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

{"title":"Transforming value-based deep vein thrombosis care through a pharmacist-led clinic.","authors":"Madison Yates, Katie Sfirlea, V Wells Brabham, Nicholas Gazda, Molly Schneider","doi":"10.1093/ajhp/zxag337","DOIUrl":"https://doi.org/10.1093/ajhp/zxag337","url":null,"abstract":"<p><strong>Purpose: </strong>To address gaps in deep vein thrombosis (DVT) care, our health system implemented a pharmacist-led DVT clinic to standardize treatment, provide immediate access to pharmacy and vascular surgery services, and reduce emergency department (ED) and inpatient utilization for DVT management.</p><p><strong>Methods: </strong>This was a retrospective, pre-post cohort study of a DVT clinic that centralized imaging, diagnosis, anticoagulant initiation, and pharmacy services into a single outpatient location. Patients diagnosed with a DVT between January 1, 2023, and December 31, 2024, were included. The co-primary outcomes were the proportion of systemwide DVT encounters occurring in the acute care setting compared before and after the DVT clinic opened (2023 vs 2024) and compared between patients seen in the clinic or not (2024 only). A χ2 test was used to analyze the co-primary outcomes, with significance defined as a P value of less than 0.05.</p><p><strong>Results: </strong>The pharmacist saw 205 patients across 363 visits in 2024. Compared to 2023 baseline data, the proportion of systemwide DVT encounters occurring in the ED in 2024 decreased from 88.6% to 53.3% (P < 0.001), while the rate of inpatient admission for DVT decreased from 25.5% to 13.9% (P < 0.001). Stratified analysis of the 2024 data demonstrated significantly lower acute care utilization for DVT among patients managed in the DVT clinic compared to those not seen, including for ED encounters (15.2% vs 91.5%; P < 0.001) and inpatient admissions (1.8% vs 26%; P < 0.001).</p><p><strong>Conclusion: </strong>The pharmacist-led DVT clinic represents a transformative advancement in pharmacy practice, redefining the role of pharmacists in ambulatory care and establishing a replicable model to optimize value-based care that shifts treatment for appropriate populations from acute to outpatient management.</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":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169401","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":"Genotype-Guided Dosing Improves Attainment of Therapeutic Troughs in CYP3A5 Normal Metabolizers After Kidney Transplantation.","authors":"Lilly Nguyen, Anne Przybylski, Cara Joyce, Reynold Lopez-Soler, Nicholas Shah, Luis Fernandez, Laura Cotiguala","doi":"10.1093/ajhp/zxag330","DOIUrl":"https://doi.org/10.1093/ajhp/zxag330","url":null,"abstract":"<p><strong>Purpose: </strong>CYP3A5 expressors experience delayed therapeutic tacrolimus concentrations after kidney transplantation, thus, requiring higher tacrolimus doses. Although genotype-guided dosing has demonstrated benefit with immediate-release tacrolimus, data evaluating tacrolimus extended-release (XR) formulations is limited.</p><p><strong>Methods: </strong>This retrospective, single-center cohort study included adult kidney transplant recipients with CYP3A5 normal or intermediate metabolizer phenotypes initiated on tacrolimus XR between November 2020 and August 2025. Patients received either conventional fixed-dose tacrolimus XR 4 mg daily or genotype-guided dosing (8 mg daily for normal metabolizers and 6 mg daily for intermediate metabolizers). The primary outcome was time to therapeutic tacrolimus trough concentration (≥8 ng/mL). Secondary outcomes included total dose adjustments, rate of supratherapeutic troughs, intrapatient variability, rejection rate, and renal function.</p><p><strong>Results: </strong>Eighty-one patients met inclusion criteria, including 43 patients in the conventional dosing group and 38 patients in the genotype-guided group. Genotype-guided dosing significantly improved time to therapeutic troughs ≥8 in the normal metabolizers (median 13 vs 25 days; P=0.007), but not in the overall cohort. Both normal and intermediate metabolizers in the genotype-guided group demonstrated significantly higher tacrolimus trough concentrations that were closer to the therapeutic target on post-operative day 3. Genotype-guided dosing was not associated with an increased incidence of supratherapeutic tacrolimus concentrations or adverse clinical outcomes.</p><p><strong>Conclusion: </strong>Genotype-guided tacrolimus XR dosing improved early tacrolimus concentrations and significantly shortened time to therapeutic trough attainment among CYP3A5 normal metabolizers. These findings support the use of pre-transplant CYP3A5 genotyping to optimize tacrolimus XR dosing in normal metabolizers.</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":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169481","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":"Labetalol-induced hyperkalemia in acute aortic dissection: A rare but clinically relevant adverse effect.","authors":"Faizan Butt, Zoha Khan, Paul M Badua","doi":"10.1093/ajhp/zxag297","DOIUrl":"https://doi.org/10.1093/ajhp/zxag297","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia is a potentially life-threatening electrolyte abnormality often associated with renin-angiotensin-aldosterone system (RAAS) inhibitors, renal dysfunction, or potassium-sparing agents. Non-selective beta-blockers, including labetalol, may also precipitate hyperkalemia through beta-2 (β-2)-adrenergic blockade, although this adverse effect is underrecognized, particularly in patients without underlying renal disease.</p><p><strong>Case presentation: </strong>A 59-year-old man with hypertension, diabetes, asthma, and polysubstance use disorder presented with severe chest pain and hypertensive emergency (243/132 mmHg). Imaging revealed aortic dilatation and confirmed acute type B aortic dissection. After initial medical management with intravenous (IV) esmolol and nicardipine, oral labetalol was initiated and escalated to 600 mg for anti-impulse therapy. The patient developed persistent, non-hemolyzed hyperkalemia (5.2 to 5.8 mmol/L) temporally correlating with labetalol dose escalation, despite preserved renal function (serum creatinine 1.4 to 1.8 mg/dL) and absence of RAAS inhibitors or heparin exposure. Conservative management failed, and the patient underwent thoracic endovascular aortic repair (TEVAR) with thoracic branch endoprosthesis (TBE). Post-operatively, labetalol was discontinued and replaced with carvedilol. Serum potassium (K+) normalized within 48 hours and remained without further K+ lowering agents. Naranjo Adverse Drug Reaction Probability Scale assessment yielded a score of 7, indicating a probable adverse drug reaction.</p><p><strong>Conclusions: </strong>Labetalol may induce clinically significant hyperkalemia independent of renal impairment or typical precipitating medications. This case highlights the importance of monitoring K+ in patients receiving labetalol for acute aortic syndromes and supports carvedilol as a potentially safer non-selective beta-blocker alternative with respect to K+ homeostasis.</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":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166345","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":"Response to \"Moving forward from Cockcroft-Gault creatinine clearance\".","authors":"Robert E Ariano, Sheryl A Zelenitsky, Christine J Davis, James P McCormack","doi":"10.1093/ajhp/zxag341","DOIUrl":"https://doi.org/10.1093/ajhp/zxag341","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":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172019","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":"Analysis of pharmacist authorship in leading critical care journals.","authors":"Brianna Mendoza, Sergio Castaneda, Brian L Erstad","doi":"10.1093/ajhp/zxag340","DOIUrl":"https://doi.org/10.1093/ajhp/zxag340","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate first and last (senior) pharmacist authorship in high-impact critical care journals with a focus on the representation and evolution of pharmacist contributions over time.</p><p><strong>Methods: </strong>This literature-focused review analyzed pharmacist authorship across 6 high-impact critical care journals: Intensive Care Medicine, American Journal of Respiratory and Critical Care Medicine, Critical Care, Critical Care Medicine, CHEST, and Annals of Intensive Care. First and last authors were assessed for pharmacy-related degrees using article data and supplemental searches, with articles with unconfirmed pharmacist authorship excluded. Included study designs encompassed a variety of research and review article types, including, but not limited to, retrospective cohort studies, case-control studies, systematic reviews, case reports, surveys, narrative reviews, literature reviews, animal studies, clinical studies, evaluation studies, methods studies, and observational studies; nonresearch publications were excluded.</p><p><strong>Results: </strong>A total of 83,608 articles published between 1973 and 2024 were identified, of which 24,257 met the inclusion criteria. Pharmacist authorship was identified in 272 articles (1.12%), with an overall upward trend observed over time. The highest annual representation occurred in 1988 (12 articles; 3.67%). CHEST, evaluated from 2020 to 2024, had the highest proportion of articles with pharmacist authorship (11 articles; 4.47%). Pharmacist-authored studies were commonly classified as \"other study designs,\" including narrative reviews, literature reviews, experimental studies, and survey studies.</p><p><strong>Conclusion: </strong>Pharmacist authorship generally increased over the study period, although interpretation of temporal trends is limited by differences in journal inclusion across years; however, pharmacists remain underrepresented as first and last authors.</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":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172066","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":"Interrupted time series analysis of inpatient C. difficile treatment in response to the 2017 and 2021 SHEA/IDSA updates using Oracle EHR Real-World Data.","authors":"Ronald G Hall, Sandra Falcon, Christine Vu, Benny C Shaw, Carlos A Alvarez","doi":"10.1093/ajhp/zxag333","DOIUrl":"https://doi.org/10.1093/ajhp/zxag333","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the prescribing patterns of metronidazole, vancomycin, and fidaxomicin for inpatients with Clostridioides difficile infection (CDI) in response to the 2021 Society for Healthcare Epidemiology of America (SHEA)/Infectious Diseases Society of America (IDSA) update.</p><p><strong>Methods: </strong>We evaluated metronidazole, vancomycin, and fidaxomicin use utilizing Oracle EHR Real-World Data (2014-2024). Utilization data were measured by treatment courses, defined as 10 or more days of use or use on the last day of hospitalization. To determine if there was a statistically significant change in the use of each drug by CDI severity before versus after the SHEA/IDSA guideline updates, interrupted time-series analyses were conducted using multinomial logistic regression to model the probability of being assigned specific treatment and evaluate prescribing patterns over time, with vancomycin designated as the reference. Covariates included a continuous time variable, intervention indicators for both the 2017 and 2021 updates, and time by intervention interactions for both updates.</p><p><strong>Results: </strong>A total of 70,200 CDI treatment courses were included (38,357 for nonsevere and 31,843 for severe disease). Metronidazole use dropped precipitously after 2017 for nonsevere and severe CDI. Fidaxomicin use was only statistically significantly increased for nonsevere CDI with the 2021 event (odds ratio [OR], 1.80; 95% CI, 1.30-2.50) although a nonsignificant increase continued post 2021. For severe CDI, fidaxomicin use increased after 2017 (OR, 1.56; 95% CI, 1.12-2.17), with the 2021 event (OR, 2.32; 95% CI, 1.60-3.35), and post 2021 (OR, 1.21; 95% CI, 1.04-1.41).</p><p><strong>Conclusions: </strong>The 2021 SHEA/IDSA update was associated with statistically significant increases in fidaxomicin use for inpatients with CDI. However, the increases were small.</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":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149156","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 ASHP Board of Directors.","authors":"","doi":"10.1093/ajhp/zxag328","DOIUrl":"https://doi.org/10.1093/ajhp/zxag328","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":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149370","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":"Complement inhibition in transplantation: Infectious risk demands pharmacovigilance.","authors":"Kellie J Goodlet, Michael D Nailor, Sofya Tokman, Christine Pham","doi":"10.1093/ajhp/zxag338","DOIUrl":"10.1093/ajhp/zxag338","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":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148726","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":"Evaluation of outpatient medications at neonatal care unit discharge: A descriptive analysis of frequency, quantity, and type of medications.","authors":"Aryn Solis, Peter N Johnson, Stephen Neely, Jamie L Miller","doi":"10.1093/ajhp/zxag332","DOIUrl":"https://doi.org/10.1093/ajhp/zxag332","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the medications prescribed at neonatal intensive care unit (NICU) discharge and determine what percentage are commercially available in an infant-appropriate dosage form and covered by Oklahoma Medicaid.</p><p><strong>Methods: </strong>This retrospective study included patients discharged home from a 106-bed level IV NICU at an academic medical center from January 1 and December 31, 2024. Scheduled discharge medications (excluding multivitamins, vitamin D, and iron) were included. The primary objective was to determine the number of patients who required discharge medications. Secondary objectives included evaluation of dosage forms, measurability of oral liquid doses (unmeasurable was defined as milliliters not being rounded to the nearest tenths place), and coverage based on the Oklahoma Medicaid formulary.</p><p><strong>Results: </strong>Among 936 patients identified, 151 (16.1%) were discharged on 1 or more medications, with a median of 1 (interquartile range, 1-2). A total of 262 medications were identified, with diuretics, gastrointestinal agents, and cardiovascular agents most frequently prescribed. Most discharge medications were oral liquids (n = 195, 74.4%), with 49 of these requiring extemporaneous preparation. Unmeasurable doses were prescribed for 40 oral liquids (20.5%). Tablets were prescribed for 25 medications (9.5%). The majority (n = 233, 88.9%) of medications were covered by Oklahoma Medicaid, but 103 of these (44.2%) required prior authorization.</p><p><strong>Conclusion: </strong>A minority of NICU patients required continuation of medications when discharged home. Most medications were commercially available in an infant-appropriate dosage form and covered by Medicaid, but some required alteration of a dosage form or insurance prior authorization. This study highlights areas of focus to improve transitions of care upon NICU discharge.</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":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140302","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":"Interstate EMS medication restocking after hospital closure: A pharmacy-led regulatory response.","authors":"Ryan R Morgan, Kevin Blinn, David J Hargrave","doi":"10.1093/ajhp/zxag334","DOIUrl":"https://doi.org/10.1093/ajhp/zxag334","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a multi-state regulatory and operational response that preserved EMS controlled substance access following the closure of a rural community hospital.</p><p><strong>Summary: </strong>Hospital closures can disrupt established emergency medical services (EMS) medical control relationships and medication restocking pathways, including access to controlled substances. Limited literature describes the role of hospital pharmacy departments in maintaining EMS medication continuity during system-level disruptions. Following the closure of Nashoba Valley Medical Center in Massachusetts, local EMS agencies experienced increased transport times and operational strain related to medication restocking requirements. To mitigate service disruption, the Massachusetts Department of Public Health Drug Control Program and Office of Emergency Medical Services issued a time-limited waiver permitting interstate restocking at designated New Hampshire hospitals. Hospital pharmacy leadership collaborated with EMS agencies and regulators to establish controlled substance custody safeguards, documentation workflows, and reconciliation procedures consistent with state and federal requirements. This case highlights structural differences between Massachusetts and New Hampshire EMS medication governance models and demonstrates the role of hospital pharmacy in aligning cross-jurisdictional compliance frameworks.</p><p><strong>Conclusion: </strong>Hospital pharmacists may serve as critical regulatory integrators during regional healthcare disruptions. Formal agreements, clearly defined custody models, and interagency coordination are essential to maintaining EMS controlled substance access while ensuring compliance with applicable laws and regulations.</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":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140278","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}