American Pharmacists Association

About: American Pharmacists Association is a other organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Pharmacist & Pharmacy. The organization has 2413 authors who have published 1969 publications receiving 30470 citations. The organization is also known as: APhA & American Pharmaceutical Association.

Augmented Renal Clearance in the Critically Ill: How to Assess Kidney Function

Abstract: BACKGROUND:Augmented renal clearance in critically ill patients can result in underdosing of life-saving drugs, potentially leading to therapeutic failure. To detect this phenomenon, correct assessment of the kidney function is essential. Currently, little is known about the validity of mathematical formulas to estimate renal function in this subset of patients.OBJECTIVE:To evaluate the validity of different methods to estimate kidney function in critically ill patients with augmented renal clearance by comparing measured renal clearance with estimated clearance using different formulas.METHODS:An observational, retrospective, single-center study was conducted in a 34-bed surgical intensive care unit (SICU) of the University Hospitals Leuven, Leuven, Belgium. Adults admitted to the SICU in 2010 with a measured creatinine clearance (CrCl) of 120 mL/min or more (based on 24-hour urinary collection) were included. The measured clearance values were compared with estimated clearance values as calculated by th...

Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery.

Abstract: Background: Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8. Methods: The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardiopulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval]. Results: Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0.95]) and C-reactive protein (0.72 [0.58-0.82]) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40.5] vs. 1.2 [0.7-1.5] ng/ml; P < 0.001). Conclusion: Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.

Evaluation of the Use of Inhaled Medications by Hospital Inpatients with Chronic Obstructive Pulmonary Disease

Abstract: Background: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing. Patients with COPD are treated with a variety of inhaled medications. Previous studies evaluating inhaler technique have had varied results but have generally found high rates of misuse of these devices. There is a paucity of studies of inhaler technique focusing on North American patients with COPD who have been admitted to hospital. Objective: To evaluate the inhaler technique of patients with COPD who have been admitted to hospital and to identify baseline patient characteristics and/or inhaler devices associated with poor inhaler technique. Methods: Patients with a diagnosis of COPD who were admitted to the hospitalist or internal medicine service at a tertiary care hospital in British Columbia between October 2010 and April 2011 were identified. After giving informed consent, recruited patients demonstrated their inhaler technique, which was evaluated with standardized checklists. Errors in technique were categorized as either noncritical or critical. Critical errors were defined as those resulting in little or no medication reaching the lungs. Results: Thirty-seven patients (mean age 78 years) participated in the study. Twenty-two (59%) of the patients made critical errors while demonstrating their inhaler technique. Patients using metered-dose inhalers were more likely to make a critical error than patients using other inhalers (13/14 [93%] versus 9/23 [39%]; relative risk 2.38, p = 0.002). On average, 26% of the steps for using an inhaler were performed incorrectly. Twenty-three (62%) of the patients reported having received previous counselling on inhaler technique, but only 13 (57%) of these 23 patients had received such counselling in the previous 6 months. Conclusions: More than half of the patients in this study misused their inhaler devices, and many made critical errors that would result in inadequate amounts of drug reaching the lung. Many of the patients were not receiving regular counselling on appropriate inhaler technique. Health care professionals should be aware of poor inhaler technique, should routinely evaluate their patients’ inhaler technique, and should provide counselling. RESUME Contexte : On observe une augmentation de la prevalence de la maladie pulmonaire obstructive chronique (MPOC). Les patients atteints d’une MPOC sont traites par divers medicaments en inhalation. Des etudes anterieures evaluant les techniques d’utilisation propres a chaque inhalateur ont degage divers resultats, mais ont generalement revele un taux eleve d’utilisation inadequate des inhalateurs. Il existe tres peu d’etudes sur les techniques d’utilisation des inhalateurs menees specifiquement chez des patients nord-americains atteints d’une MPOC et hospitalises. Objectif : Evaluer la technique d’utilisation des inhalateurs chez des patients atteints d’une MPOC qui ont ete hospitalises et determiner les caracteristiques de depart des patients ou les dispositifs d’inhalation associes a une mauvaise technique d’utilisation. Methodes : On a repere les patients affectes d’une MPOC qui ont ete admis au service de medecine hospitaliere ou au service de medecine interne d’un hopital de soins tertiaires de Colombie-Britannique entre octobre 2010 et avril 2011. Apres avoir accorde leur consentement eclaire, les patients recrutes ont montre leur technique d’utilisation de leur inhalateur, qui a ete evaluee a l’aide de listes de controle standardisees. Les erreurs dans la technique d’utilisation ont ete classees comme etant non critiques ou critiques. Les erreurs critiques etaient definies comme des erreurs ayant eu comme resultat que peu ou pas de medicament atteignait les poumons. Resultats : Au total, 37 patients (âge moyen de 78 ans) ont participe a l’etude. De ces patients, 22 (59 %) ont fait des erreurs critiques lors de la demonstration de leur technique d’utilisation. Les patients qui utilisaient des aerosols doseurs etaient plus susceptibles de faire des erreurs critiques que ceux utilisant d’autres inhalateurs (13/14 [93 %] contre 9/23 [39 %]; risque relatif de 2,38, p = 0,002). En moyenne, 26 % des etapes d’utilisation d’un inhalateur ont ete effectuees incorrectement. Parmi les patients, 23 (62 %) ont indique avoir deja recu des conseils sur la technique d’utilisation de l’inhalateur, mais seulement 13 (57 %) de ces 23 patients avaient recu des conseils dans les six derniers mois. Conclusions : Plus de la moitie des patients de l’etude utilisaient incorrectement leur inhalateur, et beaucoup faisaient des erreurs critiques qui avaient comme resultat qu’une quantite inadequate du medicament atteignait les poumons. Plusieurs des patients ne recevaient pas de facon reguliere des conseils sur la technique d’utilisation appropriee de leur inhalateur. Les professionnels de la sante devraient etre conscients des mauvaises techniques d’utilisation des inhalateurs, evaluer regulierement la technique d’utilisation des inhalateurs de leurs patients et donner a ces derniers des conseils sur cette technique.

Impact of pharmacist interventions on patients' adherence to antidepressants and patient-reported outcomes: a systematic review

Abstract: Background Pharmacist intervention in improving patient adherence to antidepressants is coupled with better outcomes.

Drug Dosage Adjustments According to Renal Function at Hospital Discharge

Abstract: Background:Adequate dosing of medication in renal impairment to prevent hospitalizations and adverse reactions is a growing concern in the aging society. There are several dosing guidelines available, but structural use is uncommon.Objective:To perform a retrospective analysis of the incidence of required versus implemented dosage adjustments according to guidelines in patients with renal insufficiency at discharge and evaluate specific determinants responsible for the percentage of overlooked dosage adjustments.Methods:Medication and laboratory data were collected from patients at discharge during February and November 2004. For patients with a calculated creatinine clearance less than 51 mL/min/1.73 m2, the necessity for dosage adjustments was evaluated by pharmacists. All data were collected for further research and subsequent statistical analysis.Results:At discharge, 237 of 647 (36.6%) patients had a calculated creatinine clearance less than 51 mL/min/1.73 m2. Dosage adjustment based on renal functio...