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

{"title":"Challenges in evaluating associations among vasopressors, enteral nutrition, and nonocclusive mesenteric ischemia.","authors":"Angela L Bingham, Brian L Erstad","doi":"10.1093/ajhp/zxag251","DOIUrl":"https://doi.org/10.1093/ajhp/zxag251","url":null,"abstract":"<p><strong>Purpose: </strong>Acute mesenteric ischemia is a potentially life-threatening condition resulting from thromboembolic occlusion or nonocclusive mechanisms such as vasospasm and excessive vasoconstriction. Nonocclusive mesenteric ischemia (NOMI) is of particular concern in critically ill patients receiving vasopressors and enteral nutrition (EN). This paper reviews the challenges in evaluating associations among vasopressors, EN, and NOMI and discusses the pharmacist's role in supporting patient-specific nutrition decisions during hemodynamic instability.</p><p><strong>Summary: </strong>Mesenteric ischemia most commonly involves the superior mesenteric artery and carries high mortality. Diagnosis relies primarily on computed tomographic angiography because early recognition is difficult due to nonspecific signs such as ileus, abdominal pain, and lactic acidosis. Experimental and observational data suggest vasopressors may reduce mesenteric blood flow, with pharmacovigilance analyses demonstrating associations between several vasoactive agents and acute mesenteric ischemia. However, randomized controlled trials to establish these associations are lacking. Evidence evaluating early EN in patients with shock shows low reported rates of bowel or mesenteric ischemia (generally 0%-2%). Large randomized trials found higher rates of gastrointestinal complications, including rare cases of bowel ischemia, with full-dose EN but found similar mortality in patients receiving EN and those receiving parenteral nutrition (PN). Observational data suggest cautious EN may be feasible at lower vasopressor doses, though definitions of hemodynamic stability vary. Current guidelines recommend withholding EN during uncontrolled shock but provide limited detail regarding vasopressor thresholds for EN initiation or dosing modifications. Pharmacists can contribute by evaluating vasopressor exposure, recognizing patient-specific factors that may increase concern for gastrointestinal intolerance or ischemia, and participating in interprofessional decisions regarding EN initiation, advancement, and reassessment.</p><p><strong>Conclusion: </strong>NOMI is uncommon but serious in critically ill patients. The relationships between vasopressors, EN, and NOMI remain uncertain due to diagnostic challenges and limited high-quality comparative data. Clinical decisions should be individualized, with vigilance in at-risk patients.</p>","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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842604","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":"Vancomycin pharmacokinetics and dosing in critically ill adult patients on continuous renal replacement therapy: A scoping review.","authors":"Maha S Assadoon, Jeffrey C Pearson, Shayma H Alzaidi","doi":"10.1093/ajhp/zxag257","DOIUrl":"https://doi.org/10.1093/ajhp/zxag257","url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury is common in critically ill patients, frequently requiring the use of continuous renal replacement therapy (CRRT). Both critical illness and CRRT significantly alter vancomycin pharmacokinetics, affecting dosing and therapeutic drug monitoring. This scoping review aimed to evaluate vancomycin pharmacokinetics and dosing in critically ill adults receiving CRRT.</p><p><strong>Summary: </strong>A systematic scoping review was conducted using PRISMA-ScR guidelines. Studies published through April 2026 were identified using a comprehensive search of Ovid MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Included studies were in English, involved critically ill adult patients on CRRT, and assessed vancomycin pharmacokinetics and dosing using single- or multiple-dose population pharmacokinetics. Authors screened studies using a standard form, and disagreements were resolved through consensus. The searches retrieved 114 studies, and 24 were included. Vancomycin total clearance (CL) ranged from 1.5 to 4.8 L/h and was consistently influenced by CRRT. CRRT accounted for at least 50% of total CL, with CRRT modality and intensity being key determinants. Vancomycin's volume of distribution varied within a range of 0.4 to 1.4 L/kg. Population pharmacokinetic studies showed high interindividual variability, and dose simulation studies supported model-informed precision dosing. Simulation studies reported loading and maintenance dose ranges of 15-30 mg/kg and 5-20 mg/kg daily, respectively.</p><p><strong>Conclusion: </strong>Vancomycin dosing in patients on CRRT is highly variable due to significant pharmacokinetic alterations, emphasizing the need for individualized dosing, therapeutic drug monitoring, and model-informed approaches. Future studies should focus on validating personalized dosing strategies and linking pharmacokinetic/pharmacodynamic targets with clinical outcomes in this population.</p>","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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842631","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":"Improving patient safety with triple-scan technology for insulin pen administration.","authors":"Courtney K Wulffson, Melissa M Babin, Merissa T Andersen Pinotti","doi":"10.1093/ajhp/zxag247","DOIUrl":"https://doi.org/10.1093/ajhp/zxag247","url":null,"abstract":"<p><strong>Purpose: </strong>High-alert medications such as insulin pose serious risks to patients when used in error. In response to vulnerabilities identified in existing insulin administration workflows, we implemented a comprehensive approach to mitigate the risk of errors in the hospital setting.</p><p><strong>Summary: </strong>A new electronic health record capability, referred to as the \"triple-scan system,\" was introduced to enhance insulin pen administration safety. This system requires nurses to scan the patient's wristband barcode, the insulin pen manufacturer's barcode, and the pharmacy's linking label barcode applied to the pen before it is retrieved from an automated dispensing machine. Other measures were also implemented to prevent errors, including a 2-nurse verification process and visual aids. A performance dashboard was used to track insulin pen administration. After the triple-scan system was integrated into workflows, the performance dashboard showed increasing numbers of barcodes scanned over a period of 4 months, whereas the number of unscanned barcodes remained low. Postimplementation surveys of 174 nurses indicated high satisfaction with the new system, with 67% (n = 116) reporting improved patient safety and 71% (n = 124) finding it user friendly.</p><p><strong>Conclusion: </strong>The triple-scan system ensures the use of a single insulin pen for each patient, which may enhance patient safety by helping to prevent exposure to blood-borne pathogens. Engaging nurses as essential stakeholders and providing ongoing support and training were critical to the success of this intervention. Continuous monitoring and improvements are necessary to ensure the long-term sustainability of the triple-scan system.</p>","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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842563","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":"Capability, opportunity, and motivation: Three necessary components of behavior change by students and residents during experiential training.","authors":"Brian L Erstad","doi":"10.1093/ajhp/zxag253","DOIUrl":"https://doi.org/10.1093/ajhp/zxag253","url":null,"abstract":"","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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835852","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":"Pharmacist leadership behaviors and technician outcomes: A stratified organizational analysis of transformational and transactional styles in a community pharmacy setting.","authors":"Kenneth C Hohmeier, Dakota Raines, Valerie Wasem, Sina Sini Hosseini, Ashley Woodyard, Chris Pegg, James B Knight, Shane P Desselle","doi":"10.1093/ajhp/zxag234","DOIUrl":"https://doi.org/10.1093/ajhp/zxag234","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate pharmacy technicians' perceptions of pharmacist leadership styles and their impact on retention, career commitment, organizational commitment, resilience, and engagement in expanded or advanced responsibilities within one division of a large community pharmacy chain.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among pharmacy technicians in 22 community pharmacies in eastern Tennessee. The self-administered online survey incorporated validated components from the Multifactor Leadership Questionnaire (MLQ) and Brief Resilience Scale, as well as coworker support measures. Technicians were recruited using a modified Dillman's approach, with both certified and noncertified individuals invited to participate. Descriptive and inferential statistics, including chi-square tests, t tests, analysis of variance, and correlational analyses, were used to assess relationships between leadership styles and technician outcomes. Pharmacies were stratified into tertiles based on MLQ scores to examine organizational-level differences. Transformational leadership emphasizes coaching and inspiration, whereas transactional leadership emphasizes structured expectations and performance-based rewards.</p><p><strong>Results: </strong>Among 175 invited technicians, the response rate was 48.6%, representing 86.4% of surveyed pharmacies. Top-tertile pharmacies had significantly higher mean scores for both transformational and transactional leadership (P < 0.05) as well as leadership outcomes. Transformational leadership was strongly correlated with coworker support (r = 0.688, P < 0.001) and weakly correlated with resilience (r = 0.218, P < 0.05). Transactional leadership was moderately correlated with coworker support (r = 0.487, P < 0.001) and organizational commitment (r = 0.402, P < 0.001) and weakly correlated with resilience (r = 0.287, P < 0.05). Stratification revealed clear differences in technician retention, commitment, and resilience across leadership engagement levels.</p><p><strong>Conclusion: </strong>Higher levels of transformational and transactional leadership, as measured by the MLQ, were associated with more favorable technician outcomes, including stronger coworker support, higher organizational commitment, and greater resilience. Stratifying pharmacies by leadership engagement highlights the organizational impact of effective leadership behaviors. Fostering transformational leadership supported by constructive transactional structure among pharmacists may enhance technician outcomes and support resilient, high-performing pharmacy teams.</p>","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":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805091","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":"Professional Policies Approved by the 2026 ASHP House of Delegates.","authors":"","doi":"10.1093/ajhp/zxag221","DOIUrl":"https://doi.org/10.1093/ajhp/zxag221","url":null,"abstract":"","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805066","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":"Inaugural Address of the Incoming President: On Our Way.","authors":"Kim W Benner","doi":"10.1093/ajhp/zxag230","DOIUrl":"https://doi.org/10.1093/ajhp/zxag230","url":null,"abstract":"","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805093","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":"2026 Joint Address from the ASHP President and the Chief Executive Officer.","authors":"Melanie A Dodd, Samuel V Calabrese","doi":"10.1093/ajhp/zxag229","DOIUrl":"10.1093/ajhp/zxag229","url":null,"abstract":"","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805058","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":"The Power of Mentorship.","authors":"Donald E Letendre","doi":"10.1093/ajhp/zxag180","DOIUrl":"https://doi.org/10.1093/ajhp/zxag180","url":null,"abstract":"","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805056","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":"2026 Report of the ASHP Treasurer.","authors":"Lisa M Gersema","doi":"10.1093/ajhp/zxag216","DOIUrl":"https://doi.org/10.1093/ajhp/zxag216","url":null,"abstract":"","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805075","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}