American Journal of Health-System Pharmacy最新文献

{"title":"Evaluation of clinical factors associated with discordant estimated glomerular filtration rate values determined from creatinine vs cystatin C.","authors":"Shemual Tsai, April Wayne, Brian L Erstad, David E Nix","doi":"10.1093/ajhp/zxaf097","DOIUrl":"10.1093/ajhp/zxaf097","url":null,"abstract":"<p><strong>Purpose: </strong>Estimated glomerular filtration rate (eGFR) is the standard for categorizing renal function. Current creatinine-based estimates have been demonstrated to have limited accuracy, with national organizations encouraging use of cystatin C to calculate eGFR. This study aimed to describe the relationship between eGFR calculated using serum cystatin C (eGFRcysC) vs serum creatinine (eGFRcreat) using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.</p><p><strong>Methods: </strong>A retrospective review was performed for the period from July 2018 through June 2022 that included inpatient adults with a measured serum cystatin C level and a paired serum creatinine level obtained within 24 hours of each other. eGFRcreat and eGFRcysC were calculated using the CKD-EPI equations. The primary objective was to identify factors that were significantly associated with discordance between eGFRcysC vs eGFRcreat, which was expressed as the percentage difference in eGFR (eGFRpct_diff). Differences in eGFRpct_diff by patient subgroup were assessed using a paired t test or ANOVA as appropriate. Univariate and multivariate regression analyses were performed to further identify variables associated with eGFRpct_diff.</p><p><strong>Results: </strong>The study population included 226 patients. The mean (95% confidence interval) eGFRpct_diff by patient subgroup was as follows: CKD stage 4, 45.0% (25.6% to 64.4%); weight loss of greater than 10% in 1 year, -33.9% (-45.6% to -22.2%); cancer, -36.1% (-48.2% to -24.1%); and hemiplegia, -32.7% (-46.2% to -19.2%). Thirty-seven patients had at least one 24-hour urine collection for determination of creatinine clearance. Measured 24-hour creatinine clearance was better correlated with eGFRcysC (R2 = 0.754) than it was with eGFRcreat (R2 = 0.557) or creatinine clearance calculated using the Cockcroft-Gault creatinine equation (R2 = 0.288).</p><p><strong>Conclusion: </strong>Cautious interpretation is recommended when estimating renal function from serum creatinine alone in patients with conditions associated with loss of muscle mass, including weight loss, cancer, hemiplegia, and immobility.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e812-e818"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of antimicrobial stewardship certification program and its impact on low-resource settings.","authors":"Richard Faator Dery, Emily Perry, Paul Carson, Elizabeth Skoy","doi":"10.1093/ajhp/zxaf077","DOIUrl":"10.1093/ajhp/zxaf077","url":null,"abstract":"<p><strong>Purpose: </strong>Antimicrobial resistance has become an increasing concern worldwide. Antimicrobial stewardship (AMS) is a critical approach to protect against the danger of untreatable microbes. AMS programs frequently rely on the expertise of infectious diseases-trained physicians and pharmacists, yet access to such expertise is frequently limited in rural or smaller facilities like critical access hospitals (CAHs) and skilled nursing facilities (SNFs). However, nearly all these facilities have a staff or contract pharmacist available, even in more rural parts of the United States. These pharmacists may be important potential resources to promote stewardship in these low-resource settings.</p><p><strong>Summary: </strong>The North Dakota Department of Health and Human Services and North Dakota State University collaborated to provide free AMS certification to predominantly rural pharmacists through a program offered by the Society of Infectious Diseases Pharmacists (SIDP) between 2018 and 2022, except in 2020 (due to the COVID-19 pandemic). Eighty-five pharmacists out of 113 applications were selected to complete the program. The preferential selection was based on whether pharmacists worked in a CAH or SNF or were willing to assist the above healthcare facilities in AMS activities. Fifty-four percent of the participants completed the program and developed an AMS intervention at their facilities, with 32% having interventions in progress at the time of assessment and 9% lost to follow-up over 4 years.</p><p><strong>Conclusion: </strong>Pharmacists were incentivized to gain expertise in AMS in low-resource settings by providing free SIDP certification through the state health department. This may be a cost-effective use of state dollars to promote AMS in low-resource settings.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e837-e841"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of responses from artificial intelligence programs to medication-related questions derived from critical care guidelines.","authors":"Blake Williams, Brian L Erstad","doi":"10.1093/ajhp/zxaf075","DOIUrl":"10.1093/ajhp/zxaf075","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the recommendations given by 4 publicly available artificial intelligence (AI) programs in comparison to recommendations in current clinical practice guidelines (CPGs) focused on critically ill adults.</p><p><strong>Methods: </strong>This study evaluated 4 publicly available large language models (LLMs): ChatGPT 4.0, Microsoft Copilot, Google Gemini Version 1.5, and Meta AI. Each AI chatbot was prompted with medication-related questions related to 6 CPGs published by the Society of Critical Care Medicine (SCCM) and also asked to provide references to support its recommendations. Responses were categorized as correct, partially correct, not correct, or \"other\" (eg, the LLM answered a question not asked).</p><p><strong>Results: </strong>In total, 43 responses were recorded for each AI program, with a significant difference (P = 0.007) in response types by AI program. Microsoft Copilot had the highest proportion of correct recommendations, followed by Meta AI, ChatGPT 4.0, and Google Gemini. All 4 LLMs gave some incorrect recommendations, with Gemini having the most incorrect responses, followed closely by ChatGPT. Copilot had the most responses in the \"other\" category (n = 5, 11.63%). On average, ChatGPT provided the greatest number of references per question (n = 4.54), followed by Google Gemini (n = 3.43), Meta AI (n = 3.06), and Microsoft Copilot (n = 2.04).</p><p><strong>Conclusion: </strong>Although they showed potential for future utility to pharmacists with further development and refinement, the evaluated AI programs did not consistently give accurate medication-related recommendations for the purpose of answering clinical questions such as those pertaining to critical care CPGs.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e842-e847"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Darbepoetin alfa use in trauma and acute care surgery patients who abstain from blood products: A case series and discussion.","authors":"Madilyn Harris, Jacqueline Bishop, William J Olney, Dina Ali, Alexis Nickols, Sara E Parli","doi":"10.1093/ajhp/zxaf099","DOIUrl":"10.1093/ajhp/zxaf099","url":null,"abstract":"<p><strong>Purpose: </strong>Individuals may abstain from blood products due to religious or cultural beliefs. For trauma victims, blood loss is associated with anemia, decreasing oxygen delivery, and alternative treatment methods to blood transfusion are warranted in this population. Literature has investigated the use of epoetin alfa, an albumin-containing erythropoiesis-stimulating agent (ESA), to treat anemia for this indication; however, this may be problematic as albumin is a blood-derived product. Darbepoetin alfa is an albumin-free ESA alternative. This case series describes the use of darbepoetin alfa on anemia and outcomes in patients who abstain from blood products.</p><p><strong>Summary: </strong>Trauma and acute care surgery patients are at risk for development of anemia related to traumatic injury as well as acute blood loss. Blood product transfusion is a common therapeutic intervention; however, patients may abstain from blood product administration. The 9 patients described herein with anemia (hemoglobin concentration of <7 g/dL or hematocrit level of <21%) during a hospital stay abstained from blood products and received darbepoetin alfa. Initial hemoglobin levels ranged from 4.1 to 10.1 g/dL, and patients received darbepoetin from 1 day to up to 17 consecutive days during their hospital stay. One patient experienced a type II non-ST elevation myocardial infarction.</p><p><strong>Conclusion: </strong>The use of darbepoetin alfa appeared to be a therapeutic option to treat anemia in trauma and acute care surgery patients who abstain from blood products. Future studies are needed to compare epoetin alfa and darbepoetin alfa.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e796-e804"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an electronic early treatment assessment and monitoring questionnaire for oral anticancer medication.","authors":"Tiffany Bui, Brooke Looney, Josh DeClercq, Bridget Lynch, Kristen Whelchel, Scott Nelson, Leena Choi, Autumn D Zuckerman","doi":"10.1093/ajhp/zxaf060","DOIUrl":"10.1093/ajhp/zxaf060","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the implementation of an electronic early treatment assessment and monitoring (eTEAM) questionnaire within the electronic health record (EHR) patient portal designed to identify early adverse effects to oral anticancer therapy requiring pharmacist intervention.</p><p><strong>Methods: </strong>This quality improvement analysis used the 5 dimensions of the RE-AIM implementation science framework to assess use of an innovative eTEAM questionnaire sent to patients 7 to 14 days after initial counseling on oral anticancer therapy. RE-AIM outcomes included the following: reach and adoption: the number of eTEAM questionnaires sent and the number of eTEAM responses received; effectiveness: the number of pharmacist interventions resulting from the eTEAM questionnaire; implementation: pharmacist responses to a postimplementation survey and semistructured individual interviews; maintenance: responses from postimplementation semistructured individual interviews with pharmacists. Results are reported descriptively.</p><p><strong>Results: </strong>Of the 182 patients sent an eTEAM questionnaire, 47% (n = 85) responded. Pharmacists performed 29 interventions in 25 responding patients, most often due to adverse effects (n = 25) or adherence (n = 4). Most pharmacists agreed that the eTEAM questionnaire was appealing and feasible to use and that its use positively impacted their practice and patient care. Pharmacists recommended that the eTEAM questionnaire be improved by standardizing documentation of patients' actual oral anticancer medication start date in a discrete field.</p><p><strong>Conclusion: </strong>The eTEAM questionnaire was positively received by patients, and pharmacists were supportive of its continued use based on feasibility and impact on practice. The eTEAM questionnaire effectively identified opportunities for pharmacist interventions in patients starting oral anticancer medications.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e827-e836"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy practice for therapeutic orphans: Current and future reflections for pediatric pharmacy.","authors":"Carlton K K Lee, Peter N Johnson","doi":"10.1093/ajhp/zxaf073","DOIUrl":"10.1093/ajhp/zxaf073","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e848-e852"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral values for implementation of AI and machine learning in healthcare.","authors":"Kenneth A Richman","doi":"10.1093/ajhp/zxaf056","DOIUrl":"10.1093/ajhp/zxaf056","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1026-1030"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leading through vulnerability: How psychotherapy made me a better pharmacy leader.","authors":"Ashley Duty","doi":"10.1093/ajhp/zxaf064","DOIUrl":"10.1093/ajhp/zxaf064","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1035-1036"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining pharmacy student enrollment, its impact on health-system pharmacy, and a call to action.","authors":"Lisa M Richter, Stacy A Taylor, Mate M Soric","doi":"10.1093/ajhp/zxaf062","DOIUrl":"10.1093/ajhp/zxaf062","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1031-1034"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene-ius at work: Hemophilia B treatment enters a new era.","authors":"Madison W Northington, Sarah E Rice, Abigail L Holmes, Courtney S Watts Alexander","doi":"10.1093/ajhp/zxaf005","DOIUrl":"10.1093/ajhp/zxaf005","url":null,"abstract":"<p><strong>Purpose: </strong>Hemophilia B is a rare, hereditary bleeding disorder characterized by a deficiency in clotting factor IX (FIX). Traditional therapeutic strategies involve an economically and physically burdensome combination of prophylactic and episodic (ie, on-demand) administration of clotting factor concentrates (CFCs). The first gene therapy for hemophilia B, etranacogene dezaparvovec (Hemgenix), was approved by the Food and Drug Administration (FDA) in November 2022, with approval for fidanacogene elaparvovec (Beqvez) following in April 2024, produced by CSL Behring and Pfizer, respectively. This literature review aims to provide an overview of current therapeutic strategies for the treatment of hemophilia B, introducing and focusing on the efficacy and safety of the novel gene therapies etranacogene dezaparvovec and fidanacogene elaparvovec.</p><p><strong>Summary: </strong>Both FDA-approved hemophilia B gene therapies, etranacogene dezaparvovec and fidanacogene elaparvovec, utilize adeno-associated virus (AAV) vectors for delivery of the gene encoding FIX. Each of these medications has a distinct AAV serotype, but they have the same treatment modality, with the goal of curing the disease and reducing or eliminating prophylactic CFC requirements. Despite their different AAV serotypes, both products deliver a functional copy of the gene encoding the Padua variant (variant R338L) of human FIX. Recent clinical trials have demonstrated efficacy in increasing FIX concentrations leading to reduced frequency of spontaneous bleeding episodes; however, safety and response durability remain concerns.</p><p><strong>Conclusion: </strong>For the first time in history, individuals with hemophilia B have access to potentially curative therapies through gene therapy. Both etranacogene dezaparvovec and fidanacogene elaparvovec offer significant efficacy, reducing the number of bleeding episodes and raising FIX concentrations with a single lifetime administration. While concerns remain regarding long-term safety and durability, these therapies represent a major advancement in reducing treatment burden and improving quality of life for patients. The future of hemophilia B management now holds the promise of greater independence from frequent prophylactic treatments.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"960-969"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}