The latest medical research on Pharmacist
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about pharmacist gathered by our medical AI research bot.
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Fluctuating Voriconazole Concentrations during Extracorporeal Membrane Oxygenation.Journal of Pharmacy and Pharmacology
Patients requiring extracorporeal membrane oxygenation (ECMO) demonstrate complex drug pharmacokinetics due to alterations in clearance and volume of distribution, necessitating close therapeutic drug monitoring.
A 19-year-old Caucasian female with no past medical history was transferred from an outside hospital and admitted to the intensive care unit for acute respiratory distress syndrome secondary to a fresh water drowning event. The patient decompensated, requiring veno-arterial ECMO, which was subsequently changed to veno-venous ECMO. She was diagnosed with a Scedosporium apiospermum fungal pneumonia and was started on voriconazole. Throughout the course of antifungal therapy, the patient's voriconazole concentrations were labile, ranging from subtherapeutic, requiring dose increases to twice the labeled therapeutic dose, followed by subsequent supratherapeutic concentrations, requiring dose reductions.
Our findings demonstrate how voriconazole drug concentrations can be unpredictable when administered during ECMO and the importance of close monitoring of drug concentrations. More studies are needed to provide sufficient guidance on administering voriconazole in critically ill patients receiving ECMO.
Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices.International Journal of Epidemiology
Specialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population.
This study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population.
Prescribing rates, measured as the number of items/1000 population in key disease areas.
Data corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population.
Most of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation.
Dabigatran-Induced Nephropathy and Gastrointestinal Bleeding and Its Successful Treatment with Idarucizumab: A Case Report.Hospital Pharmacy
Recently, the atrial fibrillation treatment guidelines have been updated to now recommend Non-vitamin K antagonist oral anticoagulants (NOACs) as t...
Safety of Propofol When Used for Rapid Sequence Intubation in Septic Patients: A Multicenter Cohort Study.Hospital Pharmacy
Septic patients are at risk for hypotension, and this risk may increase during rapid sequence intubation (RSI). Sedatives such as propofol must be used carefully due to its ability to reduce vascular sympathetic tone. Since the safety of propofol for RSI is not well described in sepsis, this was a study evaluating propofol and its effects on hemodynamics when used for RSI in a septic population.
We conducted a multicenter, retrospective, cohort study of patients with sepsis or severe sepsis requiring sedation for RSI. Patients receiving a propofol bolus for RSI were compared to patients undergoing RSI without a propofol bolus. The safety profile of propofol was evaluated according to the rates of post-intubation hypotension and vasopressor utilization between groups.
A total of 179 patients (79 propofol, 100 non-propofol) were evaluated. There were no differences in hypotension (81% vs 78%; P = .62) or vasopressor utilization between the propofol and non-propofol groups (43% vs 49%; P = .43). Patients in the non-propofol group had increased APACHE II scores and healthcare-associated infections.
In this cohort study, administration of propofol for RSI in patients with sepsis and severe sepsis did not increase incidence of hypotension or vasopressor use, but acute illness may have introduced provider selection bias causing less propofol use in the non-propofol group. Larger prospective studies are needed to better characterize the adverse hemodynamic effects of propofol, before propofol bolus doses for RSI can be considered for safe use in this population.
A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis.Hospital Pharmacy
Cefixime is a third-generation cephalosporin that has been used for the treatment of a wide range of infections in children and adults. The inciden...
Conscientious Objection: A Review of State Pharmacy Laws and Regulations.Hospital Pharmacy
Most states have adopted conscience clauses since the Roe v. Wade paradigm in the 1970s; however, not all clauses are respective to pharmacists. Th...
Erratum: Extemporaneously compounded medicines [Correction].Australian Prescriber
[This corrects the article DOI: 10.18773/austprescr.2017.001.].
The Impact of Pharmacists on Telehealth During Transitions of Care: A Literature Review.Journal of Pharmacy and Pharmacology
To provide a review of pharmacists' impact during transitions of care (TOC) visits utilizing telehealth.
An electronic literature review was conducted on studies that addressed pharmacists' impact on telehealth during TOC. Articles included in the review were randomized or observational studies, cohort studies, case series or case reports, literature reviews, or pilot studies conducted on adults. Articles investigating children were excluded from the review.
Of the articles identified, 14 studies met the eligibility criteria and were selected for the literature review. All of the studies were published in English between 2013 and 2021. Most were conducted in the United States of America (n = 12) with 1 conducted in Ireland (n = 1) and 1 in Australia (n = 1). The majority of telehealth monitoring was conducted via phone (n = 8), video conferencing (n = 3), or both (n = 2) in patients' homes by pharmacists alone (n = 8) while the remaining studies involved telemonitoring by a combination of pharmacy fellows, residents, and/or students. These findings showed that pharmacist intervention in patient care showed improved patient outcomes and goal markers for a variety of health conditions as well as lower rates of 30 day, 60 day, and 90 day hospital readmissions.
Pharmacist involvement in telehealth monitoring had a positive impact on TOC interventions and overall patient outcomes including decreased hospital readmissions and increased patient medication adherence.
A Retrospective Review of an Inhaler to Nebulizer Therapeutic Interchange Program Across a Health System.Journal of Pharmacy and Pharmacology
The hospitals of the Saint Alphonsus Health System (SAHS) have implemented a metered dose inhaler (MDI) to nebulization therapeutic interchange program in which all orders for albuterol/ipratropium and inhaled corticosteroid/long-acting beta agonists (ICS/LABA) MDIs are therapeutically interchanged to nebulizers by pharmacy.
The primary outcome measure is to assess the percent of albuterol/ipratropium and ICS/LABA inhalers therapeutically interchanged to nebulized solutions. Secondary outcomes include assessment of readmission rates, the percentage of patients discharged with the appropriate MDI, and a financial analysis of the implementation of the therapeutic interchange program.
This retrospective observational cohort study was approved by the system's institutional review board and conducted between October 15, 2019, and February 15, 2020. Adult patients with history of asthma or COPD admitted to one of the SAHS hosptials with an order placed for ipratropium/albuterol, fluticasone/salmeterol, mometasone/formoterol, or budesonide/formoterol MDIs were eligible for inclusion. Patients were excluded if they were presumed to have or tested positive for COVID-19.
Therapeutic interchanges were successfully completed in 94.3% of the orders included in this evaluation. Discharge discrepancies occurred in 14.3% of orders assessed. No correlation was found between discharge discrepancies and 30-day readmissions. The MDI to nebulized solution interchanges saved $13,908.16 in medication cost in the sample population.
The first phase of implementing the SAHS inhaler to nebulizer therapeutic interchange program was operationally and clinically successful. The program is projected to continue to reduce medication waste and provide cost savings for the health system.
Antidepressants in adolescence.Australian Prescriber
In adolescence, antidepressants are second-line treatment options after psychological therapy for anxiety and obsessive compulsive disorder. They m...
Medicines for long-term obesity management.Australian Prescriber
Obesity is always genetic or epigenetic in origin in an obesogenic environment. Dietary therapy is required for weight loss. Drugs to suppress hung...
Troponins in myocardial infarction and injury.Australian Prescriber
Troponins are proteins that are integral components of the contractile mechanism of muscle, including cardiac muscle. Cardiac troponins Iand T can ...