Implementation of a medication delivery service for ambulatory oncology infusion patients.

OBJECTIVE: Patients receiving infusions for the treatment of cancer are commonly prescribed supportive care medications which are filled through retail pharmacies. The initial phase of the COVID-19 pandemic created hurdles for patients to receive supportive care medications due to concerns related to exposure risk. Meds-to-Chemo Chairs (M2CC) was created allowing an onsite retail pharmacy to dispense and hand-deliver supportive care prescriptions to patients in the infusion suite. The purpose of this study was to assess the value of this program. DATA SOURCES: The volume of prescriptions dispensed through the M2CC service, as well as the financial impact, was tracked through the prescription software system used by the onsite retail pharmacy dispensing and delivering the medications. DATA SUMMARY: Through the first 2.5 years of the program, M2CC has delivered over 13,000 prescriptions with an estimated gross revenue of $3.5 million. CONCLUSIONS: The M2CC medication delivery program has proved to be highly successful and feasible.

Hematological adverse events in the management of glioblastoma.

BACKGROUND: Hematological adverse events (HAEs) are common during treatment for glioblastoma (GBM), usually associated with temozolomide (TMZ). Their clinical value is uncertain, as few investigations have focused on outcomes for HAEs during GBM treatment. METHODS: We combined data from two randomized clinical trials, RTOG 0525 and RTOG 0825, to analyze HAEs during treatment for GBM. We investigated differences between chemoradiation and adjuvant therapy, and by regimen received during adjuvant treatment. RESULTS: 1454 patients participated in these trials, of which 1154 (79.4%) developed HAEs. During chemoradiation, 44.4% of patients developed HAEs (54% involving more than one cell line), and were most commonly lymphopenia (50.6%), and thrombocytopenia (47.5%). During adjuvant treatment, 45% of patients presented HAEs (78.6% involving more than one cell line), and were more commonly leukopenia (62.7%), and thrombocytopenia (62.3%). Median overall survival (OS) and progression free survival (PFS) were longer in patients with HAEs (OS 19.4 months and PFS 9.9 months) compared to those with other or no adverse events (OS 14.1 months and PFS 5.9 months). There was no significant difference in survival between grade 1 and/or 2 versus grade 3 and/or 4 HAEs. History of HAEs during chemoradiation was a protective factor for presentation of HAEs during adjuvant therapy. CONCLUSION: HAEs are common during GBM treatment, and often involve more than one cell line (more likely during adjuvant therapy). HAEs may be associated with prolonged OS and PFS, particularly during adjuvant therapy. HAEs during chemoradiation was a protective factor for HAEs during adjuvant therapy.

Association of time to antibiotics and clinical outcomes in adult hematologic malignancy patients with febrile neutropenia.

Objective The objective of this study was to determine the clinical impact of time to antibiotic administration in adult inpatients who have hematologic malignancies and develop febrile neutropenia. Methods A retrospective chart review was conducted to screen for all febrile neutropenia events amongst adult hematologic malignancy patients between 1 January 2010 and 1 September 2014. All included patients were admitted to the hospital at the time of fever onset, having been admitted for a diagnosis other than febrile neutropenia. Descriptive statistics and logistic generalized estimated equations were used to analyze the data. Results Two hundred forty-four neutropenic fever events met inclusion criteria. Thirty-five events (14.34%) led to negative clinical outcomes (in-hospital mortality, intensive care unit transfer, or vasopressor requirement), with an in-house mortality rate of 7.4%. The time to antibiotics ranged from 10 min to 1495 min. The median time to antibiotics in the events that led to negative outcomes was 120 min compared to 102 min in the events that did not lead to the negative outcome ( p = 0.93). Conditional order sets were used to order empiric antibiotics in 176 events (72.1%) and significantly reduced time to antibiotics from 287 min to 143 min ( p = 0.0019). Conclusion Prolonged time to antibiotic administration in hematologic malignancy patients who develop neutropenic fever was not shown to be associated with negative clinical outcomes.

Factors associated with optimized tacrolimus dosing in hematopoietic stem cell transplantation.

OBJECTIVE: The primary objective was to analyze the initial tacrolimus concentrations achieved in allogeneic hematopoietic stem cell transplantation patients using the institutional dosing strategy of 1 mg IV daily initiated on day +5. The secondary objectives were to ascertain the tacrolimus dose, days of therapy, and dose changes necessary to achieve a therapeutic concentration, and to identify patient-specific factors that influence therapeutic dose. The relationships between the number of pre-therapeutic days and incidence of graft-versus-host disease and graft failure were delineated. METHODS: A retrospective chart review included adult allogeneic hematopoietic stem cell patients who received tacrolimus for graft-versus-host disease prophylaxis in 2012. Descriptive statistics, linear and logistic regression, and graphical analyses were utilized. RESULTS: Ninety-nine patients met the inclusion criteria. The first concentration was subtherapeutic (<10 ng/ml) in 97 patients (98%). The median number of days of tacrolimus needed to achieve a therapeutic trough was 10 with a median of two dose changes. The median therapeutic dose was 1.6 mg IV daily. Approximately 75% of patients became therapeutic on ≤ 2 mg IV tacrolimus daily. No relationship was found between therapeutic dose and any patient-specific factor tested, including weight. No relationship was found between the number of days of therapy required to achieve a therapeutic trough and incidence of graft-versus-host disease or graft failure. CONCLUSION: An initial flat tacrolimus dose of 1 mg IV daily is a suboptimal approach to achieve therapeutic levels at this institution. A dose of 1.6 mg or 2 mg IV daily is a reasonable alternative to the current institutional practice.

Application and interview features used to assess applicant qualifications for residency training.

PURPOSE: To determine what factors residency program directors (RPDs) consider and what methods they use to assess applicants. METHODS: Respondents ranked the importance of 27 applicant features within domains: academics/credentials, application features/program fit, involvement, professional experience, research/ teaching experience, and postgraduate year 1 (PGY-1) residency experience. Rank was assigned in an ordinal fashion (1 = most important feature). The domains were characterized by their importance (mean % ± SD) in selecting candidates for interviews. Participants characterized their screening process according to 8 application and 6 interview features and the corresponding applicant dimensions evaluated. RPDs rated the importance of 14 methods applicants used to communicate with the program and 3 methods by which references were obtained. A Likert scale was used for rating (4 = crucial features). The approaches the program used to evaluate 12 application features or interpersonal interactions were reported. RESULTS: The most important application domain was application features/program fit (26.28 ± 19.11). The highest ranked application feature was program fit (2.04 ± 1.17). The applicant's cover letter, recommendation letters, curriculum vitae, and interview meal were commonly used to assess communication and interpersonal skills, knowledge base, and experience. The most important communication venue was the on-site interview (3.95 ± 0.23). Recommendations solicited by RPDs (3.42 ± 0.69) were most important. Programs formally evaluated the interview (89%) and recommendation letters (84%). CONCLUSION: Understanding the importance that RPDs place on application and interview features, as well as the process used to assess communication skills and interpersonal interactions, should allow residency candidates to become more competitive residency prospects.

Impact of PhORCAS references on overall application score for postgraduate year 1 pharmacy residency candidates.

PURPOSE: The disparity between the number of applicants for postgraduate year 1 (PGY1) pharmacy residency positions and the number of available residency positions increases the need to optimize how applicants are evaluated. The purpose of the study described here was to evaluate the correlation of ratings of residency candidate characteristics by academic and professional references listed on residency applications with overall application score, applicant ranking, and the likelihood of candidates receiving an invitation to interview. METHODS: A multicenter, retrospective study was conducted to evaluate the correlation of reference writers' ratings of 13 candidate characteristics and their overall recommendations with program-determined outcomes (eg, final application score, applicant ranking, and invitation to interview) through analysis of PGY1 applications submitted through the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2015 through 2018. Keywords and themes within the open-ended section of letters of reference were also analyzed for correlation with overall application score. RESULTS: A total of 5,923 references listed on 1,867 applications to 4 PGY1 pharmacy residency programs processed by PhORCAS were included in the analysis. For the majority of applicant characteristic ratings (ie, 74% of 56,872 ratings overall), reference writers rated candidates as exceeding expectations, and applicants were "highly recommended" by these evaluators in 91% of cases. References' average characteristic ratings and overall recommendations were poorly correlated with final application score (R2 = 0.12 [P < 0.0001] and R2 = 0.08 [P < 0.0001], respectively), final ranking (R2 = 0.02 [P < 0.0001] and R2 = 0.03 [P < 0.0001], respectively), and invitation to interview (R2 = 0.07 [P < 0.0001] and R2 = 0.04 [P < 0.0001], respectively). For the themes evaluated, references' use of teaching words best correlated with normalized final application score, although the correlation was poor (R2 = 0.007, P = 0.0001). CONCLUSION: Reference writers' ratings of PGY1 residency candidate characteristics in PhORCAS are poorly correlated with application score, applicant ranking, and invitation to interview. The results of this study suggest that the existing PhORCAS standardized form for submitting references is of limited utility in its current state.