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

{"title":"Artificial Intelligence Training for Informatics Students and Pharmacy Residents.","authors":"Julie Pawola, Kevin T Fuji, Catherine Palmer","doi":"10.1093/ajhp/zxag336","DOIUrl":"https://doi.org/10.1093/ajhp/zxag336","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":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140212","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":"Immunoglobulin Use, Availability, and Administration Considerations in Measles Prevention.","authors":"Dustin Le, Amina Ahmed, Michael Raschka, Patricia Stinchfield, Jeffery Goad","doi":"10.1093/ajhp/zxag315","DOIUrl":"https://doi.org/10.1093/ajhp/zxag315","url":null,"abstract":"<p><p>In 2026, the National Foundation for Infectious Diseases (NFID), with the Infectious Diseases Society of America (IDSA), convened a Measles Summit in response to the largest U.S. measles resurgence in over three decades, with more than 3,000 confirmed cases mostly among unvaccinated individuals. Many clinicians and public health professionals have limited firsthand measles experience, underscoring the need for clinical guidance. In this commentary, we examine immune globulin (IG) use for measles post-exposure prophylaxis (PEP) amid fragile supply and logistical challenges. GamaSTAN®, the sole Food and Drug Administration (FDA)-licensed intramuscular IG product, faces episodic availability, non-returnable single-vial economics, and a 2013 recommendation to double the PEP dose, increasing per-patient demand. IVIG is increasingly employed when patients weigh 30 kg or more, beyond the weight at which an adequate dose of immune globulin can be given intramuscularly, or when IMIG supply is constrained, while concurrent lot withdrawals compromise institutional formularies. We review evidence-based patient selection for PEP, emphasizing that the Measles, Mumps, and Rubella (MMR) vaccine remains first-line within 72 hours of exposure, with IG reserved when vaccination is contraindicated or potentially ineffective. Immunosuppressive therapies vary widely in their effects on the safety and efficacy of live vaccines. We therefore argue against categorizing every biologic, immunomodulator, or steroid as an automatic MMR contraindication, which would overestimate IG-PEP demand and preclude MMR for eligible patients. We propose class-specific stratification and an electronic health record decision-support rule to better align IG demand with genuine need. Finally, we address declining potency standards for measles antibody, attributable to waning donor titers, and offer guidance on dosing, multi-site pediatric administration, and infusion logistics within the PEP window.</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":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140247","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":"Executive summary of the 2026 ashp commission on goals: next-generation therapeutics: cell & gene therapy (cgt) and other ultra-high-cost drugs.","authors":"Monica Mehta","doi":"10.1093/ajhp/zxag305","DOIUrl":"https://doi.org/10.1093/ajhp/zxag305","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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122694","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":"Incretin Mimetics for Patients Living with Type 2 Diabetes in a Predominantly Hispanic/Latino Population: Analysis of Prescribing Frequency and Predictors of Use.","authors":"Cristian R Villalva, Kelli Sims, Olivia Ramey, Sarah R Bermudez","doi":"10.1093/ajhp/zxag321","DOIUrl":"https://doi.org/10.1093/ajhp/zxag321","url":null,"abstract":"<p><strong>Purpose: </strong>Studies indicate incretin mimetic utilization is relatively low, especially among patients of Hispanic/Latino ethnicity. The objective of this study was to evaluate the frequency of incretin mimetic prescribing and identify predictors of prescribing within a predominantly Hispanic/Latino population at a county-funded hospital system.</p><p><strong>Methods: </strong>A retrospective chart review of patients living with type 2 diabetes was conducted. The primary endpoint evaluated percentage of patients prescribed an incretin mimetic during August 2023 to August 2024. The secondary endpoint evaluated predictors to prescribing such as prescriber specialty, visit(s) with an ambulatory care clinical pharmacist, insurance status, clinical laboratory values, comorbidities, and medications used for concomitant comorbidities.</p><p><strong>Results: </strong>A total of 502 patients were randomly selected for review, of which 42.6% (n = 214) were prescribed an incretin mimetic. Key predictors of prescribing were: sex (OR = 0.62, 95% CI [0.41, 0.92], P = 0.019), obesity (OR = 2.65, 95% CI [1.84, 3.82], P < 0.001), hyperlipidemia (OR = 1.57, 95% CI [1.04, 2.38], P = 0.032), endocrinology clinic visit(s), (OR = 3.91, 95% CI [2.43, 6.27], P < 0.001), and visit(s) with an ambulatory care clinical pharmacist (OR = 1.72, 95% CI [1.06, 2.81], P = 0.030). There was no significant difference in prescribing for Hispanic/Latino vs non-Hispanic/Latino populations within this study.</p><p><strong>Conclusion: </strong>Incretin mimetics are historically underutilized among patients of Hispanic/Latino ethnicity despite their evidence-based benefits in patients with type 2 diabetes. Engagement with endocrinology and ambulatory care clinical pharmacy services may contribute to increased prescribing within clinical settings.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122700","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":"Effects of ketamine infusion rate and cumulative dosing on incidence of delirium in medical intensive care unit patients.","authors":"Jennifer Miller, Justin Johnson, Carryl Laserna, Alexis Grady, Sarah Dubin, Ceno Fraire, Brooke A Smith, Kelli Henry","doi":"10.1093/ajhp/zxag326","DOIUrl":"https://doi.org/10.1093/ajhp/zxag326","url":null,"abstract":"<p><strong>Purpose: </strong>Ketamine is increasingly used for analgosedation in mechanically ventilated intensive care unit (ICU) patients, but its association with delirium remains unclear. This study evaluated the relationship between maximum hourly ketamine rate and cumulative dose during hospitalization, with the incidence of delirium.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included mechanically ventilated adult medical ICU patients who received ketamine infusions for sedation (January 2013-June 2025) at two tertiary centers. Data collected included demographics, sedation requirements, and daily Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The primary outcome was delirium at any point during ICU stay. Primary and secondary exposure variables included maximum hourly ketamine rate and cumulative ketamine dose. A modified Poisson regression was used to evaluate associations between the exposure variables and incidence of delirium, adjusting for confounders.</p><p><strong>Results: </strong>Of 837 screened patients, 114 met inclusion criteria and 42 (36.8%) developed delirium. Baseline characteristics were similar. Patients with delirium had longer duration of mechanical ventilation, (210.7 vs 140.9 hours, P <0.01), ICU length of stay (364.7 vs 268.6 hours, P =0.04), and higher morphine milligram equivalents (5,126.8 vs 2911.8, P = 0.04). No association was observed between delirium with maximum hourly ketamine rate (RR 1.15, P = 0.21) or cumulative dose (RR 1.0, p=0.97). Restricted cubic spline analysis showed a trend towards increased delirium risk with increasing maximum hourly ketamine rates (P = 0.06).</p><p><strong>Conclusion: </strong>Maximum hourly ketamine infusion rate and cumulative dose in mechanical ventilated patients in the medical ICU were not associated with ICU delirium.</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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122673","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":"Polypharmacy and anticholinergic burden in hospitalized older patients: The role of medication recognition and reconciliation in therapeutic deprescribing.","authors":"Francesca Curri, Andrea Cignarella, Francesca Venturini, Carlotta Campodall'Orto, Chiara Curreri, Giuseppe Sergi, Caterina Trevisan","doi":"10.1093/ajhp/zxag323","DOIUrl":"https://doi.org/10.1093/ajhp/zxag323","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy is a crucial issue in the older population. Hospitalization provides an opportunity for medication review but can also reveal new clinical issues that require further prescriptions. Informatic systems for medication recognition and reconciliation (MRR) can assist physicians in the care process, especially at hospital discharge. This study aimed to assess whether implementation of an electronic MRR tool in an acute geriatric ward was associated with: 1) changes in medication count and anticholinergic cognitive burden from hospital admission to discharge; and 2) emergency department accesses, rehospitalizations, and mortality over a six-month follow-up.</p><p><strong>Methods: </strong>This observational retrospective study involved 382 patients consecutively admitted to the Geriatric Unit of the Padua University Hospital from January 1 to December 31, 2017, with available data on medications taken before admission and prescribed at discharge. Two groups were considered: 247 patients admitted before (pre-MRR) and 135 after (post-MRR) the implementation of an electronic MRR tool (July 2017). For each patient, data on health, functional and cognitive status, medications, and total anticholinergic cognitive burden (ACB) at admission and discharge were collected.</p><p><strong>Results: </strong>The study population had an average age of 86.5 years, and 66.8% were females. The mean hospital stay was 12 days, and 26.1% of patients were re-hospitalized within 6 months of follow-up. At admission, more than 60% of the sample was taking ≥5 drugs. The prevalence of polypharmacy (≥5 drugs) and hyperpolypharmacy (≥10 drugs) was 48.2% and 15.4%, respectively, in the pre-MRR group, and 54.1% and 18.5% in the post-MRR group, with no significant differences between groups. A significant increase in the number of medications at discharge was observed in both groups, more markedly in the pre-MRR than in the post-MRR group (average change +1.44 vs +0.73 drugs, p=0.009). Considering ACB, the post-MRR group had a 46% reduced probability (OR=0.54, 95%CI: 0.33-0.87) of being prescribed drugs with anticholinergic burden at discharge.</p><p><strong>Conclusions: </strong>Implementation of electronic MRR tools in acute geriatric wards may help improve the quality rather than the quantity of prescriptions at hospital discharge; however, it does not seem to be associated with medium-term clinical outcomes in older 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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122605","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":"Clinical Consultation: Continuous Antibiotic Irrigation Through the IRRAflow Device for Central Nervous System Infections.","authors":"M Gabriela Cabanilla, Kevin Kaucher, Matthew J Briski, Joseph A Iovine, Jacob Hurt","doi":"10.1093/ajhp/zxag327","DOIUrl":"https://doi.org/10.1093/ajhp/zxag327","url":null,"abstract":"<p><p>Bacterial central nervous system (CNS) infections carry high morbidity and mortality, and their management is complicated by limited antibiotic penetration across the blood brain barrier. The IRRAflow system is a dual-lumen ventricular catheter that enables continuous active cerebrospinal fluid exchange and has been used off-label for antibiotic delivery in refractory CNS infections. This clinical consultation reviews the available evidence, describes the device and its proposed rationale, and offers practical guidance for clinicians. Published experience is limited to case reports, case series, and small retrospective cohorts. In addition, there is no pharmacokinetic data available and clinical dosing is described for only two agents. The available evidence is insufficient to establish efficacy, define safe-use criteria, or support dosing strategies. Continuous antibiotic irrigation via IRRAflow cannot currently be recommended for routine use. Where it is used, it should be reserved for infections refractory to standard care, at experienced centers, with active clinical pharmacist involvement in agent selection, dosing, and monitoring, ideally within a prospective study.</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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122640","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":"From Classroom to Megaproject: MS-HSPAL Students Support a New Hospital Tower Activation.","authors":"Hanna Iarussi, Dylan McWilliams, Isaac Schmiesing, Ben Lopez, Trisha A Jordan, Kelly J Scheiderer, Karen Sharp, Dennis R Delisle, Lisa G Mostafavifar","doi":"10.1093/ajhp/zxag325","DOIUrl":"https://doi.org/10.1093/ajhp/zxag325","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the development and implementation of an innovative elective course that integrated Master of Science in Health-System Pharmacy Administration and Leadership (MS-HSPAL) students into pharmacy planning and activation activities associated with a major hospital expansion, and to highlight considerations for health systems seeking to leverage learners during large-scale organizational initiatives.</p><p><strong>Summary: </strong>Large-scale health system projects require substantial planning, coordination, and leadership resources, yet also present unique experiential learning opportunities. In preparation for opening a new hospital tower, an 8-week elective course was developed that incorporated MS-HSPAL and Master of Healthcare Administration students into operational workstreams supporting hospital activation. Through structured project assignments, preceptor oversight, participation in leadership meetings, and involvement in go-live, students contributed to workflow redesign, communication planning, automation readiness, operational support, and patient move activities. Learner participation expanded project capacity during a resource-intensive time while providing meaningful leadership development. Key elements supporting success included strong leadership engagement, clearly defined student responsibilities, and alignment of educational and organizational goals.</p><p><strong>Conclusions: </strong>This elective experience demonstrated how a structured learning model can integrate learners into a healthcare megaproject. Participation in real-world planning and activation activities allowed students to further develop leadership, project management, and operational competencies that are difficult to replicate in a traditional classroom or rotation-based environment. Given the learning benefits observed, health systems undergoing expansion or other large-scale transformation should consider incorporating learners into these initiatives as a strategy to enhance project capacity while preparing future healthcare leaders.</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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122654","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":"Elevating pharmacy technicians as essential healthcare practitioners.","authors":"Daniel N Nyakundi, Kimberly M Boler, Sarina Clinton, Troy A Cox, Stephanie N Rice-Erlenbusch, Merissa L Waldron, Autumn Pinard","doi":"10.1093/ajhp/zxag319","DOIUrl":"https://doi.org/10.1093/ajhp/zxag319","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":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122697","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":"Improvement of Autonomic and Cognitive Dysfunction by Memantine in a Patient with Dementia with Lewy Bodies and Cardiac Conduction Defect: A Case Report.","authors":"Chih-Chung Huang, Yun-Chih Yeh, Chun-Lun Hsu, Yan-Wen Zeng, Chun-Yen Chen, Shin-Chang Kuo, Yi-Wei Yeh","doi":"10.1093/ajhp/zxag320","DOIUrl":"https://doi.org/10.1093/ajhp/zxag320","url":null,"abstract":"<p><strong>Purpose: </strong>Dementia with Lewy bodies (DLB) ranks among the most frequent neurodegenerative cognitive disorders, characterized by multi-domain deficits including autonomic dysfunction and fluctuating cognition. Current management remains symptomatic, particularly in patients with comorbidities limiting standard therapies.</p><p><strong>Summary: </strong>We report a 73-year-old female with DLB and pre-existing cardiac conduction defects, rendering cholinesterase inhibitors contraindicated. Following memantine (10 mg/day) treatment over three months, changes in autonomic and cognitive measures were observed. Heart rate variability parameters increased, accompanied by a reduction in SCOPA-AUT score and an increase in MMSE score. No adverse events were observed.</p><p><strong>Conclusion: </strong>These findings suggest memantine as a potential therapeutic alternative for DLB patients with autonomic fragility.</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":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122646","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}