bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability of Imipenem-Cilastatin Sodium in AutoDose Infusion System Bags
Authors: Trissel Lawrence A. , Xu Quanyun A.
Published: January 2018

The objective of this study was to evaluate the physical and chemical stability of imipenem-cilastatin sodium 250 mg/100 mL and 500 mg/100 mL (of each drug component) admixed in 0.9% sodium chloride injection packaged in AutoDose Infusion System bags.

Triplicate test samples were prepared by bringing the required amount of imipenem-cilastatin sodium injection to volume with 0.9% sodium chloride injection. A total of 100 mL of each of the test solutions was packaged in each of three ethylene vinyl acetate (EVA) AutoDose bags designed for use in the AutoDose Infusion System for each storage condition. Samples were protected from light and evaluated at appropriate intervals for up to three days at 23°C and 14 days at 4°C.

Physical stability was assessed using a multistep evaluation procedure that included turbidimetric and particulate measurement in addition to visual inspection. Chemical stability was assessed with stability-indicating high performance liquid chromatography (HPLC) analytical techniques, based on initial drug concentrations and concentrations at appropriate intervals over the study periods. The admixtures were clear throughout the study when viewed in normal fluorescent room light and with a Tyndall beam. Measured turbidity and particulate content were low initially and exhibited little change throughout the study. HPLC analysis revealed extensive decomposition in the samples, with imipenem being the less stable component.

The instability of the imipenem-cilastatin sodium admixtures is consistent with previous studies. Admixtures stored under refrigeration should be used immediately upon warming to room temperature due to the rapid rate of imipenem decomposition. The AutoDose Infusion System bags were not found to affect adversely or improve the physical and chemical stability of this drug.
Mitoxantrone, Etoposide, and Cytarabine (MEC) Regimen for Relapsed or Refractory Acute Myelogenous Leukemia
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases, reviewing issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Questions and Answers from the F.I.X.;Vesicant Policies;Neonatal Abstinence Syndrome (NAS);Endotracheal Administration of Drugs;Low-Dose Oral Vitamin K
Authors: Cada Dennis
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is on online drug information service available to subscribers of The Formulary Monograph Service, or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X.
With Levothyroxine, Be Careful where you Put the Decimal; It Should Go without Saying: Successful Weight-Based Programs Require a Weight; Don't Confuse Varicella Virus Vaccine with Varicella-Zoster Immune Globulin
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Panhypogammaglobulinemia Associated with Phenytoin Therapy;Status Epilepticus after Abrupt Withdrawal of High-Dose Gabapentin Therapy;Thalidomide-Induced Neuropathy;Ergot Toxicity as a Result of Over-the-Counter Drug Use;Systemic Absorption of Ophthalmic Medication Leads to Child's Overdose;Risperidone-Induced Hyperprolactinemia
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Impact of Computerized Prescriber Order Entry on Medication Errors at an Acute Tertiary Care Hospital
Authors: Igboechi Chike Augustine , Ng Carol L. , Yang Chuiling S. , Buckner Althea N.
Published: January 2018

The authors analyzed medication errors documented in a hospital's database of clinical interventions as a continuous quality improvement activity. They compared the number of errors reported prior to and after computerized prescriber order entry (CPOE) was implemented in the hospital. Results indicated that in the first 12 months of CPOE, overall medication errors were reduced by more than 40%, incomplete orders declined by more than 70%, and incorrect orders decreased by at least 45%. Illegible orders were virtually eliminated but the level of medication errors categorized by drug therapy problems remained significantly unchanged. The study underscores the positive impact of CPOE on medication safety and reemphasizes the need for proactive clinical interventions by pharmacists.
Pediculicide Resistance in Head Lice: A Survey
Authors: Pray W. Steven
Published: January 2018

The head louse is an obligate human parasite. Evidence points to the growing resistance of head lice to nonprescription pesticides (eg, synergized pyrethrins, permethrin). To gather data, recent pharmacy graduates were surveyed about treatment failures and resistant lice. The response rate was 28.4%, with 173 of 609 surveys returned. One hundred and thirty-one pharmacists provided information that they had gathered during counseling sessions or other contacts with patients. Patients who remained infested after using either synergized pyrethrins or permethrin were encountered by 81.7% and 78.6% of pharmacists, respectively; these treatment failures occurred once or twice weekly in 58.1% of pharmacists' practices. Patients treating themselves more frequently or in higher doses with pesticides in an attempt to rid themselves of lice were reported by 62.6% of pharmacists. Patients reported the use of gasoline, kerosene, or other dangerous treatments once weekly or more in the experience of 42% of pharmacists. Resistant head lice had been a problem in their areas for 1 or 2 years for 42.8% of pharmacists. A smaller percentage (5.3%) of pharmacists had received official confirmation that resistant head lice were present in their areas. Pharmacists recommended nontoxic options (eg, combing and vacuuming) 19.8% of the time with positive results. Resistance seems to be a widespread, growing phenomenon and is not entirely related to patients' inability to use pesticides correctly. Pharmacists should consider recommending nontoxic alternatives that do not pose a threat to the patient or environment and do not contribute to resistance.
Analysis of Clinical Intervention Documentation by Dispensing Pharmacists in a Teaching Hospital
Authors: Davydov Liya , Caliendo Gina C. , Smith Lawrence G. , Mehl Bernard
Published: January 2018

Decentralized pharmacists have a valuable role in preventing medication errors. At Mount Sinai Hospital, each pharmacist's contact with a prescriber to correct or clarify a possible prescribing error is documented on the original order. Our pharmacists are also encouraged to document interventions as part of the pharmacist intervention program. The authors undertook a blinded observational study to determine the percentage of prescriber contacts documented as pharmacist clinical interventions. This 2-month study was conducted in two nursing units with computerized physician order entry. All orders from these units were collected and evaluated for possible prescribing errors and documentation of a pharmacist's contact with a prescriber. Additionally, all pharmacist interventions documented in these units during the study period were collected and entered into the pharmacist intervention database. The percentage of all pharmacist interventions vs the number of documented prescriber contacts on original orders was then calculated. A total of 14 pharmacists were involved in the provision of pharmaceutical care to patients in the study units. During the 2-month study period, a total of 221 orders required pharmacists to contact prescribers regarding potential prescribing errors. However, only 109 (49.3%) of these were documented as clinical interventions. The findings indicate a need for improved documentation of clinical services (eg, interventions) performed by pharmacists.
Hoelzer Regimen for Therapy of Adult Acute Lymphoblastic Leukemia
Authors: Moussavian Parvaneh A. , Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
A Review of the PDA Literature
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

With this article, our 13th installment, we begin the second year of this series devoted to PDA use in pharmacy practice. Previous articles have focused on hardware and software issues; organizer skills; the digital peripheral brain; and how to find, download, and install software. In this article, we provide a brief review of PDAs in the health care literature.
Development and Implementation of a Tablet Splitting Education Program in a Veterans Affairs Medical Center
Authors: Schellhase Ellen M. , Hardin Anne K.
Published: January 2018

Tablet splitting offers several benefits to the patient and the health care system, including more specific and appropriate dosages and improved cost effectiveness. Tablet-splitting programs have been established in a variety of health care settings. The Roudebush VAMC in Indianapolis, Indiana, implemented a pilot program to educate patients about tablet splitting. Each patient was evaluated for ability to split tablets; eligible patients received comprehensive education on tablet splitting. Twelve pharmacy clerkship students from two universities carried out the program over seven nonconsecutive weeks. One hundred and three patient encounters were documented. The total cost savings from the interventions was $7986.32. A more comprehensive program has the potential to save $413,000 annually. The essential role of pharmacy students in this program demonstrated their importance in the provision of health care and patient education.
Resume Orders List of Unacceptable Abbreviations Homeopathics/Herbals on the MAR Pharmacist Review of Orders Brand/Generic Drug Labeling Storage of Concentrated Electrolytes Adhering to National Patient Safety Goals 2004 Draft Standards on Medication Use Double-Check Procedures
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environments. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Downtime Procedures (Part 1)
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center. Questions or suggestions should be addressed to Alicia S. Miller, Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. E-mail: miller-4@medctr.osu.edu .
Baclofen: Alcohol Withdrawal
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Bridging the Gap: Towards a Safer Medication Use Process
Authors: Colodny Lisa
Published: January 2018

Due to increasing concern about medication safety since the publication of the 1999 Institute of Medicine Report, the Medical Safety Committee of Broward General Medical Center evaluated prescribing practices for inpatient admissions during a 2-week period. Criteria were consistent with nationally recognized guidelines for safe prescribing practices that included the avoidance of specific abbreviations and other problematic prescribing habits. The results of the use evaluation were presented to all medical staff committees and other key groups as identified by the executive medical council. The safety group identified three key improvements: the prohibition of the abbreviation “U” for units, the use of a leading zero for dosages that require a decimal point, and the absence of a trailing zero for dosages that do not require a decimal. Educational programs were conducted to increase awareness of the targeted safety criteria, and the outcomes of this education were measured. Significant improvement resulted for both of the targeted criteria (abbreviation of “U” for units and leading/trailing zeros). The abbreviation of “units” decreased from 11% to 1%, whereas unsafe use of leading/trailing zeros decreased from 4% to 0.5%.
Bleomycin, Etoposide, and Cisplatin (BEP) Regimen for Testicular Cancer
Authors: Roark Kathleen M. , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Icodextrin Peritoneal Dialysis Solution
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800–322–4349. The June 2003 monograph topics are aprepitant, gemifloxacin, desirudin for injection, gatifloxacin ophthalmic solution, and pegvisomant. The DUE is on aprepitant.
Start Low and Go Slow
Authors: Tobias Dianne E.
Published: January 2018

This continuing feature focuses on the medication needs of the geriatric population, a group that is especially vulnerable to a variety of medication-related problems (including medication errors). The goals of this series are to increase awareness about the inherent risks and challenges of pharmacologic therapy in elderly patients and to promote optimal medication use in this high-risk population. Questions and comments are appreciated and should be directed to Dianne E. Tobias, PharmD, CGP at detobias@aol.com .
PDA Multimedia: Bells and Whistles or Clinically Relevant Features?
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

PDAs are increasingly offering the user multimedia functionality. In this article, we address multimedia features and how they can be used in practice.
An Assessment of Free, Online Drug-Drug Interaction Screening Programs (DSPs)
Authors: Lam Minh V. , Mccart Gary M. , Tsourounis Candy
Published: January 2018

Objective

This study evaluated the content and usability of four free, online drug-drug interaction screening programs (DSPs) and one proprietary DSP (CD-ROM format) requiring an annual fee.

Methods

Free, online DSPs that obtain their drug interaction information from unique providers were located through a comprehensive search of the Internet. For comparison purposes, a well-established, fee-based DSP was also included in the study. A tool for evaluating the DSPs for usability and quality of content was created. The usability characteristics assessed included ease of use, ability to support more than two drug entries at the same time, speed, and multifunctionality. Evaluation of content was based on accuracy, completeness, references, drug interaction management, and readability. A five-member panel of clinical pharmacists and drug information specialists in academia and the pharmaceutical industry validated the survey tool.

Results

Based on overall usability, Drkoop.com (Multum) rated higher than the other free DSPs, but below the comparator, DrugReax (Micromedex). Walgreens.com (Medi-Span) and Medscape (First Data-Bank) ranked lowest among all the DSPs in terms of usability. Based on content, Walgreens ranked first and Clinical Pharmacology 2000 (Gold Standard Multimedia) ranked last (P= 0.015, ANOVA).

Conclusion

All of the evaluated DSPs were useful. Some were better than others depending on the assessment category. Walgreens rated the highest in terms of accuracy, completeness, and drug interaction management information. Drkoop.com rated the highest with regard to comprehensive references and pharmacist-assessed, consumer-friendly language. All of the free, online DSPs could improve their speed of information retrieval.
Drug-Induced Psychiatric Symptoms Drug Shortages Sexually Transmitted Diseases
Authors: Generali Joyce A.
Published: January 2018

To help readers monitor the most important developments in specialized areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs. A cumulative index to Basic Bibliography topics will be published semiannually in June and December.
Neonatal Intensive Care Unit Pathway
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “pre-scribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center.
Questions and Answers from the F.I.X. Adverse Event Reference Cisplatin/Epinephrine in Bovine Collagen Gel Cross-Sensitivity: Plavix (Clopidogrel) and Ticlid (Ticlopidine) Anergy Skin Testing Diltiazem Ointment
Authors: Cada Dennis
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service, or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349. If you would like to comment on any of the following questions or answers, please e-mail them to Dennis Cada at dcada@drugfacts.com
Will CDC-Recommended Vaccine Abbreviations Reduce the Risk of Misinterpretation? Unintended Discontinuation of Drugs a Patch or Oral Therapy? Oral Vancomycin Does Not Treat Systemic Infections
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Retroperitoneal Hematoma Caused by Low-Molecular-Weight Heparin Retroperitoneal Hemorrhage Due to Warfarin Thromboembolism and Clozapine Therapy Neutropenia Caused by Valproic Acid Amoxicillin Crystalluria as a Cause of Acute Renal Failure Facial Hyperpigmentation Associated with Imipramine Readers Address Psychiatric Problems Related to Opiates
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Lifestyle Drugs: A Useful Distinction for Pharmacy Benefit Coverage Policies?
Authors: Teagarden J. Russell
Published: January 2018

Managed care pharmacists are involved formally with the interface between the delivery and financing of health care; their work thus entails an accountability for both elements. Interpreted broadly, managed care pharmacists are pharmacists working within the sphere of a health care system, health care purchaser, health insurer, managed care organization, or benefit administration agency. Patients, the pharmacy profession, and society are best served by this broad interpretation, because the interdependency of financing and delivery is inextricably linked to the achievement of good health outcomes. This continuing feature will explore contemporary issues facing managed care pharmacists.
Tracking Vaccination Rates among HIV-Positive Patients with a Computerized Reminder System
Authors: Segarra-Newnham Marisel
Published: January 2018

Objective

This study deterimined vaccination rates at a Veterans Affairs HIV clinic before and after the 1997 implementation of a computerized reminder system.

Methods

Before implementation of a computerized reminder system, vaccinations were not always recorded on patients' medical records. After implementation, vaccinations were documented in the computer record and the system alerted providers when patients became due for a pneumococcal vaccine, tetanus booster, or other immunization. Charts for all patients (n = 211) enrolled in the HIV clinic were assessed for vaccination dates. Vaccination rates for patients (n = 71) enrolled before 1997 were compared with rates for patients (n = 140) enrolled after the computerized system was installed. The new system enabled the clinical pharmacist to monitor vaccination rates on a quarterly basis and facilitate patient appointments.

Results

Vaccination rates for patients enrolled before 1997 were 100% for initial pneumococcal vaccination and 100% for tetanus. Seventy-six percent of patients due for a pneumococcal vaccine booster had received it. In contrast, patients enrolled after 1997 had vaccination rates of 94% for pneumococcal vaccine; eight recently enrolled patients did not have documentation of vaccination. The clinical pharmacist scheduled these patients and the rate increased to 97%. Due to a product shortage, only 61% of patients enrolled after 1997 had received tetanus vaccine.

Conclusions

A computerized reminder system allows for reliable tracking of vaccination rates and can be used by pharmacists to improve preventive care for HIV-positive patients. Overall vaccination rates were well above the national norm.
Cisplatin, Vinblastine, and Bleomycin (PVB) Regimen for Testicular Cancer
Authors: Iheagwara Nnenna L. , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Zoledronic Acid: Postmenopausal Osteoporosis
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Low-Molecular-Weight Heparin Therapy for Patients Undergoing Total Knee Replacement Surgery: Cost and Outcomes
Authors: Allen Lisa R. , Bonck Michael J. , Lofgren Kendra L. , Mayo Kevin W. , Mozaffari Essy
Published: January 2018

Objective:

In March 1997, a community hospital system changed the low-molecular-weight heparin (LMWH) product on formulary from enoxaparin to dalteparin through a therapeutic interchange for all uses except patients undergoing total knee replacement (TKR) surgery. In October 1997, therapeutic interchange of LMWHs (enoxaparin to dalteparin) was instituted for patients undergoing TKR surgery. The cost equivalence of these therapies in TKR surgery was evaluated.

Methods:

A cohort of patients admitted to three health-system facilities who underwent primary TKR surgery between July 1, 1996 and December 31, 1998 was assembled retrospectively. Costs and outcomes associated with a formulary interchange for LMWH products (from enoxaparin to dalteparin) initiated in October 1997 for TKR surgery were analyzed using data abstracted hospital records and decision support systems. To evaluate equivalence between the drugs, the difference in median inpatient health care costs (with 95% confidence intervals [CIs]) was calculated. Equivalence of outcomes (eg, adverse events) in terms of risk ratios was also evaluated.

Results:

Inpatient costs were essentially equivalent for patients treated with enoxaparin (n = 88) and dalteparin (n = 101), with a slightly higher median cost among enoxaparin-treated patients ($172 [95% CI, -$17 to + $395]). CIs for the crude and regression-adjusted findings included the possibility of no cost difference (ie, $0). The median time to hospital discharge was identical, at 6 days. Outcomes were otherwise similar between the two groups.

Conclusions:

Our therapeutic interchange program was successful. Inpatient costs were equivalent when patients were treated with either enoxaparin or dalteparin for TKR surgery.
Etoposide and Cisplatin (EP) for Testicular Cancer
Authors: Solimando Dominic A. , Waddell Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
JNC 7: New Guidelines for the Management of Hypertension
Authors: Howard Patricia A.
Published: January 2018

This continuing feature will update readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number one killer in the US, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, pharmacists can have a significant impact on prevention and treatment — if they keep current with developments in drug therapy. Address comments to Patricia A. Howard, PharmD, Professor and Vice Chair, Pharmacy Practice, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160–7231. E-mail: phoward@kumc.edu .
Adverse Events following Hospital Discharge Assessing and Treating Hypertension in the Geriatric Patient: The JNC 7 Report
Authors: Tobias Dianne E.
Published: January 2018

This continuing feature focuses on the medication needs of the geriatric population, a group that is especially vulnerable to a variety of medication-related problems (including medication errors). The goals of this series are to increase awareness about the inherent risks and challenges of pharmacologic therapy in elderly patients and to promote optimal medication use in this high-risk population. Questions and comments are appreciated and should be directed to Dianne E. Tobias, PharmD, CGP at detobias@aol.com .
Quinine-induced Disseminated Intravascular Coagulation Fatal Lactic Acidosis with Metformin and Antiretrovirals Valsartan-Induced Angioedema Red Blood Cell Aplasia with Mycophenolate Mofetil Thalidomide-Induced Bradycardia
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Building Speciality Practice Resource Libraries
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

With hundreds of clinical applications on the market, pharmacists may find it difficult to select the best software for their specific practices. In this installment, we identify software by pharmacy specialization type.
Pharmacy Renovation: One Pharmacist's Experience
Authors: Huntzinger Paul Evan
Published: January 2018

After military base closures in the immediate San Francisco Bay area, the availability of non-cost prescription medications to eligible retirees through military medical facilities was greatly reduced. Of the seven major military installations in this region in the 1990s, only Coast Guard Island, Alameda remained. Consequently, prescription volume at the Coast Guard Alameda Pharmacy increased 70% between July 1997 and December 2002. The increased prescription volume made significant demands on pharmacy resources, necessitating (1) an expanded formulary; (2) more storage space in the prescription processing area, (3) increased operational efficiency; and (4) enhanced patient privacy measures. Pharmacy renovation was required to meet these demands. The renovation process involved a step-wise approach that included justification/approval; renovation design, the establishment of a temporary pharmacy, and the reestablishment of services in the renovated pharmacy.
Anemia and Epoetin Alfa in the Intensive Care Unit
Authors: McGoldrick Michael , Fraser Gilles L.
Published: January 2018

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes.
Factors Affecting Job Satisfaction among Hospital Pharmacists
Authors: Sansgiry Sujit S. , Ngo Caroline
Published: January 2018

Objective

Job satisfaction is the favorableness with which employees view their work. Two main factors that affect job satisfaction are intrinsic and extrinsic job characteristics. Intrinsic factors lead to satisfaction, whereas extrinsic characteristics prevent dissatisfaction. The objective of this study was to determine the level of job satisfaction among hospital pharmacists at the Texas Medical Center by looking specifically at intrinsic and extrinsic factors that managers may use to promote a higher level of job satisfaction.

Methods

A survey about intrinsic and extrinsic job characteristics was administered to hospital pharmacists. The survey employed a 5-point “strongly agree” (5) to “strongly disagree” (1) scale; satisfaction was measured using two previously validated scales abbreviated as JS1 and JS2. Eighty-five completed surveys were received for a response rate of 26%.

Results

The mean age of the respondents was 40 years (± 9.7); the majority of respondents were female (64.3%). In general, pharmacists were satisfied with their job. The mean job satisfaction scores on the two scales were 3.32 ± 0.86 for JS1 and 3.43 ± 0.84 for JS2. Job satisfaction was significantly correlated with intrinsic (rJS1 = 0.61, rJS2 = 0.54, P < 0.05) and extrinsic factors (rJS1 = 0.64, rJS1 = 0.61, P < 0.05). Furthermore, intrinsic and extrinsic factors were significantly correlated with each other (r = 0.48, P < 0.05).

Conclusion

Hospital pharmacists at the Texas Medical Center were satisfied with their current jobs and liked their jobs. Intrinsic and extrinsic factors were significantly correlated with job satisfaction and with each other, indicating their importance when measuring job satisfaction.
Questions and Answers about the 2004 Medication Management Standards
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environments. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Don't Lose Track of Orders during Clarification Never Prescribe Leucovorin Calcium as “Folinic Acid” Confusion Mounting over Drug Name Suffixes Fellowship in Medication Safety
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Preventing Adverse Drug Events with Rounding Pharmacists Adverse Drug Events Involving COX-2 Inhibitors Psoriasis Associated with Rofecoxib Adverse Events Seen with Ribavirn Therapy for SARS Immediate Hypersensitivity to Clavulanic Acid Thrombocytopenia with Vancomycin
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Zoledronic Acid vs Pamidronate for the Prevention of Hypercalcemia of Malignancy or Bone Metastases in Hospital Outpatients: Time Analysis and Economic Implications
Authors: Gammon David C. , Le Hoang T.
Published: January 2018

Zoledronic acid, a third-generation bisphosphonate, is one of the most potent agents in its class available for treating patients with hypercalcemia of malignancy (HCM) and osteolytic metastasis. Pamidronate and zoledronic acid have both shown safety and efficacy beyond 24 months of use and both decrease the risk of bone complications in patients with other cancers and multiple myeloma. Based on the equivalence of these two products, our cancer center evaluated the financial impact and potential reductions in administration time from the shortened zoledronic acid infusion of 15 minutes compared with that of 2 hours for pamidronate. Fifty-three oncology/hematology outpatients, including 28 patients who had previously received pamidronate, received 305 total doses of zoledronic acid 4 mg given as an IV infusion in an 8-month period. Although the acquisition costs of zoledronic acid 4 mg are greater than that for pamidronate 90 mg, we retrospectively identified equivalent reimbursements per dose, as a percentage of cost. The conservation of time and resources for the administration of zoledronic acid offered an opportunity to treat more patients with the existing nursing staff and the opportunity to improve the quality of life for our patients by shortening their time in the clinic.
Cyclophosphamide and Fludarabine with or without Rituximab (CF ± R) for Chronic Lymphocytic Leukemia or Non-Hodgkin's Lymphoma
Authors: Ghitani Neda , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Atrial Fibrillation: Rhythm Control or Rate Control — Which Strategy is Preferred?
Authors: Howard Patricia A.
Published: January 2018

This continuing feature will update readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number one killer in the US, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, pharmacists can have a significant impact on prevention and treatment — if they keep current with developments in drug therapy.
Don't Accept Verbal Chemotherapy Orders Zostrix Cream Confused with Zovirax Cream Know Each Drug's Purpose Verify Medication Histories Oral Morphine Alert
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Medication Administration Considerations for Patients Receiving Enteral Tube Feedings
Authors: Dickerson Roland N.
Published: January 2018

Nutrition Support Consultant features issues pertinent to the clinical aspects of pharmacy nutrition support practice.
Using a PDA to Capacity
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

Most of us are satisfied when we obtain between 10% to 20% of the functional capacity of any given technology. When we adopt technology into our personal and professional lives, we often make a minimal investment and therefore gain a minimal return. We are usually trying to solve a specific problem, and we attempt to intuitively operate technology (such as a personal computer or personal digital assistant) without reading instructions until we reach a level whereby we get our primary job assignments accomplished. Getting more out of the technology in our lives is the subject of this article.
Orlistat in Obese Patients with Type 2 Diabetes: A Retrospective Assessment of Weight Loss and Metabolic Effects
Authors: Allie Edward C. , Kane Michael P. , Busch Robert S. , Bakst Gary , Hamilton Robert A.
Published: January 2018

Almost two-thirds of the adult American population is overweight. Obesity is associated with a higher incidence of hypertension, dyslipidemia, diabetes mellitus and coronary artery disease. Orlistat, a gastrointestinal lipase inhibitor, provides an option for weight loss management in addition to diet and exercise. This study assessed the metabolic response of patients with type 2 diabetes mellitus to orlistat. Forty-one patients with type 2 diabetes who received orlistat in a private endocrinology practice were identified by a computer-assisted retrospective chart review. Orlistat's effects on weight, blood pressure, lipid parameters, hemoglobin A1C (HbA1C), and concurrent medication use were identified. Analysis of the 23 patients who remained on the drug for a minimum of 3 months revealed statistically significant reductions in patient weight, body mass index (BMI), total cholesterol, HDL cholesterol, and LDL cholesterol levels. For patients with type 2 diabetes who were able to tolerate the drug, orlistat was associated with improvement in several cardiovascular risk factors.
Cognitive Impairment with Statins?; Premature Ejaculation after Discontinuing an SSRI; Adverse Reactions to Trimethoprim/Sulfamethoxazole in Patient with AIDS; Neutropenia Associated with Piperacillin-Tazobactam; Hypertensive Crisis with Antidepressant Imatinib-Associated Pulmonary Alveolar Proteinosis
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Clinical Pharmacy Services in a Pediatric Emergency Room
Authors: Mialon Paula J. , Williams Penny , Wiebe Robert A.
Published: January 2018

This continuing feature will focus on recent advancements in the areas of pediatrics and neonatal pharmacology and on methods for reducing medication error risk in this patient population. Most pharmacological agents are designed with the adult in mind, and there is little literature-based data from which to derive dosing schedules and proper drug administration techniques for the pediatric and neonatal patient. Moreover, pharmacological response in this group is not well understood. We hope that this feature will help you provide pharmaceutical care to this high-risk population. Direct questions or comments to hospitalpharmacy@drugfacts.com .
Ibritumomab; Tositumomab
Authors: Gordon Susan M. , Solimando Dominic A. , Waddell J. Aubrey , Durkin Robert J.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
For Every Problem a Solution; For Every Solution a Problem; Carpuject Syringe Mix-Ups; Carpuject Syringe Tampering; Tamiflu Gains Strength
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers‘ names will be published if desired. ISMP may be contacted at the address shown below.
Identifying Potentially Inappropriate Drugs for Geriatric Patients: Updating the Beers List; More Evidence for Treating Systolic Hypertension in the Elderly
Authors: Tobias Dianne E.
Published: January 2018

This continuing feature focuses on the medication needs of the geriatric population, a group that is especially vulnerable to a variety of medication-related problems (including medication errors). The goals of this series are to increase awareness about the inherent risks and challenges of pharmacologic therapy in elderly patients and to promote optimal medication use in this high-risk population. Questions and comments are appreciated and should be directed to Dianne E. Tobias, PharmD, CGP at detobias@aol.com .