American Journal of Health-System Pharmacy最新文献

{"title":"Pharmacy resident medical emergency response training programs: How much life to give them?","authors":"Nicholas T Truong, Andrew K Posen, Jennie B Jarrett","doi":"10.1093/ajhp/zxae390","DOIUrl":"10.1093/ajhp/zxae390","url":null,"abstract":"<p><p>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727442","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":"Considerations in educating patients receiving oral anticoagulation: Quality over quantity.","authors":"William E Dager, Anne E Rose, Kelly M Rudd","doi":"10.1093/ajhp/zxaf024","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf024","url":null,"abstract":"<p><p>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699339","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":"A review of mirvetuximab soravtansine-gynx in folate receptor -expressing platinum-resistant ovarian cancer.","authors":"Judith A Smith, Patrick Medina, Mary Miao, Kathleen N Moore","doi":"10.1093/ajhp/zxaf011","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf011","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>To evaluate the pharmacology, efficacy, safety, and dosing and administration considerations (including adjusted ideal body weight [AIBW] dosing) for mirvetuximab soravtansine-gynx, a first-in-class folate receptor α (FRα)-directed antibody-drug conjugate for platinum-resistant ovarian cancer (PROC).</p><p><strong>Summary: </strong>A literature search was conducted in PubMed using the terms \"ovarian cancer\" and \"mirvetuximab soravtansine\" of articles published from inception to April 16, 2024. Relevant publications, abstracts, and clinical trials were reviewed. Mirvetuximab soravtansine-gynx is dosed at 6 mg/kg AIBW every 3 weeks and comprises an FR-binding antibody, a hydrophilic disulfide linker, and a maytansinoid DM4 payload. Mirvetuximab soravtansine-gynx binds to FRα, which induces receptor-mediated internalization, lysosomal degradation, and release of DM4-containing cytotoxic metabolites. Meaningful anticancer activity in PROC was demonstrated in the single-arm phase 2 SORAYA trial (objective response rate, 32.4%; 95% confidence interval, 23.6% to 42.2%) and the confirmatory, randomized phase 3 MIRASOL trial (median progression-free survival with mirvetuximab soravtansine-gynx vs chemotherapy, 5.62 vs 3.98 months; hazard ratio, 0.65; 95% confidence interval, 0.52-0.81; P < 0.0001]). Ocular disorders (eg, keratopathy and blurred vision), nausea, diarrhea, and fatigue were among the most common adverse events (AEs) that occurred during clinical trials.</p><p><strong>Conclusion: </strong>This review of trial data and pharmacology information for AIBW dosing of mirvetuximab soravtansine-gynx will help support its integration into the PROC treatment landscape. The review also discusses recommendations for prophylaxis, monitoring, and management of common AEs, including eye drop regimens to mitigate ocular events. Mirvetuximab soravtansine-gynx is an effective, novel agent for PROC that targets a newly established biomarker. Established interventions can help mitigate AEs and support the safe use of mirvetuximab soravtansine-gynx.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699336","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":"Clevidipine and a cost-saving initiative for titratable intravenous antihypertensive agents.","authors":"Haley Pajunen, Joy Bittner, Roberta Aulie, Reid Larson","doi":"10.1093/ajhp/zxaf074","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf074","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>This quality improvement initiative assessed the utilization of clevidipine (Cleviprex) in an institutional setting. The purpose was to identify cost-saving opportunities and implement strategies to promote cost-effective and clinically appropriate use of antihypertensive agents in various clinical scenarios.</p><p><strong>Summary: </strong>This research was a single-center retrospective chart review of patients who received clevidipine from January 1 to August 31, 2023. Patients who were 18 years of age or older and had at least one documented clevidipine administration were included. In the patient population, 70% received clevidipine for a surgical hypertension indication and 30% received it for a medical hypertension indication. Only 18% of patients on clevidipine received concurrent antihypertensive agents, indicating that 82% of patients received clevidipine as first-line treatment. The results also showed significant medication waste when stocking 100-mL vials of clevidipine: less than 5 mL total was administered for 76.9% of the vials used in the operating room. In a cost comparison of the institution's titratable intravenous antihypertensives on formulary, clevidipine in a 100-mL vial was the most expensive agent. A 2-phase approach to reduce medication waste and overall medication use was implemented. During phase 1, the clevidipine inventory was converted from 100-mL to 50-mL vials to reduce the amount of wasted medication. Order set revisions were carried out in phase 2 to create a guideline-directed, tiered approach to optimize antihypertensive medication therapy.</p><p><strong>Conclusion: </strong>A review of clevidipine utilization at the institution identified multiple strategies to reduce use, medication waste, and overall medication cost through appropriate use of intravenous antihypertensive agents.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676596","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":"https://doi.org/10.1093/ajhp/zxaf075","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><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":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","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":"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, Autumn Zuckerman","doi":"10.1093/ajhp/zxaf060","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf060","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><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 intervention in patients starting oral anticancer medications.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","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":"Strategies to prevent awareness with paralysis following administration of neuromuscular blocking agents.","authors":"Dustin D Linn, Megan A Rech, Brett A Faine","doi":"10.1093/ajhp/zxaf072","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf072","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Awareness with paralysis (AWP) is an increasingly recognized complication of neuromuscular blocker use and is associated with adverse patient experiences. This manuscript describes the incidence of AWP and mitigation strategies that can be employed to prevent its occurrence and ensure optimal patient care.</p><p><strong>Summary: </strong>Preventative strategies are essential to reduce the incidence of AWP. Approaches for prevention include awareness of the duration of action of analgesics, sedatives, and neuromuscular blocking agents (NMBAs), timely administration of postprocedural sedation, use of NMBAs for the shortest duration possible, and monitoring of the depth of sedation and neuromuscular blockade. Pharmacists are integral members of the multidisciplinary team in the emergency department and intensive care unit, where nonoperative neuromuscular blocker use is most common. Pharmacists can play a key role in eliminating AWP through their knowledge of the pharmacokinetics and pharmacodynamics of sedatives and NMBAs and their role in medication selection and monitoring.</p><p><strong>Conclusion: </strong>By applying key strategies to prevent AWP, pharmacists can help make AWP a never event in both procedural and continuous use of NMBAs.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676648","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 leadership: Balancing the roles of colleague and manager.","authors":"Laura Jean Myhre, Laurel Ann Oetjen, Heidi Diann Finnes, Julie Lynn Cunningham","doi":"10.1093/ajhp/zxaf076","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf076","url":null,"abstract":"<p><p>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676635","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":"https://doi.org/10.1093/ajhp/zxaf073","url":null,"abstract":"<p><p>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","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":"Evaluation of pharmacist-prescribed nirmatrelvir/ritonavir for patients with COVID-19.","authors":"Jason Srey, Samantha Divan, Andrew J Sowles, Michelle Rasmussen, Ralph A Yates, Adriane N Irwin","doi":"10.1093/ajhp/zxaf061","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf061","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Authorization of nirmatrelvir/ritonavir expanded outpatient treatment options for those with coronavirus disease 2019 (COVID-19), but prescribing of the medication is complex. The objective of this study was to evaluate the appropriateness of nirmatrelvir/ritonavir prescribing through a pharmacist-driven service as compared to usual care.</p><p><strong>Methods: </strong>This was a retrospective cohort study. Patients prescribed nirmatrelvir/ritonavir by a pharmacist between May 1 and December 31, 2022, were temporally matched to those who received nirmatrelvir/ritonavir through usual care. The primary outcome was the percentage of patients appropriately prescribed nirmatrelvir/ritonavir by meeting criteria related authorization-specific requirements, assessment of hepatic and renal function, and management of drug interactions. Descriptive and inferential statistics were performed.</p><p><strong>Results: </strong>There were 106 patients in each cohort (N = 212). Patients were mainly female (n = 135, 63.7%) and mainly 65 years of age or older (n = 117, 55.2%). All study-defined criteria for appropriate nirmatrelvir/ritonavir prescribing were met in 88.7% of patients (n = 94) who received care through the pharmacist-driven service, as compared to 41.5% of patients (n = 44) managed through usual care (P < 0.0001). In both groups nirmatrelvir/ritonavir was consistently prescribed within 5 days of symptom onset and to patients with a qualifying comorbid condition (P = 0.498). However, hepatic (P = 0.030) and renal (P = 0.024) laboratory values were more likely to be current when the prescription arose from a pharmacist as opposed to the usual care process. Drug interactions also were more likely to be identified and mitigated by pharmacists (P < 0.0001).</p><p><strong>Conclusion: </strong>Nirmatrelvir/ritonavir was appropriately prescribed by pharmacists in most cases, demonstrating that pharmacists can support safe and effective use of nirmatrelvir/ritonavir for patients with complex comorbidities and medication regimens.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676619","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}