The Canadian journal of hospital pharmacy最新文献

{"title":"Optimal Therapeutic Drug Monitoring Strategy for IV Aminoglycosides and IV Vancomycin in People with Cystic Fibrosis: A Systematic Review.","authors":"Jessie Jiang, Nicole Giunio-Zorkin, Victoria Su, Renée Dagenais","doi":"10.4212/cjhp.3429","DOIUrl":"10.4212/cjhp.3429","url":null,"abstract":"<p><strong>Background: </strong>Given altered pharmacokinetics in people with cystic fibrosis (pwCF), there is debate regarding optimal strategies for therapeutic drug monitoring (TDM) for aminoglycosides and vancomycin administered intravenously.</p><p><strong>Objectives: </strong>To determine the TDM strategy for IV aminoglycosides and IV vancomycin associated with optimal clinical outcomes in pwCF.</p><p><strong>Data sources: </strong>Several databases (MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov ) were searched from inception to November 15, 2020, with searches rerun on February 13, 2023.</p><p><strong>Study selection and data extraction: </strong>Full articles evaluating TDM strategies and clinical outcomes in pwCF receiving IV aminoglycosides or IV vancomycin were included.</p><p><strong>Data synthesis: </strong>Three studies met the inclusion criteria for IV aminoglycosides, and 1 study met the inclusion criteria for IV vancomycin. Data are presented with descriptive analyses.</p><p><strong>Conclusions: </strong>The available evidence is insufficient to determine an optimal TDM strategy for IV aminoglycoside or IV vancomycin therapy in pwCF.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"317-323"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Hospital Pharmacy Practice: Pathways to Independent Clinical Pharmacy Practice.","authors":"Jonathan Penm","doi":"10.4212/cjhp.3527","DOIUrl":"10.4212/cjhp.3527","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"263-264"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways to Developing Clinical Pharmacist Practitioners: Is There a Better Way Forward? (Path-CPP).","authors":"Ravi Parmar, Michael Legal, Karen Dahri, Kerry Wilbur, Stephen Shalansky, Nilufar Partovi","doi":"10.4212/cjhp.3384","DOIUrl":"10.4212/cjhp.3384","url":null,"abstract":"<p><strong>Background: </strong>Clinical Pharmacist Practitioners (CPPs) are independent care providers who practise to their full scope and have a positive impact on the quality of patient care. Ideally, all pharmacists in Canada would perform at this level. However, there is significant diversity in pharmacy practice across the country and among practice settings. It would be valuable to better understand how pharmacists attain CPP-level practice and what strategies might enable more pharmacists to practise at this level.</p><p><strong>Objectives: </strong>To understand the perceptions of current CPPs and stakeholders in the health care system regarding the status of the CPP role in Canada and to propose pathways that would facilitate the attainment and recognition of CPP-level practice.</p><p><strong>Methods: </strong>A qualitative study was conducted using semistructured interviews of peer-nominated CPPs and health care system stakeholders. Interviews were recorded, transcribed, and then analyzed using thematic analysis.</p><p><strong>Results: </strong>Interviews involving 13 CPPs and 6 health care system stakeholders, conducted between March and July 2020, yielded 3 theme categories related to CPP roles, each containing subthemes, and 3 distinct themes relating to pathways forward. The 3 pathway themes were the following: that a legislative solution for expanded pharmacist scope is needed, that a new degree program is not required for pharmacy in Canada, and that a unified national credential signifying high-level practice might allow for better recognition of CPPs.</p><p><strong>Conclusions: </strong>The full potential of pharmacists practising with advanced scope of practice in Canada has yet to be realized. Although significant external challenges exist, pharmacists must reframe the narrative by clearly articulating and defining their role within the Canadian health care system to increase CPP-level practice.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"302-308"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist Prescribing at Inpatient Discharge in Alberta.","authors":"Reem Almawed, Jennifer Shiu, Tammy Bungard, Theresa Charrois, Pawandeep Gill","doi":"10.4212/cjhp.3346","DOIUrl":"10.4212/cjhp.3346","url":null,"abstract":"<p><strong>Background: </strong>Pharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no literature exists about pharmacist prescribing for inpatients at the time of discharge.</p><p><strong>Objectives: </strong>The primary objective was to report the proportion of patients for whom inpatient pharmacists with APA prescribed at discharge across Alberta, Canada. Secondary objectives were to describe discharge interventions other than prescribing that were provided, enablers of and barriers to discharge prescribing, and differences in discharge prescribing by facility or population type, clinical area, and health care charting system.</p><p><strong>Methods: </strong>A descriptive, cross-sectional web-based survey of inpatient pharmacists with APA across Alberta was conducted over a 6-week period in early 2022.</p><p><strong>Results: </strong>A total of 104 respondents met the inclusion criteria. Under half (45/102, 44.1%) of the participants reported prescribing at discharge. Those that reported prescribing at discharge did so for only a median 14.5% of their patients. The most common enabler of discharge prescribing was a supportive care team, and the most common barrier was the presence of other prescribers. Pharmacists who did not report prescribing at discharge selected \"discomfort with being responsible for the prescription\" and \"fear of professional liability\" as barriers more often than those who did report discharge prescribing (51.0% [26/51] vs 33.3% [13/39] and 43.1% [22/51] vs 25.6% [10/39], respectively). The proportion of pharmacists who reported prescribing at discharge was greater with increasing population/facility size (30% [6/20] of pharmacists in settings that served small populations vs 50% [29/58] of those in settings that served large populations).</p><p><strong>Conclusions: </strong>Inpatient pharmacists who use APA at discharge reported prescribing for only a minority of patients, and discharge prescribing practices varied widely across the province. Future areas of research include how pharmacists can overcome barriers to prescribing at discharge.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"275-281"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprocedural Management with Therapeutic Tinzaparin for a Hemodialysis Patient with a Mechanical Heart Valve.","authors":"Daniel Martino, Tammy J Bungard","doi":"10.4212/cjhp.3402","DOIUrl":"10.4212/cjhp.3402","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"334-336"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41144529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.","authors":"Isla Drummond, Elissa S Y Aeng, Patrick Yeh, Christine Chen, Aaron M Tejani","doi":"10.4212/cjhp.3405","DOIUrl":"10.4212/cjhp.3405","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs).</p><p><strong>Objectives: </strong>To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients.</p><p><strong>Methods: </strong>This cross-sectional study included patients from 16 health care facilities in British Columbia. ADC reports were run for the period August 2021 to January 2022 to identify salbutamol and ipratropium inhalers removed from ADCs.</p><p><strong>Results: </strong>Over the study period, 8.3% (2180/26 324) of salbutamol and ipratropium inhalers were withdrawn from ADCs unnecessarily for the same patient encounter within a 2-day timeframe, and another 1118 (4.2%) represented instances when multiple inhalers were withdrawn for the same patient at the same time. Overall, 12.5% (3298/26 324) of all salbutamol and ipratropium inhalers were withdrawn unnecessarily. The total cost of these inhalers was about $31 600 over the 6-month period.</p><p><strong>Conclusions: </strong>This evaluation revealed considerable wastage of inhalers, leading to wasted expenditures. Other health authorities should conduct similar analyses to determine whether similar problems exist in their settings.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"314-316"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Brunswick Pharmacy Assessment Clinic: A Novel, Pharmacist-Led, Virtual Collaborative Practice Hub for the Assessment and Prescribing of Nirmatrelvir/Ritonavir for Patients with COVID-19.","authors":"Bradley B Adams, Britney Sansom, Nadine Doiron, Douglas Doucette, Josée Gagnon, Daniel Landry, Michael LeBlanc, Julie Levesque, Faith Louis, Timothy MacLaggan, Heather K Naylor","doi":"10.4212/cjhp.3365","DOIUrl":"10.4212/cjhp.3365","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"327-330"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetaminophen Dose Considerations in Frail and Malnourished Elderly Patients: A Case Report of Hepatotoxicity with Therapeutic Doses.","authors":"Etienne Boudrias-Dalle, Alice Chen","doi":"10.4212/cjhp.3415","DOIUrl":"10.4212/cjhp.3415","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"337-339"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Prescribing Practices for Urinary Tract Infection in a Pediatric Emergency Department: Is This a Problem Worth Cefix-ing?","authors":"Jordan Kelly, Trevor Toy, Deonne Dersch-Mills, Antonia S Stang, Cora Constantinescu, Joan L Robinson","doi":"10.4212/cjhp.3444","DOIUrl":"10.4212/cjhp.3444","url":null,"abstract":"<p><strong>Background: </strong>Pediatric urinary tract infection (UTI) is associated with diagnostic and therapeutic challenges.</p><p><strong>Objective: </strong>To determine the least-broad-spectrum oral antibiotic that would cover 80% of pathogens from lower (afebrile) and upper (febrile) UTIs in a Canadian pediatric emergency department (ED).</p><p><strong>Methods: </strong>This retrospective case series involved children discharged from the ED between September 2020 and February 2021 with a diagnosis of UTI and collection of a sample for urinalysis that had growth on culture.</p><p><strong>Results: </strong>Of 188 patients who met the inclusion criteria, 184 (97.9%) were discharged on antibiotics. Culture results indicated a UTI in 170 cases (92.4% of those discharged on antibiotics). The 95 urinary isolates from lower UTIs were susceptible to cephalexin (n = 81, 85.3%), cefixime (n = 78, 82.1%), nitrofurantoin (n = 76, 80.0%), trimethoprim-sulfamethoxazole (TMP-SMX) (n = 64, 67.4%), and amoxicillin (n = 55, 57.9%). The 75 urinary isolates from upper UTIs were susceptible to cefixime (n = 71, 94.7%), TMP-SMX (n = 57, 76.0%), and amoxicillin (n = 48, 64.0%). The mean prescribed duration of antibiotic therapy was 8.3 days for patients with a lower UTI and 9.1 days for those with an upper UTI (mean difference 0.80 days, 95% confidence interval 0.05-1.54).</p><p><strong>Conclusions: </strong>Empiric treatment with cephalexin or nitrofurantoin would have been successful for almost all lower UTIs. More complete reporting of cephalexin minimal inhibitory concentrations might have allowed use of this drug for most upper UTIs. Although there was a trend toward shorter duration of therapy for lower versus upper UTI, lower UTIs were always treated for longer than recommended by current guidelines.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"290-295"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wise Words from the Good Doctor (Seuss).","authors":"Ashley Walus","doi":"10.4212/cjhp.3526","DOIUrl":"10.4212/cjhp.3526","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"76 4","pages":"346"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}