CANADIAN JOURNAL OF HOSPITAL PHARMACY最新文献

{"title":"A Point Prevalence Survey of Antimicrobial Usage in New Brunswick Hospitals.","authors":"Rachel Cormier, Timothy D. MacLaggan, Daniel Landry, R. Harris, Andrew J. Flewelling","doi":"10.4212/cjhp.v75i2.3093","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3093","url":null,"abstract":"Background\u0000Prevalence surveys are useful tools for assessing the appropriateness of antimicrobial therapy.\u0000\u0000\u0000Objectives\u0000The primary objective was to assess patterns of antimicrobial utilization and appropriateness in New Brunswick hospitals. The secondary objective was to assess the impact of hospital size and the presence of a penicillin allergy label on antimicrobial appropriateness.\u0000\u0000\u0000Methods\u0000A point prevalence survey was conducted of inpatients taking 1 or more systemic antimicrobials during admission to hospitals in New Brunswick. A structured protocol and web-based data collection tool (National Antimicrobial Prescribing Survey) were used for this survey. Data regarding hospital size and presence of a penicillin allergy label were also collected. Antimicrobial utilization was assessed in terms of guideline compliance and appropriateness. Results were summarized descriptively. A χ2 analysis was performed to describe secondary outcomes.\u0000\u0000\u0000Results\u0000Ten hospitals participated, and a total of 2200 patients were admitted at the time of the survey. The overall prevalence of antimicrobial use was 22.7% (500/2200). A total of 648 antimicrobials were ordered. The most frequently prescribed antimicrobials by class were first-generation cephalosporins (14.0%, 91/648), third-generation cephalosporins (11.3%, 73/648), and piperacillin-tazobactam (10.2%, 66/648). The most common indications for antimicrobial therapy were respiratory tract infections (27.3%, 177/648), urinary tract infections (12.2%, 79/648), and intra-abdominal infections (11.4%, 74/648). Compliance with local or regional treatment guidelines, where applicable, was 66.2% (188/284). Provincially, 68.1% (441/648) of the antimicrobial orders were deemed appropriate. Larger centres had substantially higher rates of appropriateness (p < 0.001). The presence of a penicillin allergy label had no impact on appropriateness (p = 0.21).\u0000\u0000\u0000Conclusions\u0000Several opportunities for targeted interventions were identified to improve antimicrobial prescribing, including decreasing the use of broad-spectrum antimicrobials, increasing guideline compliance, and ensuring documentation of antimicrobial duration by prescribers.","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"79-88"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49453264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Trends in Dispensing of Sodium Glucose Cotransporter 2 Inhibitors.","authors":"M. Fralick, Diana Martins, Mina Tadrous, T. Gomes","doi":"10.4212/cjhp.v75i2.3066","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3066","url":null,"abstract":"Background\u0000Three large cardiovascular outcome trials have investigated the safety of sodium glucose cotransporter 2 (SGLT2) inhibitors.\u0000\u0000\u0000Objective\u0000To analyze the nationwide dispensing of SGLT2 inhibitors before and after the publication of these trials.\u0000\u0000\u0000Methods\u0000A cross-sectional study was conducted of monthly prescription dispensing of SGLT2 inhibitors from May 23, 2014, to April 30, 2019, using nationwide data for Canada. An autoregressive integrated moving average (ARIMA) model was fitted to the monthly number of tablets dispensed for each SGLT2 inhibitor; the model included a ramp intervention function at the publication dates of interest to estimate the impact on SGLT2 inhibitor dispensing patterns.\u0000\u0000\u0000Results\u0000The rate of canagliflozin and dapagliflozin dispensing declined after publication of results of the empagliflozin cardiovascular trial in September 2015. After publication of results of the canagliflozin trial in June 2017, which indicated a reduction in cardiovascular events and an increase in the risk of lower-limb amputation, canagliflozin remained the most commonly dispensed SGLT2 inhibitor, but its rate of dispensing declined further. In contrast, the rate of empagliflozin dispensing increased, while the rate of dapagliflozin dispensing was unchanged. After publication of the dapagliflozin trial in November 2018, which indicated no clear reduction in cardiovascular events, short-term trends in dispensing of canagliflozin, empagliflozin, and dapagliflozin were largely unaffected.\u0000\u0000\u0000Conclusions\u0000The cardiovascular outcome trials appeared to have an important impact on the dispensing of SGLT2 inhibitors in Canada.","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"104-107"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44603117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of Therapeutic Drug Monitoring to Guide Vancomycin Dosing Regimens: Trough Concentration versus Ratio of Area Under the Curve to Minimum Inhibitory Concentration.","authors":"Ariane Du Sault, M. Parent, C. Simard","doi":"10.4212/cjhp.v75i2.3114","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3114","url":null,"abstract":"Background\u0000The most recent vancomycin monitoring guideline recommends targeting a value for area under the curve (AUC) of 400 to 600 mg*h/L, with an assumed minimum inhibitory concentration (MIC) of 1 mg/L. Few studies have investigated the effect of this method on vancomycin dosing regimens, relative to a target trough concentration of 15 to 20 mg/L.\u0000\u0000\u0000Objective\u0000To compare vancomycin dosing regimens generated with the 2 monitoring methods.\u0000\u0000\u0000Methods\u0000This retrospective chart review included hospitalized patients who received vancomycin between May 2019 and April 2020. The dosing regimens were compared, with the paired Student t test, in terms of unit dose, daily dose, and dosing interval. Variables of interest were collected from electronic medical charts. A pharmacy resident used first-order pharmacokinetic equations to determine dosing regimens based on AUC monitoring. Local pharmacists retrospectively determined dosing regimens for trough-based monitoring.\u0000\u0000\u0000Results\u0000Of 100 courses of treatment initially identified, 66 were included in the analysis. The unit dose was similar with the 2 methods (1086 mg with AUC-based monitoring versus 1100 mg with trough-based monitoring; p = 0.62). AUC monitoring was associated with a 12.8% lower daily dose (2294 mg versus 2630 mg; p < 0.001) and a 13.5% longer dosing interval (13.24 h versus 11.67 h; p < 0.001) relative to trough-based monitoring. AUC monitoring also generated a lower extrapolated trough concentration (12.90 mg/L versus 16.22 mg/L; p < 0.001).\u0000\u0000\u0000Conclusions\u0000A target trough concentration of 15 to 20 mg/L was confirmed as being unnecessarily high. AUC monitoring could allow a reduction in daily vancomycin dose and an extension of the dosing interval relative to trough-based monitoring.","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"89-96"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44285949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De la surtension à la surcapacité.","authors":"Tania Mysak","doi":"10.4212/cjhp.v75i2.3295","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3295","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"152"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42026828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Intravenous versus Oral Antimicrobials in a Large Regional Health Authority.","authors":"Manpreet Dulku, Tina Sekhon, A. Tejani","doi":"10.4212/cjhp.v75i2.3173","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3173","url":null,"abstract":"Background\u0000Many antimicrobials given by the intravenous (IV) route have oral (PO) formulations with high oral bioavailability. The advantages of using the PO rather than the IV formulation include lower risk of adverse reactions, shorter length of hospital stay, and lower health care costs.\u0000\u0000\u0000Objectives\u0000The primary objective was to determine the proportions of patients who received the IV and PO formulations of antimicrobials with high oral bioavailability. The secondary objectives were to determine the proportion of patients who were eligible to receive PO antimicrobials from the start of treatment, the proportion who qualified for IV-to-PO step-down, and areas of improvement to increase use of PO antimicrobials.\u0000\u0000\u0000Methods\u0000A retrospective chart review was conducted in hospitals in the Fraser Health Authority, British Columbia, between October 18, 2019, and March 5, 2020. Two hundred charts were randomly selected for patients who had received either azithromycin, ciprofloxacin, clindamycin, fluconazole, levofloxacin, linezolid, moxifloxacin, metronidazole, sulfamethoxazole-trimethoprim, or voriconazole.\u0000\u0000\u0000Results\u0000Of the 200 patients, 124 (62.0%) received the PO formulations, while 76 (38.0%) received the IV formulations. Of the 76 patients receiving IV antimicrobials, 39 (51.3%; 95% confidence interval 44.7%-57.9%) were eligible to receive PO antimicrobials from the start of treatment or could have been stepped down from IV to PO administration.\u0000\u0000\u0000Conclusions\u0000More than half of patients who received IV therapy were eligible to receive the PO formulation of antimicrobials known to have high oral bioavailability; relative to earlier studies, this proportion has not improved over time. This finding highlights the need for continued vigilance in encouraging the use of PO rather than IV formulations for hospitalized patients.","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"108-112"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48221642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2021-2022 Research, Education, and Sabbatical Grant Recipients.","authors":"","doi":"10.4212/cjhp.v75i2.3298","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3298","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"129-130"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43567732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Digoxin Toxicity Leading to Institutionalization of an Elderly Woman.","authors":"Kimberley Nix, Luiza Nicoleta Radu, J. Zou, Meghan E O Vlasschaert","doi":"10.4212/cjhp.v75i2.3069","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3069","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"118-121"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46071690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an Opioid Stewardship Program to Promote Safer Opioid Prescribing.","authors":"L. Ti, T. Mihic, H. James, S. Shalansky, M. Legal, S. Nolan","doi":"10.4212/cjhp.v75i2.3115","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3115","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"113-117"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49056082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overstretched to Overcapacity.","authors":"Tania M. Mysak","doi":"10.4212/cjhp.v75i2.3294","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3294","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 2 1","pages":"151"},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44325378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOGETHER CONFERENCE 2022 POSTER ABSTRACTS / RÉSUMÉS DES AFFICHES DU CONGRÈS ENSEMBLE 2022","authors":"Various Authors","doi":"10.4212/cjhp.v75i2.3296","DOIUrl":"https://doi.org/10.4212/cjhp.v75i2.3296","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"44 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75936994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}