The Canadian journal of hospital pharmacy最新文献

{"title":"Impact of Short-Acting Spinal Anesthetic on Discharge from Postanesthetic Care Unit: A Retrospective Analysis.","authors":"Meghan Ludlam, Isla Drummond, Angela Lo","doi":"10.4212/cjhp.3618","DOIUrl":"10.4212/cjhp.3618","url":null,"abstract":"<p><strong>Background: </strong>Chloroprocaine has recently regained accessibility as a short-acting local anesthetic in Canada. It offers an alternative to bupivacaine, the predominant spinal anesthetic used at Vancouver Coastal Health sites in Vancouver, British Columbia.</p><p><strong>Objective: </strong>To compare the recovery profile of surgical patients who received either chloroprocaine or bupivacaine for spinal anesthesia.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study involved adult patients who received chloroprocaine or bupivacaine as spinal anesthetic for short-duration surgery. The primary outcome was the time from admission to the postanesthesia care unit (PACU) to discharge from the PACU. Time from PACU admission to discharge readiness was also assessed, along with the perioperative variables of type of operation performed, duration of surgery, dose of anesthetic, dose of intraoperative analgesic, and number of days from operation to hospital discharge.</p><p><strong>Results: </strong>The study involved 145 patients aged 30 to 94 years: 72 who received chloroprocaine and 73 who received bupivacaine. For the primary outcome, there was a nonsignificant shorter time from PACU admission to discharge for the chloroprocaine cohort (mean difference 36 minutes, <i>p</i> = 0.07). There was a significant difference favouring chloroprocaine over bupivacaine in the time from PACU admission to meeting PACU discharge criteria (mean difference 48 minutes, <i>p</i> < 0.001). Chloroprocaine was associated with significantly shorter surgery duration (mean difference 5 minutes, <i>p</i> = 0.026). Regression analysis showed a significant correlation between the anesthetic given and the time to meeting PACU discharge eligibility (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Use of chloroprocaine was associated with earlier time to patients meeting PACU discharge criteria. These findings support the potential benefit of chloroprocaine over bupivacaine in terms of achieving earlier PACU discharge readiness, although this difference did not consistently translate into earlier actual PACU discharge.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3618"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618105","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":"Further Defining Optimal Pharmacist-to-Patient Ratios to Ensure Comprehensive Direct Patient Care in Medical and Surgical Units across British Columbia Hospitals.","authors":"Shelly Zq Lu, Michael Legal, Karen Dahri, Shazia Damji","doi":"10.4212/cjhp.3655","DOIUrl":"10.4212/cjhp.3655","url":null,"abstract":"<p><strong>Background: </strong>Patient care ratios for pharmacists are not well defined in Canada. A recent work-sampling study involving 6 medium and large hospitals within the region served by Lower Mainland Pharmacy Services, British Columbia, reported pharmacist-to-patient ratios of 1:13, 1:26, and 1:14 in internal medicine teaching units, hospitalist or internal medicine nonteaching units, and surgical units, respectively.</p><p><strong>Objective: </strong>To determine the pharmacist-to-patient ratios required to provide comprehensive pharmaceutical care to adult patients admitted to medical and surgical units in medium and large hospitals in British Columbia.</p><p><strong>Methods: </strong>In this cross-sectional electronic survey study, participants were asked to provide estimates of the time spent on and the frequency of 17 comprehensive pharmaceutical care tasks identified in the previous study, which was based on a Delphi method. The survey data were used to calculate pharmacy staffing ratios according to the World Health Organization workforce calculator.</p><p><strong>Results: </strong>Fifty-eight pharmacists responded to the survey, of whom 41 (71%) were from medium and large hospitals. The optimal pharmacist-to-patient ratios were calculated as 1:7 for internal medicine teaching units; 1:10 for internal medicine nonteaching, hospitalist, and family practice units; and 1:14 for surgical units.</p><p><strong>Conclusions: </strong>The pharmacist-to-patient ratios calculated in this study, using only pharmacists' self-reported information, were lower than those found previously. Further research is required to determine whether completion of every comprehensive care task is necessary, or if staffing ratios should reflect combinations of comprehensive care tasks based on patient complexity. National consensus guidelines on pharmacist staffing ratios may be valuable, given the current lack of standardization of pharmacy staffing ratios in hospitals.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3655"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412230","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":"Environmentally Responsible Inhaler Disposal in Hospitals: Is There Such a Thing?","authors":"Brandon Tong, Aaron M Tejani","doi":"10.4212/cjhp.3662","DOIUrl":"10.4212/cjhp.3662","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3662"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412229","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":"Health Care Workers' Perceptions of a Pharmacist-Led Collaborative Practice Agreement for Prescribing Nirmatrelvir/Ritonavir to Eligible Patients with COVID-19.","authors":"Britney Sansom, Bradley B Adams, Donaldo D Canales, Douglas Doucette, Josée Gagnon, Michael LeBlanc, Julie Levesque, Faith Louis, Timothy MacLaggan, Heather K Naylor, Bryn Nurse","doi":"10.4212/cjhp.3596","DOIUrl":"10.4212/cjhp.3596","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3596"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412231","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":"Reducing Sugammadex Expenditure through Educational Initiatives in an Urban Tertiary Care Hospital System: A Cost-Reduction Study.","authors":"Erin Ingoldsby, Eric Romeril, April Liu, Tal Levit, Ekta Khemani","doi":"10.4212/cjhp.3648","DOIUrl":"10.4212/cjhp.3648","url":null,"abstract":"<p><strong>Background: </strong>Sugammadex, a selective relaxant binding agent, works by encapsulating rocuronium or vecuronium to reverse neuromuscular blockade. It is an asset in emergencies requiring expedient reversal of neuromuscular blockade, such as situations involving difficult airways. A prevalent concern relating to sugammadex use is its higher cost compared with traditional reversal agents, contributing to more than 20% of operating room drug expenditures at Hamilton Health Sciences (Hamilton, Ontario) in 2019/20.</p><p><strong>Objective: </strong>To use iterative Plan-Do-Study-Act cycles to reduce annual sugammadex expenditure at Hamilton Health Sciences by 50% from costs in the 2020/21 fiscal year.</p><p><strong>Methods: </strong>Five Plan-Do-Study-Act cycles were implemented (January to April 2021) to increase awareness about the cost of sugammadex and appropriate indications for its use. The organization's Department of Pharmacy supplied data regarding acquisition of sugammadex before, during, and after the Plan-Do-Study-Act cycles, which were analyzed quantitatively. A data set regarding difficult airways at Hamilton Health Sciences was analyzed alongside the sugammadex data to aid in understanding the need for accessibility of this drug.</p><p><strong>Results: </strong>Use of sugammadex in fiscal year 2021/22 at Hamilton Health Sciences decreased by 75% from the previous fiscal year, without compromising patient safety or drug availability. Analysis of the difficult airway data revealed that both anticipated and unanticipated cases of difficult airway were still prevalent across all hospitals, which highlights the importance of maintaining access to and knowledge of how to use sugammadex in the setting of difficult airways.</p><p><strong>Conclusions: </strong>This cost-reduction project showed that user-based program designs can have a meaningful impact on resource utilization. Additionally, the difficult airway data set emphasized the clear need to maintain availability of and capabilities for administering sugammadex, given the prevalence of emergency airway situations.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3648"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412232","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":"Multiple Successful Desensitizations to Brentuximab Vedotin in the Setting of Relapsed Peripheral T-Cell Lymphoma: Case Report.","authors":"Alina R Rashid, Philip Kuruvilla","doi":"10.4212/cjhp.3614","DOIUrl":"10.4212/cjhp.3614","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3614"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018616","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":"Management of Status Epilepticus and Infections in a Patient with Lennox Gastaut Syndrome.","authors":"Amanda Y Leong, Tom Gieni, Christopher Doig, Daniel J Niven, Julie Kromm","doi":"10.4212/cjhp.3667","DOIUrl":"10.4212/cjhp.3667","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3667"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017747","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":"Incidence of Delirium during the Initiation Phase of Morphine and Hydromorphone Therapy in Cancer Patients: A Retrospective Comparative Study.","authors":"Hironori Tanaka, Rei Tanaka, Takeshi Kamoshida, Shigeki Morimoto, Junya Sato, Hiroshi Ishikawa, Tetsu Sato, Tetsumi Sato, Akiyoshi Saitoh, Daisuke Yamada, Mina Kondo, Kenji Takahashi, Chieko Takahashi, Michihiro Shino","doi":"10.4212/cjhp.3515","DOIUrl":"10.4212/cjhp.3515","url":null,"abstract":"<p><strong>Background: </strong>Opioids are known to induce delirium, and the incidence of delirium induced by individual opioids has been investigated. However, only a limited number of studies have examined the incidence of delirium induced by oral hydromorphone.</p><p><strong>Objective: </strong>To investigate whether differences exist in the incidence of delirium associated with oral morphine and oral hydromorphone during the initiation phase of treatment.</p><p><strong>Methods: </strong>The participants were opioid-naive inpatients with cancer who started oral morphine or oral hydromorphone at Shizuoka Cancer Center (in Shizuoka, Japan) between June 2017 and November 2020. The incidence of delirium in the first week of opioid use was compared between the 2 groups.</p><p><strong>Results: </strong>A total of 90 patients met the inclusion criteria, 27 who received oral hydromorphone and 63 who received oral morphine. The incidence rate of delirium in the oral hydromorphone group tended to be higher (19%, 5/27) than in the oral morphine group (8%, 5/63), although the difference was not statistically significant (odds ratio 0.4, 95% confidence interval, 0.1-1.4, <i>p</i> = 0.16 by the Fisher exact test). Propensity score matching was used to control for differences in patient background as confounders in the development of delirium, following which the incidence rate of delirium remained higher, but not significantly so, in the oral hydromorphone group (11%, 2/19) than in the oral morphine group (5%, 1/19) (odds ratio 0.5, 95% confidence interval 0.04-5.7, <i>p</i> > 0.99 by the Fisher exact test).</p><p><strong>Conclusions: </strong>There was no statistically significant difference in the incidence of delirium between those who received morphine and those who received hydromorphone, which suggests that for opioid-naive inpatients with cancer, oral hydromorphone can be used in a manner similar to that for oral morphine.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3515"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019438","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":"Adverse Drug Reactions in Pregnant People with Hypertension and/or Diabetes: Temporal Profile and Associated Factors.","authors":"Jéssica E C Cavalcanti, Priscilla K V Bezerra, Gabriela S Oliveira, Anny L F Silva, Sarah D V Medeiros, Ricardo N Cobucci, Rand R Martins","doi":"10.4212/cjhp.3601","DOIUrl":"10.4212/cjhp.3601","url":null,"abstract":"<p><strong>Background: </strong>Pregnant people, especially those with diabetes mellitus or hypertension, are particularly vulnerable to adverse drug reactions (ADRs).</p><p><strong>Objective: </strong>To determine the incidence of and factors associated with ADRs in hospitalized pregnant people with diabetes and/or hypertension.</p><p><strong>Methods: </strong>This prospective cohort study involved pregnant people with diabetes and/or hypertension admitted to a maternity hospital in Natal, Brazil, between August 2019 and July 2022. Data for various patient characteristics and the occurrence of ADRs were collected by means of interviewing patients and searching their medical charts. Multivariate logistic regression was used to identify and analyze the association of ADRs with various patient characteristics and other factors.</p><p><strong>Results: </strong>A total of 571 pregnant people met the inclusion criteria. Over the study period, the incidence rate of ADRs was 634.4 (95% confidence interval [CI] 522.7-787.1) per 1000 patient-days, with 123 (21.5%) of the patients experiencing at least 1 incident. ADRs occurred predominately in the first 24 hours, with a marked decrease in frequency to the seventh day of admission. Methyldopa was identified as the cause in 42.1% (8/19) of cases of headache and 39.5% (17/43) of cases of sedation. Systemic corticosteroids were responsible for almost all cases of hyperglycemia (97.0% [32/33]). Blurred vision (82.4% [14/17]) and sedation (14.0% [6/43]) were related to the administration of antiemetics and antinauseants, especially scopolamine. Longer hospitalization time (OR 1.052, 95% CI 1.010-1.097, <i>p</i> = 0.016) and greater number of prescribed medications (OR 1.200, 95% CI 1.099-1.310, <i>p</i> < 0.001) were related to the occurrence of ADRs.</p><p><strong>Conclusions: </strong>In this study, 1 of every 5 hospitalized pregnant people had at least 1 ADR, most often in the first 24 hours, with a decrease in incidence in the following days. Pregnant people with longer hospital stays and a greater number of medications had a higher risk of ADRs.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"78 1","pages":"e3601"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019354","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":"Le <i>JCPH</i> se joint au International Collaboration of Pharmacy Journal Editors (ICPJE), anciennement connu sous le nom de « Granada Group ».","authors":"Stephen Shalansky","doi":"10.4212/cjhp.3744","DOIUrl":"10.4212/cjhp.3744","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"77 4","pages":"e3744"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815312","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}