Vancomycin use, dosing and serum trough concentrations in the pediatric population: a retrospective institutional review

Background: Vancomycin is used primarily for Gram-positive infections. Recommended dosage regimens and targeted therapeutic levels vary between institutions.Objectives: This study aims to describe therapeutic levels according to initial vancomycin doses and patient’s age. A secondary objective was to evaluate appropriateness of vancomycin use in our hospital.Methods: A retrospective chart review was conducted at the Children’s Hospital of Eastern Ontario. Patients included in this study were classified by age (neonates, infants, children and adolescents) and categorized into those who received vancomycin ≤5 and >5 days. Initial vancomycin dosing regimens and corresponding initial trough levels obtained were evaluated. Initial trough levels drawn in relation to the third, fourth, or fifth doses corresponding to the first course of therapy were analyzed. Acceptable trough levels ranged from 5-20 mg/L.Results: One-hundred-and-sixty-four patients who received intravenous vancomycin in 2013 were included. Of the 229 courses of vancomycin, 190 (83%) were used 5 days or less (mean 4.9 days). Sixteen infants (88.9%) and 21 adolescents (100%), who received vancomycin empiric dosing of 60 mg/kg/day, had initial trough levels >5mg/L. However, in the children’s group 20 (37.7%) did not reach levels >5 mg/L. None of vancomycin minimum inhibitory concentration (MIC) values were >1mg/L for the four patients who had infections due to methicillin-resistant Staphylococcus aureus strains.Conclusions: In our institution, initial empiric vancomycin dosing of 60 mg/kg/day resulted in levels ≥5mg/L in most infants and adolescents. It remains unclear why some children aged 1-12 years did not achieve these levels

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

Objective: The objectives of this study are to describe opioid stewardship practices in hospitals being implemented globally, in addition to investigating the attitudes and perceptions of health professionals regarding opioid stewardship in the hospital setting. Methods: A survey was developed by the research team to ask about participants’ attitudes and perceptions regarding opioid stewardship practices. The survey was piloted for performance by five independent third-party healthcare professionals prior to being made available online, being hosted using Research Electronic Data Capture software, with invitations distributed by the International Pharmaceutical Federation (FIP). Descriptive analyses were used to describe the features of the study, and responses obtained from the survey were further categorised into subgroups separating answers relating to attitudes and perceptions, and policies and regulations. Results: Overall, there were 50 respondents from 18 countries, representing an 8% response rate from the FIP hospital pharmacy section mailing list. In total, 33/50 (66%) participants agreed opioids are overused nationally, with 22/49 (45%) agreeing they are overused at their workplace. Furthermore, 32/50 (64%) agreed the opioid crisis is a significant problem nationally, and 44/50 (88%) agreed opioid stewardship would reduce problems associated with the opioid crisis. Policies to educate providers about safe opioid prescribing were uncommon, not exhibited in 26/46 (57%) of hospitals, with all EMR and SE Asia hospitals not displaying this policy. Policy for investigation of narcotic discrepancies was present in 34/46 (74%) of hospitals, and there was a policy for reporting discrepancies at 33/46 (72%) hospitals. Conclusion: In conclusion, healthcare professionals in the American region are more likely to perceive the opioid crisis as a problem, as opposed to those from the European region. Regardless of the presence or absence of a crisis, the implementation of further opioid education and stewardship practices are necessary globally and will contribute to safer prescribing and utilisation practices in hospitals

Patient satisfaction survey of the “Healthy Heart” pharmaceutical care service – evaluation of pharmacy labelling with pharmaceutical pictograms

Abstract Introduction Low adherence is a major challenge in healthcare worldwide, being particularly dangerous for patients with chronic diseases, such as cardiovascular diseases and heart failure, where strict adherence is essential. Non-adherence is observed in almost half of patients, and the consequences encompass a lack of therapeutic effects, health deterioration, decreased quality of life, and even death. For cardiovascular patients, the great importance of health education and pharmaceutical education can be provided within pharmaceutical care in community pharmacies. Therefore, our study aimed at evaluating the level of satisfaction with the “Healthy Heart” pharmaceutical service, in which patients received pictograms with dosage information affixed to their medication. Material and methods The study was designed for patients who had been prescribed an antiplatelet medication for the first time. The patients were recruited by 577 pharmacies that took part in the study after completing a special course. Ultimately, 1590 patients were enrolled in the study. The project ran from November 2019 to January 2022. Results Most of patients had a positive attitude to the “Healthy Heart” pharmaceutical service. More than 85% of the respondents were of the opinion that the pictograms facilitated the use of the medication, and 81.7% of the respondents stated that the system of labels helped in adherence. Over 66% of the respondents thought that such labels should be included in pharmacy services, and 77.92% of the participants reported that this system of labelling medications should be offered through all pharmacies. Conclusions Pharmaceutical labels in the pharmacists’ everyday practice can largely improve patient adherence. These efforts, provided as part of their pharmaceutical services, can have a huge influence on optimisation of patient health outcomes

Flu Vaccinations in Pharmacies—A Review of Pharmacists Fighting Pandemics and Infectious Diseases

The phenomenon of population ageing observed over recent years involves growing healthcare needs and the limited staffing and financing of healthcare systems, and as such demands some functional changes in the healthcare model in many countries. This situation is particularly significant in the face of a pandemic, e.g., flu, and currently COVID-19.As well as social education, preventive vaccinations are the most effective method of fighting the infectious diseases posing a special threat to seniors. Despite this, the vaccination coverage level in most European countries is relatively low. This is largely due to patients having limited access to vaccinations. In some countries, implementing vaccinations in pharmacies and by authorized pharmacists has significantly improved vaccination coverage rates and herd immunity, while lowering the cost of treating infections and the resulting complications, as well as minimizing the phenomenon of inappropriate antibiotic therapies. This article presents the role of pharmacists in the prevention of infectious diseases, pointing out the measurable effects of engaging pharmacists in conducting preventive vaccinations, as well as analyzing the models of implementing and conducting vaccinations in pharmacies in selected countries, and depicting recommendations regarding vaccinations developed by international organizations. The presented data is used to suggest requirements for the implementation of preventive vaccinations in community pharmacies

A Globally Optimal k-Anonymity Method for the De-Identification of Health Data

Background: Explicit patient consent requirements in privacy laws can have a negative impact on health research, leading to selection bias and reduced recruitment. Often legislative requirements to obtain consent are waived if the information collected or disclosed is de-identified. Objective: The authors developed and empirically evaluated a new globally optimal de-identification algorithm that satisfies the k-anonymity criterion and that is suitable for health datasets. Design: Authors compared OLA (Optimal Lattice Anonymization) empirically to three existing k-anonymity algorithms, Datafly, Samarati, and Incognito, on six public, hospital, and registry datasets for different values of k and suppression limits. Measurement: Three information loss metrics were used for the comparison: precision, discernability metric, and non-uniform entropy. Each algorithm's performance speed was also evaluated. Results: The Datafly and Samarati algorithms had higher information loss than OLA and Incognito; OLA was consistently faster than Incognito in finding the globally optimal de-identification solution. Conclusions: For the de-identification of health datasets, OLA is an improvement on existing k-anonymity algorithms in terms of information loss and performance