CANADIAN JOURNAL OF HOSPITAL PHARMACY最新文献

{"title":"Patterns of Antimicrobial Use in an Outpatient Hemodialysis Unit.","authors":"Sylvia Sivarajahkumar, Miranda So, Andrew M Morris, Charmaine Lok, Chaim M Bell, Marisa Battistella","doi":"10.4212/cjhp.v75i1.3250","DOIUrl":"10.4212/cjhp.v75i1.3250","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving hemodialysis (HD) are at high risk of infections, including those caused by multidrug-resistant organisms. Given that antimicrobial exposure is a major risk factor for the emergence of these resistant organisms, minimizing inappropriate use is imperative. To optimize use, it is important to understand patterns of antimicrobial prescribing in this setting.</p><p><strong>Objectives: </strong>To measure antimicrobial use and to describe prescribing patterns among patients receiving outpatient HD.</p><p><strong>Methods: </strong>A retrospective observational case series study was performed in an outpatient HD unit from February to April 2017. Adults for whom at least 1 antimicrobial was prescribed were included. The primary outcome was total antimicrobial days of therapy (DOT) per 1000 patient-days. Secondary outcomes were the characteristics of the antimicrobial prescriptions, in terms of antimicrobial class, indication, purpose, route, and prescriber group.</p><p><strong>Results: </strong>Antimicrobials were prescribed for 53 (16%) of the 330 patients treated in the HD unit during the study period; the total number of prescriptions was 75. Antimicrobial use was 27.5 DOTs/1000 patient-days. Fluoroquinolones were the most frequently prescribed type of antimicrobial (<i>n</i> = 17, 23%), whereas the second most frequently prescribed were first-generation cephalosporins (<i>n</i> = 16, 21%). The most common indication was skin or soft-tissue infection (<i>n</i> = 14, 19%), followed by bloodstream infection (<i>n</i> = 13, 17%). Of the 75 antimicrobials, 48 (64%) were prescribed for empiric therapy, 19 (25%) for targeted therapy, and 8 (11%) for prophylaxis. Two-thirds of the antimicrobials prescribed (<i>n</i> = 50, 67%) were oral medications, and most (<i>n</i> = 72, 96%) were ordered by hospital prescribers.</p><p><strong>Conclusions: </strong>Antimicrobial use was common in this study setting, with 1 in 6 HD patients receiving this type of medication. The findings of this study create opportunities to standardize antimicrobial prescribing at the local level for common infections that occur in patients receiving outpatient HD.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"15-20"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677003/pdf/cjhp-75-15.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787512","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":"Effectiveness and Safety of Palbociclib plus Endocrine Therapy in Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer: Real-World Results.","authors":"Cristina Fernández-Cuerva,&nbsp;Juan Carlos Del Rio Valencia,&nbsp;Rocio Tamayo Bermejo","doi":"10.4212/cjhp.v75i1.3252","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3252","url":null,"abstract":"<p><strong>Background: </strong>Real-world data are critical to demonstrate the reproducibility of evidence and the external generalizability of randomized clinical trials. Palbociclib is an oral small-molecule inhibitor of cyclin-dependent kinases 4/6 that has been shown to improve progression-free survival when combined with letrozole or fulvestrant in phase 3 clinical trials.</p><p><strong>Objective: </strong>To evaluate real-world outcomes in patients with metastatic breast cancer who received palbociclib in combination with endocrine therapy in routine clinical practice.</p><p><strong>Methods: </strong>In this retrospective observational multicentre study, data were evaluated for all women with metastatic breast cancer who were treated with palbociclib from April 2017 to September 2019. Treatment response was assessed through progression-free survival according to the Response Evaluation Criteria in Solid Tumors, version 1.1.</p><p><strong>Results: </strong>Fifty-three patients were included in the study, with median age 57 years (range 31-87 years). For all patients treated with palbociclib, median progression-free survival by the end of the study period was 14.4 months (95% confidence interval [CI] 6.2-22.2 months). Twenty-three women who received palbociclib as a first-line treatment did not experience progression-free survival; for these patients, the median treatment duration was 12.1 months (95% CI 1.4-28.0 months). For the 23 patients who received palbociclib as second-line therapy for metastatic breast cancer, median progression-free survival was 13.3 months (95% CI 4.1-22.4 months). Among the 7 women who received palbociclib as third-line therapy, median progression-free survival was 6.0 months (95% CI 0.9-11.1 months). The most common adverse events were hematologic, with grade 3 or 4 neutropenia occurring in 20 (38%) of the 53 patients.</p><p><strong>Conclusions: </strong>This study provides data from a real-world setting that match the results of previous studies in terms of effectiveness (i.e., progression-free survival) when palbociclib plus endocrine therapy was used as second- or third-line treatment. Palbociclib had appropriate tolerability and a profile of easily manageable adverse effects, with none of the patients suspending their treatment because of toxic effects.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"26-33"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8676999/pdf/cjhp-75-26.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787514","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":"La raison pour laquelle je me suis fait vacciner contre la COVID-19.","authors":"Susan K Bowles","doi":"10.4212/cjhp.v75i1.3248","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3248","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"4-5"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8676993/pdf/cjhp-75-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876983","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":"Les données probantes au service de la défense des intérêts et des priorités en matière de formation.","authors":"Sean P Spina","doi":"10.4212/cjhp.3378","DOIUrl":"https://doi.org/10.4212/cjhp.3378","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"348"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524552/pdf/cjhp-75-348.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237695","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":"Canadian Hospital Pharmacists' Perceptions of Workplace Preparedness and Personal Well-Being during the COVID-19 Pandemic.","authors":"Patrick Yeh,&nbsp;Rumi McGloin,&nbsp;Rochelle M Gellatly","doi":"10.4212/cjhp.3225","DOIUrl":"https://doi.org/10.4212/cjhp.3225","url":null,"abstract":"<p><strong>Background: </strong>Little is known about hospital pharmacists' experiences during the COVID-19 pandemic, as studies to date have focused on community pharmacy practices.</p><p><strong>Objectives: </strong>To determine hospital pharmacists' perceptions of their workplace preparedness for the COVID-19 pandemic and to measure their mental well-being with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS).</p><p><strong>Methods: </strong>Pharmacists working in Canadian hospital inpatient settings during the COVID-19 pandemic were invited to participate in a 2-part online survey. Part A was a 46-item survey containing statements related to directions and support from leadership, personal protective equipment practices, work environment, and emotions. Part B assessed respondents' mental well-being using the validated 14-item WEMWBS. Responses to both parts of the survey were based on Likert scales. The survey was open from July to September 2020. Descriptive analyses were applied.</p><p><strong>Results: </strong>A total of 432 hospital pharmacists consented to participate in the study. Most respondents were women (337/432, 78%), and most were 25 to 44 years old (293/432, 68%). Most respondents were confident that their workplace and pharmacy department were effectively managing patient demand (314/389, 81%) and the pandemic more generally (263/394, 67%). They also felt that their workplace teams were working well together (314/386, 81%). Interestingly, 22% (86/391) of the respondents did not agree that they had received training for COVID-19 infection prevention and control practices. The mean WEMWBS score was 48.9 (standard deviation 8.6), which indicated average mental well-being.</p><p><strong>Conclusions: </strong>After the initial wave of the COVID-19 pandemic, respondents perceived their hospitals and departments as being able to manage the pandemic and reported average mental well-being. Ensuring that all hospital pharmacists receive training for effective COVID-19 infection prevention and control practices is crucial. How their perceptions and well-being have changed since the time of the survey is unknown.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"276-285"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524558/pdf/cjhp-75-276.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9242371","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":"Hospital Pharmacists' Experiences with Medical Assistance in Dying: A Qualitative Study.","authors":"Theresa J Schindel,&nbsp;Phillip Woods,&nbsp;Amary Mey,&nbsp;Michelle A King,&nbsp;Margaret Gray,&nbsp;Javiera Navarrete","doi":"10.4212/cjhp.3213","DOIUrl":"https://doi.org/10.4212/cjhp.3213","url":null,"abstract":"<p><strong>Background: </strong>Pharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists' involvement, little is known about how they experience MAiD practice.</p><p><strong>Objective: </strong>To study how pharmacists experience the practice of caring for patients who seek MAiD.</p><p><strong>Methods: </strong>This qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison.</p><p><strong>Results: </strong>Nineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists' experiences were personal, relational, emotional, and dynamic.</p><p><strong>Conclusions: </strong>Each of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists' roles in MAiD.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"294-301"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524557/pdf/cjhp-75-294.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237691","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 Time is Now for Mental Health Care: Evaluating the Impact of a Clinical Pharmacist on an Acute Mental Health Unit.","authors":"Amy Soubolsky,&nbsp;Katelyn Halpape","doi":"10.4212/cjhp.3210","DOIUrl":"https://doi.org/10.4212/cjhp.3210","url":null,"abstract":"<p><strong>Background: </strong>Clinical pharmacists have a significant role in optimizing pharmacotherapy for patients admitted to acute care settings. Patients with mental health disorders are especially vulnerable to polypharmacy, adverse drug effects, medication nonadherence, and misconceptions about medication use. The Royal University Hospital in Saskatoon, Saskatchewan, currently lacks resources to provide optimal clinical pharmacy coverage for mental health inpatients.</p><p><strong>Objectives: </strong>To determine the optimal clinical role for a pharmacist providing specialized care to mental health inpatients and to evaluate the potential impact of the pharmacist on medication use and patient care.</p><p><strong>Methods: </strong>A pharmacist with 5 years of mental health-related pharmacy practice experience was temporarily assigned to the Mental Health Short Stay Unit as a practical component of a Master's program in pharmacy. Clinical activities to be completed by the pharmacist were defined on the basis of available evidence, existing performance and quality assurance indicators, and prior experience. The pharmacist's activities and recommendations during each shift were tracked and reported.</p><p><strong>Results: </strong>The pharmacist saw 94 patients over a total of 88 hours. The pharmacist made a total of 61 recommendations, of which 55 (90%) were accepted by the psychiatrist, and initiated 42 medication changes. Forty-one patients (44%) received a thorough medication assessment, and individualized, often specialized, education was provided to patients 39 times. The pharmacist was consulted by the psychiatrist 19 times.</p><p><strong>Conclusions: </strong>Pharmacists have an important role in medication management and patient education for psychiatric inpatients, and the health care team values pharmacists' unique expertise. Additional resources dedicated to defining and expanding clinical pharmacy services on inpatient psychiatry units could further optimize patient care.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"317-325"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524551/pdf/cjhp-75-317.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9242372","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":"Role of Free Valproic Acid Levels in a Patient with Severe Hypoalbuminemia: A Case Report.","authors":"Tanveer Brar,&nbsp;Sherif Hanafy Mahmoud","doi":"10.4212/cjhp.3179","DOIUrl":"https://doi.org/10.4212/cjhp.3179","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 3","pages":"239-242"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245407/pdf/cjhp-75-239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490171","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":"Trends in Use of Combination Antiretroviral Therapy and Treatment Response from 2000 to 2016 in the Canadian Observational Cohort (CANOC): A Longitudinal Cohort Study.","authors":"Alison R McClean,&nbsp;Jason Trigg,&nbsp;Claudette Cardinal,&nbsp;Mona Loutfy,&nbsp;Curtis Cooper,&nbsp;Abigail Kroch,&nbsp;Mostafa Shokoohi,&nbsp;Nimâ Machouf,&nbsp;Réjean Thomas,&nbsp;Marina B Klein,&nbsp;Deborah V Kelly,&nbsp;Alexander Wong,&nbsp;Stephen Sanche,&nbsp;Julio S G Montaner,&nbsp;Robert S Hogg","doi":"10.4212/cjhp.3234","DOIUrl":"https://doi.org/10.4212/cjhp.3234","url":null,"abstract":"<p><strong>Background: </strong>Advances in treatment have turned HIV from a terminal illness to a more manageable condition. Over the past 20 years, there have been considerable changes to HIV treatment guidelines, including changes in preferred antiretrovirals and timing of initiation of combination antiretroviral therapy (cART).</p><p><strong>Objective: </strong>To examine real-world trends in cART utilization, viral control, and immune reconstitution among people living with HIV in Canada.</p><p><strong>Methods: </strong>Data were obtained from the Canadian Observational Cohort (CANOC). CANOC participants were eligible if they were antiretroviral therapy-naive at entry and initiated 3 or more antiretrovirals on or after January 1, 2000; if they were at least 18 years of age at treatment initiation; if they were residing in Canada; and if they had at least 1 viral load determination and CD4 count within 1 year of CANOC entry. Baseline and annual mean CD4 counts were categorized as less than 200, 200-350, 351-500, and more than 500 cells/mm³. Annual mean viral loads were reported as suppressed (< 50 copies/mL), low (50-199 copies/mL), or high detectable (≥ 200 copies/mL). The cART regimens were reported yearly.</p><p><strong>Results: </strong>All CANOC participants were included (<i>n</i> = 13 040). Over the study period, the proportion of individuals with an annual mean CD4 count above 500 cells/mm³ increased from 16.3% to 65.8%, while the proportion of individuals with an undetectable mean viral load increased from 10.6% to 83.2%. As of 2007, the most commonly prescribed 2-agent nucleoside reverse transcriptase inhibitor backbone was tenofovir disoproxil fumarate and emtricitabine. In terms of third agents, non-nucleoside reverse transcriptase inhibitors were the most common class in the periods 2000-2003 and 2014-2015, protease inhibitors were most common in the period 2004-2013, and integrase inhibitors were most common in 2016.</p><p><strong>Conclusions: </strong>Concordance with treatment guidelines was demonstrated over time with respect to cART prescribing and immunologic and virologic response.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"309-316"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524546/pdf/cjhp-75-309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237693","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":"Potassium Supplementation to Prevent Severe Hypokalemia and Paralysis after High-Dose Methylprednisolone for Ophthalmopathy in Uncontrolled Graves Disease: A Case Report.","authors":"Alix-Anne Gendron,&nbsp;Antoine Marquis,&nbsp;Carolanne Mongeon,&nbsp;Andreea Statie,&nbsp;Audrey Bouchard,&nbsp;Michael Khazaka","doi":"10.4212/cjhp.3145","DOIUrl":"https://doi.org/10.4212/cjhp.3145","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 3","pages":"231-233"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245406/pdf/cjhp-75-231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10485203","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}