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(American Journal of Health System Pharmacy[TA])
9,250 results
  • Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Jun 14
  • Ford DC, Schroeder MC, … Ernst EJ
  • CONCLUSIONS: A decision-analytic model revealed vancomycin to be cost-effective, compared with metronidazole, for treatment of initial episodes of mild-to-moderate CDI in adult inpatients. From the hospital perspective, initial treatment with vancomycin resulted in a higher probability of cure and a lower probability of colectomy, recurrence, persistent recurrence, and cost per case treated, compared with metronidazole. Use of fidaxomicin was associated with an increased probability of cure compared with metronidazole and vancomycin, but at a substantially increased cost.
  • Clinical update on thrombolytic use in pulmonary embolism: A focus on intermediate-risk patients. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Jun 12
  • Eberle H, Lyn R, … Daley M
  • CONCLUSIONS: PE is a major cause of morbidity and mortality. When used in conjunction with anticoagulation, thrombolysis has been shown to reduce hemodynamic decompensation in select patients, but thrombolytic therapy is associated with high risks of bleeding and intracranial hemorrhage and its role in treating patients with intermediate-risk PE remains controversial. In the PEITHO study, the largest trial to date involving only patients with intermediate-risk PE (n = 1,006), patients receiving the thrombolytic agent tenecteplase were significantly (p = 0.02) less likely than those receiving unfractionated heparin to develop the primary outcome, a composite of death from any cause and hemodynamic decompensation or collapse within 7 days. However, a meta-analysis of data from clinical trials of systemic thrombolytic therapy in intermediate-risk PE generally showed a lack of benefit in terms of all-cause mortality and long-term complications. Novel strategies for treatment of intermediate-risk PE, including low-dose thrombolysis and catheter-directed thrombolysis, are being investigated in an attempt to identify strategies that provide therapeutic outcomes equivalent to those provided by traditional thrombolytic modalities but with a decreased risk of bleeding.The use of thrombolysis in the treatment of intermediate-risk PE is complicated by high rates of bleeding and should be limited to patients who clinically deteriorate rather than given as a standard-of-care treatment in this population. Data for low-dose thrombolysis remain limited.
  • A rare fungus on the rise: Candida auris. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Jun 12
  • Lee Y, Bao H, Viramgama S
  • CONCLUSIONS: Since C. auris was first identified in Japan in 2009, cases of C. auris infection have been on the rise in several parts of the world, including the United States, where the first case was reported in 2017; as of November 2017, a total of 206 U.S. cases in 10 states had been reported. Risk factors for C. auris infection have been difficult to identify. However, catheterization, hospitalization, and recent surgery appear to be common factors in patients with C. auris infection. Major challenges in the management of C. auris infections include the common misidentification of C. auris using conventional laboratory techniques and the pathogen's resistance profile, which includes resistance to commonly used antifungals. These challenges may lead to breakdowns in timely implementation of infection-control and prevention measures. Antimicrobial stewardship can play a key role in the management and prevention of C. auris infections.C. auris is an emerging fungus that has the potential for causing serious invasive infections. The organism is resistant to commonly used antifungals and is difficult to identify with conventional laboratory techniques. Echinocandins are currently recommended as initial therapy for the treatment of C. auris infections in adults and children at least 2 months of age.
  • Disseminated cryptococcosis associated with administration of eculizumab. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Jun 12
  • Clancy M, McGhan R, … Stevens R
  • CONCLUSIONS: A 23-year-old man with a history of minimal change nephrotic syndrome was hospitalized for acute kidney injury and abdominal pain and swelling. He was found to have disseminated pneumococcal disease, including peritonitis, bacteremia, and pulmonic endocarditis. The patient developed evidence of microangiopathic hemolytic anemia, leading to a diagnosis of atypical hemolytic uremic syndrome, and was started on eculizumab. The patient initially improved but developed septic shock 18 days after the first dose of eculizumab. All subsequent blood, respiratory, and intraabdominal cultures grew Cryptococcus neoformans. Twenty-eight days after the initial dose of eculizumab, the patient died. Autopsy findings demonstrated disseminated cryptococcosis, with infection noted in lung, myocardial, kidney, and liver tissues. Considering the complement-dependent nature of host defenses against Cryptococcus species and available evidence regarding C. neoformans pathogenicity from studies of murine models, it was hypothesized that the patient's cryptococcosis and death were secondary to administration of eculizumab and consequent blockage of the C5 component of the complement cascade. Eculizumab is known to predispose recipients to infections with encapsulated organisms; however, this was believed to be the first reported case of infection with an encapsulated yeast possibly due to eculizumab use. Patients receiving eculizumab should be monitored closely for invasive cryptococcal infections.A 23-year-old man developed fatal disseminated cryptococcosis after treatment with eculizumab.
  • Development of a standardized, citywide process for managing smart-pump drug libraries. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Jun 15; 75(12):893-900
  • Walroth TA, Smallwood S, … Fuller J
  • CONCLUSIONS: The Indianapolis Coalition for Patient Safety (ICPS), which represents 6 Indianapolis-area health systems, identified an opportunity to reduce clinically insignificant alerts that smart infusion pumps present to end users. Through a consensus-driven process, ICPS aimed to identify best practices to implement at individual hospitals in order to establish specific action items for smart-pump drug library optimization. A work group of pharmacists, nurses, and industrial engineers met to evaluate variability within and lack of scrutiny of smart-pump drug libraries. The work group used Lean Six Sigma methodologies to generate a list of key needs and barriers to be addressed in process standardization. The group reviewed targets for smart-pump drug library optimization, including dosing limits, types of alerts reviewed, policies, and safety best practices. The work group also analyzed existing processes at each site to develop a final consensus statement outlining a model process for reviewing alerts and managing smart-pump data. Analysis of the total number of alerts per device across ICPS-affiliated health systems over a 4-year period indicated a 50% decrease (from 7.2 to 3.6 alerts per device per month) after implementation of the model by ICPS member organizations.Through implementation of a standardized, consensus-driven process for smart-pump drug library optimization, ICPS member health systems reduced clinically insignificant smart-pump alerts.
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