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Safety along with Reactogenicity in the ChAdOx1 (AZD1222) COVID-19 Vaccine throughout Saudi Arabic.
Background Key performance indicators (KPIs) are a set of measures used to help an organization in assessing and achieving goals critical to success. The aim of this study was to quantify the clinical pharmacists' contribution to patient care in a tertiary care hospital using predefined clinical pharmacy KPIs. Method This study was a prospective, observational study conducted by the Pharmaceutical Care Division of a tertiary care hospital. Clinical pharmacy KPIs were submitted by each clinical pharmacist on a monthly basis for 12 months during 2017. All clinical pharmacists up to the managerial level were included in the study. Data were analyzed, stratified, and correlated using Microsoft Excel, JMP statistical software, and Spearman correlation. The study was approved by the hospital's Office of Research Affairs, RAC number 2171-080. Results A total of 42 clinical pharmacists reviewed 104 728 patient encounters. They performed an adjusted average of 1221 interventions with an acceptance rate of 91.5%, 273 medication reconciliations, 325 discharge consultations, 332 pharmacokinetic consultations, 700 total parenteral nutrition consultations and follow-ups, and 12 688 electronic order verifications per clinical pharmacist per year. These interventions collectively resulted in a cost saving of $316 087.65 per clinical pharmacist per year. Statistical significance with positive correlation was noted for a number of precepted residents/students and clinical pharmacists' experience (R = 0.382, P = .013) and board certification (R = 0.428, P = .0047). Conclusion Clinical pharmacy KPIs were able to quantify the clinical pharmacists' contributions to patient care and cost savings, which may lead to improve, standardize, and benchmark clinical pharmacy activities in the region.Objective The objective of this study was to investigate factors influencing the complexity of drug substitutions caused by drug tenders in a Danish hospital setting. Methods A sequential explanatory mixed-methods approach was employed. In the first phase, a custom-made, self-administered questionnaire was distributed to 58 pharmacists and pharmaconomists employed at the Hospital Pharmacy in the North Denmark Region. The questionnaire consisted of 13 questions, which helped to obtain quantitative information on factors complicating drug substitutions. The results were used to inform the construction of an interview guide for a focus group interview held in the following qualitative second phase of the study. The focus group included 11 pharmacists and pharmaconomists from the Hospital Pharmacy in the North Denmark Region working with drug substitutions. The focus group interview was conducted to facilitate validation of results from the questionnaire survey and to add further perspectives on identified factors influencing the complexity of drug substitutions. Results Findings from both phases of the study revealed that implementation of drug substitutions is more complex when drug strength or pharmaceutical form of a drug changes, compared with changes of drug trade name or package size. Furthermore, it was established that Anatomical Therapeutic Chemical classification codes could be used to identify drug substitutions that are typically complex, for example, L01 and N05. Several external factors were also found to influence implementation of drug substitutions, for example, related to drug usage, number of end users, and hospital wards. Conclusions From a hospital pharmacy point of view, multiple factors were identified that could influence and complicate the implementation of drug substitutions with different impact size. Those factors included both changed characteristics of drugs, Anatomical Therapeutic Chemical classification codes involved in substitution, and external factors.Purpose Proton pump inhibitors (PPIs) are commonly used medications and are historically well tolerated. Recent studies have linked PPI use to the development of chronic kidney disease (CKD) and end-stage renal disease. This study investigated the impact of discontinuing PPIs on renal function in patients with CKD. Methods We conducted a retrospective chart review of patients with established CKD, defined as 2 eGFR (estimated glomerular filtration rate) measurements of less than 60 mL/min/1.73 m2 at least 90 days apart, who were on a PPI from January 1, 2014 to December 31, 2014, with a medication possession ratio greater than or equal to 70%. We compared baseline eGFR to a final eGFR after at least 6 months of discontinuation or continuation of a PPI. After power analysis, we targeted an enrollment of 200 patients (100 in each group) to achieve a power of 0.80 and an alpha of 0.05. Summary A total of 97 patients in the PPI discontinuation group and 100 patients in the PPI continuation group met the study inclusion criteria. Baseline eGFR in the PPI continuation group was 47.9 mL/min/1.73 m2 and 50.7 mL/min/1.73 m2 in the discontinuation group. Final eGFR in the PPI continuation group was significantly higher than baseline at 51.1 mL/min/1.73 m2 (+3.25 ± 12.8, P = .01). Final eGFR in the PPI discontinuation group was 51.8 mL/min/1.73 m2 (+1.09 ± 12.8, P = .3). The average time between baseline and final eGFRs was 270 days in the PPI continuation group and 301 days in the discontinuation group. CDK activity There was no statistically significant difference in the change in eGFRs between groups (95% confidence interval [CI] = -5.48-2.03, P = .37). Conclusions Proton pump inhibitor discontinuation after prolonged continuous use in patients with CKD was not associated with a significant change in renal function after 1 year.Background Pharmacodynamic models support potential improved antimicrobial pharmacokinetic and pharmacodynamic goal attainment in patients treated with extended-infusion (EI) versus intermittent-infusion (II) cefepime. Small clinical studies demonstrate inconsistent findings in patient outcomes, necessitating a deeper review of this administration method. Methods This was a retrospective cohort study comparing patients receiving EI versus II cefepime between September 1, 2017, and March 31, 2018. The primary outcome was in-hospital all-cause mortality. Secondary objectives included length of hospital and ICU stay, time to defervescence, duration of therapy, duration of mechanical ventilation, and readmission rate. Subgroup analyses for the primary objective were conducted based on comorbid burden and isolate susceptibilities. Results No statistically significant differences were noted in the 645 included patients for the primary outcome between the EI and II groups (7.8% vs 10.4%, P = .32). Median length of stay was 9 days (IQR 12) versus 11 days (IQR 14) (P = .30), respectively. In addition, statistical significance was not seen in any of the subgroups for the primary outcome including patients with APACHE II score ≥ 20 (17.4% vs 30.6%, P = .26) and for infections caused by Pseudomonas aeruginosa (5.9% vs 20.0%, P = .23) or Enterobacteriaceae (11.1% vs 20.0%, P = .13) with minimum inhibitory concentration (MIC) ≥ 4. Conclusion No statistically significant differences were noted between EI and II groups, although benefits in specific subpopulations may exist when these results are correlated with findings from studies examining alternative antipseudomonal beta lactams.Purpose The purpose of this study was to determine if national drug shortages of electrolyte replacement products negatively impact patient care. Methods This study was a single-center, retrospective, observational cohort of adults admitted to the medical, surgical, or trauma intensive care unit (ICU) that were ordered or would have qualified for the general or continuous renal replacement therapy electrolyte replacement protocol (ERP) between April 2017 and August 2018. In October 2017, ERP use was suspended and enteral replacement was promoted due to inability to maintain consistent inventory of intravenous replacement products. The primary objective was to compare the percentage of patient days that at least 1 critically low value of potassium, magnesium, and/or phosphorus existed between protocolized and nonprotocolized electrolyte replacement. Secondary objectives included characterizing the ratio of enteral replacement to duration of critically low electrolyte values during protocolized and nonprotocolized electrolyte replacement. Results A total of 288 patients were included. The mean percentage of ICU days with low electrolyte levels in the protocolized period was significantly higher than in the nonprotocolized period (21.4% vs 17.5%, P = .0238). There was a negative relationship between the total electrolyte replacement that was given enterally and the percentage of patient days with critically low values indicating that as enteral replacement increased, percentage of days with low values decreased. The association between percentage of enteral replacement and days with critically low electrolyte values was significantly lower in the protocolized period. Conclusion Intravenous electrolyte replacement product shortages did not result in an increased incidence of critically low electrolyte values. Enteral replacement was associated with a decreased incidence of low electrolyte values.Background Few studies have compared clinical outcomes and medication use between obese and nonobese children in the pediatric intensive care unit (PICU). Objectives The primary objective was to compare clinical outcomes including mortality, PICU length of stay (LOS), and mechanical ventilation (MV) requirement between obese and nonobese children. Secondary objectives included analysis of factors associated with these outcomes and medication use between groups. Methods This retrospective study included children 2 to 17 years old admitted to the PICU over a 1-year time frame. Patients were categorized as obese, body mass index (BMI) ≥ 95th percentile, and nonobese (BMI less then 95th percentile). Three binary regression models assessed the impact of obesity on clinical outcomes. Results There were 834 admissions, with 22.1% involving obese children. There was no difference in mortality, MV requirement, or PICU LOS between groups. There were no associations with obesity and clinical outcomes found, but an association was noted for medication classes and receipt of continuous infusions on clinical outcomes. There was no difference noted in the median number (interquartile range [IQR]) of medications between obese and nonobese children, 8 (6-13) versus 9 (6-15), P = .38, but there was a difference in patients receiving a continuous infusion between obese and nonobese children, 24.4% versus 8.8%, P less then .01. The 15 most used medications in both groups included analgesics, antimicrobials, corticosteroids, bronchodilators, and gastrointestinal agents. Conclusions One-fifth of all admissions included obese children. Obesity was not associated with mortality, PICU LOS, and MV requirement, but the number of medication classes and continuous infusions were associated with these outcomes.Purpose Levetiracetam is an antiepileptic medication commonly used in critical care areas for seizure treatment or prophylaxis. Compatibility data of levetiracetam with other critical care medications are limited, which can make administration challenging. This study aims to assess the physical Y-site compatibility of intravenous levetiracetam with some other commonly used critical care medications. Methods Y-site administration was simulated by independently mixing levetiracetam with each of 11 selected medications in a 4-dram, colorless, screw-cap, glass vial, at a 11 ratio. Clinically used concentrations of each medication were compounded in 0.9% sodium chloride following United States Pharmacopeia chapter 797 standards. Physical compatibility was observed and assessed at 0, 15, and 30 minutes after mixing. Medication mixtures were considered physically incompatible if there was visual evidence of color change, gas evolution, haze, or particulate formation, pH change >10%, or if they had an absorbance value >0.
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