increased mortality, nonadherence, and reduced quality of life. Although routine medication reviews and deprescribing are recommended, further research is needed to confirm causality and effectiveness.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261466526"},"PeriodicalIF":0.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760689","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":"Comparison of Two Population Pharmacokinetic Models for Predictive Performance in Vancomycin Therapeutic Drug Monitoring.","authors":"Saki Harada, Kazutaka Oda, Shoji Kondo, Jun Toyama, Mayuka Morimoto, Yu Fujino, Utaro Kobayashi, Shiori Sato, Hirofumi Jono, Mikio Rikumaru","doi":"10.1177/00185787261475118","DOIUrl":"https://doi.org/10.1177/00185787261475118","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate model-based prediction of vancomycin concentration is essential for therapeutic drug monitoring (TDM); however, the practical criteria for selecting population pharmacokinetic (PopPK) models remain unclear. We compared the predictive performances of the Japanese Oda and Yamamoto PopPK models.</p><p><strong>Methods: </strong>This single-center retrospective study included adults aged ≥18 years who underwent vancomycin TDM between January 2023 and December 2024. Vancomycin concentrations were predicted using both models. Predictive performance was evaluated by absolute error (AE) and ΔAE, defined as AE for the Oda model minus AE for the Yamamoto model. Decision tree analysis was used to assess patient characteristics associated with differences in prediction error between the 2 models.</p><p><strong>Results: </strong>Of the 396 patients, 296 were analyzed; the median age was 80 years. The mean AE values for the Oda and Yamamoto models were 3.61 ± 3.01 and 3.78 ± 2.89 µg/mL, respectively (ΔAE, -0.172 µg/mL). Creatinine clearance (CCr), body weight (BW), age, and serum albumin (Alb) were selected as splitting variables in the decision tree analysis, and most terminal nodes displayed lower AE in the Oda model. In limited subgroups, including patients with very high CCr, lower BW, and older age, the Yamamoto model showed a lower AE. Using rounded-up serum creatinine (SCr), the mean AE was 3.63 ± 2.95 and 3.96 ± 2.99 µg/mL, respectively, for the Oda and Yamamoto models (ΔAE, -0.334 µg/mL). Rounding up a low SCr level did not improve the overall predictive performance.</p><p><strong>Conclusion: </strong>The Oda model showed a slightly lower prediction error than the Yamamoto model and may be a reasonable first-choice PopPK model for vancomycin TDM in elderly Japanese patients. Routine rounding at low SCr levels is not supported.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261475118"},"PeriodicalIF":0.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759830","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":"Sublingual Zolpidem Spray for Refractory Catatonia: A Case Report.","authors":"Shivananda Manohar J, C J Akshatha, Aditya Takiar","doi":"10.1177/00185787261476066","DOIUrl":"https://doi.org/10.1177/00185787261476066","url":null,"abstract":"<p><p>Catatonia is a neuropsychiatric syndrome characterised by motor, behavioural, and speech abnormalities. Although benzodiazepines and electroconvulsive therapy (ECT) are considered first-line treatments, a proportion of patients fail to show improvement. Emerging evidence suggests role for zolpidem in treatment-resistant catatonia cases. A 52-year-old woman presented with a 10-year history of decreased interaction, reduced speech, staring, posturing, immobility, and dependence for activities of daily living. She was diagnosed with catatonia and had a Bush-Francis Catatonia Rating Scale (BFCRS) score of 9. Treatment with lorazepam was initiated and gradually escalated to 12 mg/day over 2 weeks, resulting in only transient improvement. Subsequently, 5 sessions of ECT were given with no significant improvement. A 12-week trial of trifluperazine was also given which did not bring changes in symptom profile. Zolpidem sublingual spray was initiated at 5 mg/day and increased to 10 mg/day. Following dose optimisation, the patient demonstrated significant improvement with restoration of spontaneous speech, increased activity, and improved social interaction. Her BFCRS score decreased from 9 to 0 and the improvement was sustained for more than 2 months. Zolpidem, a selective GABA-A receptor α1 subunit agonist, may improve catatonic symptoms through modulation of dysfunctional motor circuits. The sublingual spray formulation offers rapid absorption and ease of administration. This case highlights the potential utility of zolpidem sublingual spray as an effective treatment option for refractory catatonia and highlights the need for further research to establish its efficacy and safety.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261476066"},"PeriodicalIF":0.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760089","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":"Comparing Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar)-Guided Benzodiazepine Versus Richmond Agitation-Sedation Scale (RASS)-Guided Phenobarbital Management for Alcohol Withdrawal Syndrome in Hospitalized Patients.","authors":"Han Tran, Tatianna N Pollak, Ashraf A Amadou, Tyler Haugen, Lisa M Richter, Bert Iaderosa","doi":"10.1177/00185787261475128","DOIUrl":"10.1177/00185787261475128","url":null,"abstract":"<p><strong>Background: </strong>Alcohol withdrawal syndrome (AWS) is a common and potentially severe complication of abrupt alcohol cessation. Benzodiazepines (BZD) guided by the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale are commonly used to manage alcohol withdrawal, but objective alternatives may improve outcomes. Phenobarbital (PB) guided by the Richmond Agitation-Sedation Scale (RASS) has emerged as a potential alternative. This study aimed to compare clinical outcomes in hospitalized patients with AWS receiving CIWA-Ar-guided BZD versus RASS-guided PB therapy.</p><p><strong>Methods: </strong>This retrospective cohort study included adults hospitalized with AWS across a multicenter health system in the Upper Midwest of the United States. Patients treated under the CIWA-Ar-guided BZD therapy from June 1, 2024 until August 31, 2024, were compared with those treated under the RASS-guided PB therapy from June 1, 2025 to August 31, 2025. Primary outcomes were mechanical ventilation and non-invasive ventilation (NIV) requirements. Secondary outcomes included hospital length of stay (LOS), need for intensive care unit (ICU) care, and ICU LOS.</p><p><strong>Results: </strong>A total of 125 patients were included (BZD, n = 46; PB, n = 79). Mechanical ventilation and NIV requirements were infrequent and were not statistically significantly different between groups (mechanical ventilation: 4.3% vs 1.3%, <i>P</i> = .554; NIV: 2.2% vs 5.1%, <i>P</i> = .651). RASS-guided PB therapy was associated with a shorter hospital LOS compared with CIWA-Ar-guided BZD therapy (median 3.5 days [interquartile range (IQR) 2-6.75] vs 3 days [IQR 2-4]; <i>P</i> = .025). Patients receiving BZD were more likely to require ICU care than those receiving PB (47.8% vs 26.6%, <i>P</i> = .016). Among patients requiring ICU care, ICU LOS did not differ between groups (median 2 days [IQR 1-3.75] vs 2 days [IQR 1-3]; <i>P</i> = .97).</p><p><strong>Conclusion: </strong>RASS-guided PB therapy in hospitalized patients with AWS was associated with a shorter hospital stay and a lower need for ICU care compared with CIWA-Ar-guided BZD therapy. In contrast, ICU LOS and respiratory outcomes were comparable between groups. These results suggest that RASS-guided PB therapy may be associated with reduced escalation to ICU-level care without evidence of increased adverse respiratory events.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261475128"},"PeriodicalIF":0.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722740","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":"When the Law Changes Therapy: Interrupted Time-Series Analysis of the Regulatory Impact on Intravenous Analgesic Consumption in 2 Italian Orthopaedic Hospitals (2021-2024).","authors":"Barbara Crivelli, Luca Galassi, Beatrice Faitelli, Giorgio Oriani, Benedetta Angela Maurizio, Davide Picco, Carlo Banfi, Federica Pieri","doi":"10.1177/00185787261474381","DOIUrl":"10.1177/00185787261474381","url":null,"abstract":"<p><strong>Objectives: </strong>Tramadol is a centrally acting weak opioid widely used for moderate postoperative pain in orthopaedic surgery, so its regulatory status is directly relevant to hospital pharmacists. In November 2022 the Italian Ministry of Health reclassified tramadol as a controlled substance under Section A of Presidential Decree 309/1990. Its effect on surgical-hospital prescribing has not been systematically described. We quantified the change in consumption and expenditure of intravenous (IV) tramadol and of the IV non-steroidal anti-inflammatory drugs (NSAIDs) used as alternatives in 2 Italian orthopaedic IRCCS hospitals.</p><p><strong>Methods: </strong>Retrospective 2-centre drug-utilisation study (Hospital A: 9100 procedures/year; Hospital B: 13 500/year) covering January 2021 to December 2024. Monthly dispensing and cost of IV tramadol, ketorolac, ketoprofen lysine and ibuprofen were extracted from the pharmaceutical management system. Use was expressed as Defined Daily Doses (DDDs) per 100 procedures. Pre- and post-policy periods were compared with a single-group interrupted time-series analysis using segmented linear regression with calendar-month indicators and Newey-West standard errors.</p><p><strong>Results: </strong>Mean annual IV tramadol dispensing fell from 953 to 259 units at Hospital A (-72.8%) and from 2011 to 617 at Hospital B (-69.3%). Segmented regression showed immediate level changes for IV tramadol of β₂ = -1.45 at Hospital A (<i>P</i> < .001) and -2.60 at Hospital B (<i>P</i> < .001); expressed relative to the model-predicted pre-policy level at the intervention, these correspond to immediate reductions of approximately 57% and 63%. For IV ketorolac, level changes were +2.41 (<i>P</i> = .012) and +12.68 (<i>P</i> < .001). Aggregate IV-analgesic expenditure per 100 procedures rose from €18.96 to €25.99 at Hospital A (+37%) and from €47.20 to €412.73 at Hospital B (+774%); this between-centre difference was driven by Hospital B's high-cost ready-to-use IV ibuprofen bag, which accounted for about 93% of total post-policy expenditure and 99% of the increase at that centre.</p><p><strong>Conclusions: </strong>The reclassification coincided with a marked reduction in IV tramadol use and a parallel rise in IV NSAID use. The rise in pharmacy expenditure was driven less by the regulatory shift than by the local formulary choice that accompanied it.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261474381"},"PeriodicalIF":0.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712220","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":"Drug-Drug Interactions Between Immune Checkpoint Inhibitors and Glucocorticoids: A Real-World Pharmacovigilance Analysis.","authors":"Zhen Zhang, Tao Gao, Linpei Li, Xiaoning Tan, Puhua Zeng","doi":"10.1177/00185787261463742","DOIUrl":"10.1177/00185787261463742","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors (ICIs) are frequently co-administered with glucocorticoids (GCs) in cancer treatment, yet the potential drug-drug interactions (DDIs) between these drug classes remains incompletely characterized. This study aimed to identify adverse event reporting patterns suggestive of potential interactions between ICIs and GCs.</p><p><strong>Methods: </strong>We performed a retrospective pharmacovigilance analysis of Food and Drug Administration Adverse Event Reporting System (FAERS) from January 1, 2014, to December 31, 2024. After deduplication, 14,357,295 unique reports were included. Reports were classified into 4 groups: ICIs alone, GCs alone, concomitant ICIs and GCs, and neither exposure. Potential interaction signals were evaluated at the Medical Dictionary for Regulatory Activities System Organ Class (SOC) level using descriptive statistics, disproportionality analysis, additive risk difference model, multiplicative risk ratio model, Ω shrinkage measure and chi-square signal.</p><p><strong>Results: </strong>Three SOC met the prespecified composite signal criterion: metabolism and nutrition disorders (glucose abnormalities, appetite or nutritional abnormalities, and related metabolic complications), gastrointestinal disorders (for example nausea, vomiting, diarrhea, colitis, abdominal pain, and other gastrointestinal toxicities), and investigations (for example, elevated liver enzymes or electrolyte abnormalities). In stratified analyses, co-administered programmed death-ligand 1 (PD-L1) inhibitors and GCs reports met the criterion for metabolism and nutrition disorders and gastrointestinal disorders, whereas co-administered programmed cell death protein 1 (PD-1) inhibitors and GCs reports met the criterion for gastrointestinal disorders and investigations. Co-administered Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors and GCs reports did not show consistent algorithmic support across these SOC.</p><p><strong>Conclusion: </strong>These findings indicate that co-administered ICIs and GCs were associated with reporting of specific adverse outcomes, particularly metabolic/nutritional and gastrointestinal events. These findings do not suggest that clinically indicated GCs use should be avoided in patients receiving ICIs. Rather, they support closer monitoring of metabolism and nutrition disorders, gastrointestinal disorders, and investigations when these agents are co-administered.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261463742"},"PeriodicalIF":0.9,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602349","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":"Predicting Disease Severity and Mortality Using a Simple Clinical Risk Score (ABCDMP) in Patients with AECOPD in the UAE.","authors":"Khadeijah Almarshoodi","doi":"10.1177/00185787261465850","DOIUrl":"10.1177/00185787261465850","url":null,"abstract":"<p><p>Chronic Obstructive Pulmonary Disease (COPD) stands as a leading cause of death globally, with AECOPD significantly worsening patient outcomes. The intersection of COPD with CVDs further escalates the risk, highlighting the need for precise prognostic tools. The ABCDMP score, previously validated in China, offers a simple clinical approach to risk stratification but has not been tested internationally. This study explores the efficacy of the ABCDMP score in predicting disease severity and mortality among AECOPD patients with concurrent CVDs in the UAE. This multicenter retrospective study was conducted in 18 hospitals across the UAE and assessed the predictive accuracy of the ABCDMP score for inpatient mortality, 30-day mortality, and 90-day readmission among AECOPD patients with CVDs. The study included 512 participants, of whom 343 (67.0%) were female, 391 (76.4%) were aged 65 years or older, and 89 (17.4%) had a hospital stay of more than 30 days. The ABCDMP score was evaluated using the Area Under the Receiver Operating Characteristic (AUROC). The ABCDMP score curves for inpatient death, 30-day death, and 90-day readmission were 0.55 (95% CI: 0.49-0.61), 0.48 (95% CI: 0.40-0.55), and 0.58 (95% CI: 0.52-63), respectively. Significant differences in mortality rates were observed among patients with different lengths of stay (<i>P</i> = .012) and in abilities to wash independently (<i>P</i> = .001), dress (<i>P</i> = .001), and feed (<i>P</i> = .001). Moreover, the analysis revealed significant differences in the occurrence of patient deaths across various comorbidities, notably renal diseases (<i>P</i> = .003) and atrial fibrillation (<i>P</i> = .001). The ABCDMP score's effectiveness in predicting mortality and readmission rates among AECOPD patients with cardiovascular conditions was found to be limited, indicating the need for its enhancement or the development of more accurate tools.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261465850"},"PeriodicalIF":0.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591374","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":"Suspected Caspofungin-Induced Visual Toxicity Manifesting as Temporary Decreased Vision: A Case Report.","authors":"Luca Galassi, Niccolò Magrin, Federica Pieri, Barbara Crivelli, Carlo Banfi, Beatrice Faitelli","doi":"10.1177/00185787261470599","DOIUrl":"https://doi.org/10.1177/00185787261470599","url":null,"abstract":"<p><strong>Introduction: </strong>Caspofungin is an echinocandin antifungal agent widely used for the treatment of invasive candidiasis because of its broad antifungal activity. Although ocular adverse events are listed among uncommon reactions in the Summary of Product Characteristics, detailed clinical descriptions of acute visual impairment temporally associated with caspofungin therapy are scarce.</p><p><strong>Case presentation: </strong>We report the case of a 21-year-old man who developed candidemia due to Candida guilliermondii following complex spinal surgery. Antifungal therapy with caspofungin was initiated in accordance with current clinical guidelines. Within 24 hours of treatment initiation, the patient experienced a bilateral and symmetrical reduction in visual acuity, affecting both near and distance vision. Comprehensive ophthalmologic evaluation, including slit-lamp examination, fundoscopy, and optical coherence tomography, revealed no structural ocular abnormalities. Neurological assessment and neuroimaging were unremarkable. Visual symptoms persisted with fluctuating intensity during ongoing caspofungin administration and resolved completely within 48 hours after drug discontinuation, following a switch to micafungin. No recurrence of visual impairment was observed during follow-up. Causality assessment using the Naranjo algorithm indicated a probable association between caspofungin and the adverse event.</p><p><strong>Conclusions: </strong>This case describes a transient and fully reversible visual disturbance temporally associated with caspofungin therapy, in the absence of identifiable ocular or neurological pathology. While a causal relationship cannot be established based on a single observation, this report contributes descriptive safety data relevant to real-world clinical practice. Clinicians should consider careful evaluation of new-onset visual symptoms occurring during antifungal therapy and ensure appropriate pharmacovigilance reporting to support the identification of rare or unexpected adverse drug reactions.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787261470599"},"PeriodicalIF":0.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590860","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}