American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists最新文献

Assessing Medication Confounders Before Determination of Brain Death/Death by Neurologic Criteria: A Primer, with Opioids as a Worked Example. 在神经学标准确定脑死亡/死亡之前评估药物混杂因素：以阿片类药物为例的入门

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-19 DOI: 10.1093/ajhp/zxag348

Brian L Erstad, Aarti Sarwal, Yugant Khand, Jaiva Larsen, Farshad Mazda Shirazi

{"title":"Assessing Medication Confounders Before Determination of Brain Death/Death by Neurologic Criteria: A Primer, with Opioids as a Worked Example.","authors":"Brian L Erstad, Aarti Sarwal, Yugant Khand, Jaiva Larsen, Farshad Mazda Shirazi","doi":"10.1093/ajhp/zxag348","DOIUrl":"https://doi.org/10.1093/ajhp/zxag348","url":null,"abstract":"Purpose: To provide a primer on how clinicians, particularly pharmacists, can systematically assess whether a medication may confound determination of brain death/death by neurologic criteria (BD/DNC), using pharmacokinetic and pharmacodynamic principles that can be applied to any agent with the aid of tertiary references, and using opioids as a worked example.Summary: All major guidelines require exclusion of central nervous system (CNS) depressant effect before BD/DNC determination, yet none provides a general method for deciding when a given medication has cleared. Rather than cataloging every agent, this primer sets out the parameters that govern how long any drug can suppress the neurologic examination: lipophilicity and volume of distribution, elimination pathway and the effect of hepatic or renal dysfunction, active metabolites, and the context-sensitive half-life, which lengthens with the duration of an infusion and is not predicted by the elimination half-life. Special states, including obesity, hypothermia, extracorporeal support, and overdose, further prolong effect; in overdose, delayed absorption and saturable elimination can invalidate the customary five-half-life rule. Routine toxicology screens miss many relevant substances, including synthetic opioids. Opioids illustrate the framework across three common scenarios: exposure before arrival, continuous infusion, and overdose.Conclusion: No validated serum concentration threshold defines clearance for most CNS depressants, and the safest determination rests on structured pharmacokinetic reasoning, toxicology consultation, and institutional protocols that specify how confounders are screened for and excluded, rather than on any single number or fixed waiting period.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220846","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}

引用次数: 0

2026-2027 Board of Directors Photos. 2026-2027董事会照片。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-16 DOI: 10.1093/ajhp/zxag238

引用次数: 0

Symptom-monitored loading: An evaluation of prophylactic medications in patients with severe alcohol withdrawal. 症状监测负荷：重度酒精戒断患者预防性用药的评估

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-16 DOI: 10.1093/ajhp/zxag239

Andraya Hawks, Alexis Robinson, Pari Iverson, Melanie Townsend, James Jackson

{"title":"Symptom-monitored loading: An evaluation of prophylactic medications in patients with severe alcohol withdrawal.","authors":"Andraya Hawks, Alexis Robinson, Pari Iverson, Melanie Townsend, James Jackson","doi":"10.1093/ajhp/zxag239","DOIUrl":"https://doi.org/10.1093/ajhp/zxag239","url":null,"abstract":"Purpose: The purpose of this study was to evaluate differences in outcomes among patients with severe alcohol withdrawal syndrome (AWS) who received symptom-monitored loading (SML) regimens of lorazepam, chlordiazepoxide, or gabapentin as compared to those who received Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised (CIWA-Ar)-based treatment alone during hospitalization.Methods: This retrospective cohort study compared length of hospital stay between patients who received SML with CIWA-Ar-based treatment and those who received CIWA-Ar-based treatment only. Secondary outcomes included escalation of care, the lorazepam equivalents used from CIWA-Ar scoring, and the duration of the active alcohol withdrawal protocol. All-cause mortality and respiratory compromise were safety outcomes. Eligible patients were 18 years of age or older, had an active alcohol withdrawal order set from October 2021 to September 2023, and experienced severe alcohol withdrawal within 96 hours of admission.Results: The final analysis included 240 patient encounters in the SML + CIWA-Ar group and 198 patient encounters in the CIWA-Ar-only group. The primary outcome, average hospital length of stay, was significantly shorter in the SML + CIWA-Ar group than in the CIWA-Ar-only group (mean [SD]: 5.7 [6] days vs 8.4 [10.2] days; P < 0.001). Patients in the SML + CIWA-Ar group also had a significantly lower rate of mortality from any cause (10.7% vs 17.8%; P = 0.006), and a significantly lower proportion of patients in this group required respiratory support (5.4% vs 10.6%; P = 0.043).Conclusion: This study found that patients with severe AWS who received SML dosing in addition to CIWA-Ar-based lorazepam had a shorter hospital length of stay and a decreased rate of all-cause mortality.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198691","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}

引用次数: 0

An Evaluation of Insulin Use in Hospitalized Patients with Corticosteroid-Related Hyperglycemia. 糖皮质激素相关性高血糖住院患者胰岛素使用的评价

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-15 DOI: 10.1093/ajhp/zxag346

Alexis Clarke, Sarah Ferrell, Blake Burton, Christina Ford, Elizabeth Meisberger

{"title":"An Evaluation of Insulin Use in Hospitalized Patients with Corticosteroid-Related Hyperglycemia.","authors":"Alexis Clarke, Sarah Ferrell, Blake Burton, Christina Ford, Elizabeth Meisberger","doi":"10.1093/ajhp/zxag346","DOIUrl":"https://doi.org/10.1093/ajhp/zxag346","url":null,"abstract":"Purpose: This study evaluated insulin use in hospitalized patients who developed corticosteroid-related hyperglycemia to assess current insulin management strategies, glycemic outcomes, and opportunities for optimizing institutional practice.Methods: This retrospective study was conducted at a community-based teaching health system and included hospitalized adults who experienced clinically significant hyperglycemia (blood glucose >250 mg/dL) on at least two occasions during admission between September 2024 and September 2025. The primary outcome was the percentage of patients administered intermediate or long-acting insulin following hyperglycemia. The secondary endpoints evaluated glycemic control, hypoglycemia, timing of insulin orders, and administration of optimized insulin regimens based on pharmacokinetics. This project was deemed exempt by the IRB.Results: Of 1,361 patient encounters screened, 708 unique patients were included, and 610 had type II diabetes (T2DM). Intermediate or long-acting insulin was administered more frequently in patients with T2DM than those without (71.1% vs 41.8%, p<0.001). A minority of patients had insulin before or with the first dose of steroid (T2DM 35.1% vs without T2DM 13.3%). Glycemic control was achieved most frequently in patients without T2DM (52% vs 35%, p<0.001).Conclusions: This study showed that a higher percentage of patients with T2DM received insulin before or with the first dose of steroid when compared to patients without T2DM. However, in both groups, a majority of patients received insulin after the first dose of steroid. Findings suggest that hospitalized adults with or without diabetes who develop corticosteroid-related hyperglycemia will benefit from receiving an intermediate or long-acting insulin concurrently with the ordered steroid.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198605","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}

引用次数: 0

Implementing a Multidisciplinary Fentanyl Patch Verification Workflow Across a 12-Hospital Health System. 在12家医院的卫生系统中实施多学科芬太尼贴片验证工作流程。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-14 DOI: 10.1093/ajhp/zxag345

Francis Zamora, Michelle Krichbaum, Devada Franco Singh, William Wolowich

{"title":"Implementing a Multidisciplinary Fentanyl Patch Verification Workflow Across a 12-Hospital Health System.","authors":"Francis Zamora, Michelle Krichbaum, Devada Franco Singh, William Wolowich","doi":"10.1093/ajhp/zxag345","DOIUrl":"https://doi.org/10.1093/ajhp/zxag345","url":null,"abstract":"Purpose: To describe the development, implementation, and early experience of a multidisciplinary opioid stewardship workflow designed to improve the safety of transdermal fentanyl ordering across a 12-hospital health system.Summary: A systemwide gap analysis and baseline medication use evaluation (MUE) identified inconsistent documentation of opioid tolerance, variable Prescription Drug Monitoring Program (PDMP) review, and missed opportunities to assess fentanyl patch appropriateness before dispensing. A multidisciplinary team implemented a two-step electronic workflow across 12 hospitals that paired prescriber clinical decision support with mandatory pharmacist verification, centralized fentanyl patch dispensing, standardized education, and longitudinal MUE. In the baseline sample, 12 of 36 orders did not meet institutional criteria: 11 were for acute pain in opioid-naive patients and 1 had no documented pain indication. A later postimplementation review evaluated 135 orders; 125 (92.6%) met institutional ordering criteria and 10 (7.4%) did not. Eight documented pharmacist interventions were identified; 5 recommendations were accepted, resulting in discontinuation of the fentanyl patch and conversion to a short-acting opioid, while 3 recommendations were not accepted.Conclusion: Embedding prescriber decision support and mandatory pharmacist review within the medication-use process created a reproducible fentanyl patch safety workflow across a large integrated health system. The experience supports a stewardship model that combines governance, electronic decision support, pharmacist verification, and iterative process improvement.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187509","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}

引用次数: 0

Postoperative length of stay comparison associated with a switch from alvimopan to naloxegol in patients undergoing major small and large bowel procedures. 在接受主要小肠和大肠手术的患者中，从阿尔维莫泮切换到纳洛西戈的术后住院时间比较。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-14 DOI: 10.1093/ajhp/zxag344

Hanna M Schultz, Doug Raiff

{"title":"Postoperative length of stay comparison associated with a switch from alvimopan to naloxegol in patients undergoing major small and large bowel procedures.","authors":"Hanna M Schultz, Doug Raiff","doi":"10.1093/ajhp/zxag344","DOIUrl":"https://doi.org/10.1093/ajhp/zxag344","url":null,"abstract":"Purpose: This retrospective analysis compares postoperative length of stay in patients undergoing colorectal surgery who received naloxegol or alvimopan as part of an Enhanced Recovery After Surgery (ERAS) protocol.Methods: This is a systemwide retrospective cohort. The community health system switched from alvimopan to naloxegol as the peripherally acting mu-opioid receptor antagonist (PAMORA) agent used in the colorectal ERAS protocol in December 2024. Adult patients who underwent colorectal surgery and received one PAMORA dose for surgical discharge dates between May 2024 and August 2025 were included.Results: There was no difference in median length of stay (alvimopan 3.2 days [2.2-6.2] versus naloxegol 3.3 days [2.2-5.9], p = 0.881). Median bowel function return was achieved sooner in patients receiving alvimopan (1.4 days [1.1-2.1] versus 1.7 [1.2-2.4], p = 0.015), however all-cause 30-day readmission rates were higher in the alvimopan group (15.2% versus 8.2%, p = 0.021). Patients in the alvimopan group were more likely to receive a dose prior to the procedure than naloxegol (89.1% versus 76.4%, p < 0.001). A subgroup analysis of those patients revealed there was no difference in median length of stay, median bowel function return, or incidence of postoperative ileus, with higher readmission rates in the alvimopan group (p = 0.005). The average PAMORA cost per admission who received alvimopan was approximately 16 times more expensive than naloxegol.Conclusion: Switching from alvimopan to naloxegol in colorectal ERAS protocols is a potential cost-saving initiative for formulary management that was associated with similar observed length of stay and postoperative ileus rates.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187539","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}

引用次数: 0

Reply to Ariano et al. 回复Ariano等人。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-14 DOI: 10.1093/ajhp/zxag343

Wendy L St Peter, Andrew S Bzowyckyj, Manjunath P Pai

引用次数: 0

2026 ASHP Midyear Clinical Meeting & Exhibition. 2026 ASHP年中临床会议暨展览会。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-13 DOI: 10.1093/ajhp/zxag280

引用次数: 0

Reply to "Complement inhibition in transplantation: Infectious risk demands pharmacovigilance". 回复“移植中的补体抑制：感染风险需要药物警惕”。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-13 DOI: 10.1093/ajhp/zxag342

Adrian Puertas Sanjuan, Judith Sacanell-Lacasa, Maria Rosa Gómez Domingo, Alba Pau-Parra, Jordi Riera Del Brio, Cristina Berastegui, Irina B Torres Rodríguez, Joel Rosado Rodriguez, Pilar Lalueza Broto, Laura Doménech-Moral

引用次数: 0

Evaluation of coagulation factor concentrates for persistent bleeding after cardiothoracic surgery. 凝血因子对心胸外科术后持续出血的评价。

IF 2.3

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Pub Date : 2026-10-13 DOI: 10.1093/ajhp/zxag339

Maria F Hartwig, RaeAnn Hirschy, Jordan Meckel

{"title":"Evaluation of coagulation factor concentrates for persistent bleeding after cardiothoracic surgery.","authors":"Maria F Hartwig, RaeAnn Hirschy, Jordan Meckel","doi":"10.1093/ajhp/zxag339","DOIUrl":"https://doi.org/10.1093/ajhp/zxag339","url":null,"abstract":"Purpose: The purpose of this study was to evaluate the effectiveness and safety of changes to a protocol for refractory bleeding after cardiothoracic surgery. The protocol changes included adjusting from a weight-based to a fixed-dosing strategy for 4-factor prothrombin complex concentrate (4F-PCC) and decreasing the weight-based dosing of recombinant activated factor VII (rFVIIa).Methods: This was a pre-post retrospective cohort study evaluating 198 adult patients after cardiothoracic surgery requiring cardiopulmonary bypass at an academic medical center between May 2019 to October 2021 (before protocol change) and November 2021 to September 2022 (after protocol change). The primary outcome was chest tube output at 24 hours after the operation in patients who received at least one dose of 4F-PCC or rFVIIa. Secondary endpoints included transfusion volume, the rate of re-exploration events, length of stay, and 30-day mortality.Results: The primary outcome of chest tube output at 24 hours was 720 mL in the pre-change group and 700 mL in the post-change group (P = 0.982). The volume of fresh frozen plasma (FFP) transfusions significantly decreased from a median of 4 units to 2 units (P < 0.001). The median dose of 4F-PCC in the pre- vs post-change group was 24.6 vs 26.3 units/kg (P = 0.011), while that of rFVIIa was 59.5 vs 24.5 μg/kg (P = 0.000). The other secondary and safety outcomes were similar between the groups. The average cost savings was $3,585.45 per patient.Conclusion: Patients in the post-change group had similar chest tube output, re-exploration rates, and incidence of thrombotic events. The post-change group received significantly less FFP and less coagulation factor concentrate while maintaining hemostasis and reducing cost.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187541","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}

引用次数: 0