Abstract: Vancomycin trough (Vt) concentrations of 15–20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15–20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive care unit (PICU). The primary objective was to determine if a difference exists in the incidence of renal injury in PICU patients receiving a β-lactam as compared with vancomycin therapy with Vts of 15–20 mcg/mL. This was a retrospective cohort study conducted within a PICU within a freestanding tertiary care pediatric hospital. The records of children admitted to the PICU between 10/2008–6/2009 who received vancomycin for ≥48 h targeting higher Vt concentrations of ≥15 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This cohort (V group) was compared to children admitted from July 2009–July 2013 who received cefepime or piperacillin/tazobactam for ≥72 h (B group). Serum creatinine values were collected from 48 h before until 48 h after discontinuation of therapy for calculation of estimated glomerular filtration rate. Renal injury was categorized according to pRIFLE. 57 and 112 patients were included in the V and B groups, respectively. The mean (SD) therapeutic dose of vancomycin was 63.5(17.3) mg/kg/day and the mean (SD) trough was 17.8(3.1). The mean (SD) dose of cefepime was 51(26) mg/kg/dose with an every 8 h interval. The mean (SD) dose of piperacillin/tazobactam was 77(22) mg/kg/dose with an every 6 h interval. The mean (SD) PRISM scores were 10.9(10.2), 4.24(6.4) for the V and B groups, respectively (p < 0.001). Five of 57 and 10 of 112 patients in the V and B groups, respectively, were classified as having injury according to pRIFLE. No patient was classified as having a degree of renal injury greater than the pRIFLE injury. The incidence of renal injury was 8.8% in the V group and 8.9% in the B group, respectively (p = 1). Our observations suggest that maintaining Vt concentrations ≥15 mcg/mL is not associated with an increased rate of renal injury as compared with β-lactam monotherapy in a PICU population.
Abstract: Although clinical pharmacy training in Pakistan is a novelty in the undergraduate pharmacy curriculum, it has significantly improved the practical knowledge of the undergraduate students with regards practice of pharmacy in health care settings. The implementation of the curriculum change was a major innovation but the possible negative implications were not contemplated at the time of execution and combined with a failure in regular review and assessment of the plan. This led to undesirable outcomes such as breaching of health care protocols and ethics by students, inadequate aptitude and poor clinical research skills. These shortcomings were analyzed and an evidence based improvement program known as the Evidence Based Improvement (EBI) initiative was designed containing structured modules to empower undergraduates in those areas. It was implemented by the authorities and has led to positive outcomes which render it very useful and this improvement program can serve as a guide to develop clinical pharmacy training programs in those countries where the practice of pharmacy is evolving.
Abstract: A pediatric compounded non-sterile products repository (pCNP) to optimize the effectiveness and safety of “off-label” use of compounded pharmacotherapy through complete transmission of electronic prescriptions across the continuum of care is described. The advent of electronic prescribing has the potential to refocus and resolve long-standing issues of prescription therapy for pediatric patients related to formulation, indication, dosing, and outcomes follow-up, among others. This white paper describes the architecture and function of the pCNP repository. Further, it calls on professional societies, health information technology (HIT) and pharmaceutical industries, universities, and government to create a safer pediatric pharmacotherapy system across the continuum of care. This system would include pCNPs within the existing federal and corporate database structures for medical language, and integrates advanced system safety features as requirements for prescribing, compounding, and dispensing non-mass produced prescription therapies for children.
Abstract: We aimed to assess the impact of a professional development course on clinical pharmacists’ level of confidence using physical assessment (PA) and whether it resulted in changes to their clinical practice. Workshopparticipants were asked to complete a pre-workshop survey, as well as three post-workshop surveys, to assess the pharmacists’ level of confidence in PA. Pharmacists were also asked about their integration of PA skills and use of Additional Prescribing Authority (APA). Pharmacists’ confidence in performing PA, discussing PA findings, and using PA to manage drug therapy were significantly higher at all time-points post workshop. Pharmacists with APA also indicated increased confidence with prescribing. Professional development in physical assessment may provide opportunities for pharmacists to integrate new knowledge and skills within their practice. Future research should examine if such educational opportunities will support sustainable practice change.
Abstract: The inclusion of pharmacists in the healthcare system of a developing country like Pakistan has always been a subject of debate among the healthcare professionals (HCPs), especially physicians, who have long ruled the healthcare system alone and who have had a long-held position of supremacy. The common argument against the inclusion of pharmacists is the dynamics of the healthcare system, and patients being physician oriented, hence, consider the inclusion of pharmacists as no good. Although the trend of defiance is changing, it is worthwhile mentioning here that the concept of the inclusion of pharmacist was implemented in developed countries by an evidence-based approach, i.e., to actually involve pharmacists in the disease state management of a patient and conducting a trial. This opinion calls for the same to be implemented in a developing country like Pakistan to evaluate its significance.