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1.
Am J Cardiol ; 161: 102-107, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34794606

RESUMO

Multidisciplinary Pulmonary Embolism Response Teams (PERTs) may improve the care of patients with a high risk of pulmonary embolism (PE). The impact of a PERT on long-term mortality has never been evaluated. An observational analysis was conducted of 137 patients before PERT implementation (between 2014 and 2015) and 231 patients after PERT implementation (between 2016 and 2019), presenting to the emergency department of an academic medical center with submassive and massive PE. The primary outcome was 6-month mortality, evaluated by univariate and multivariate analyses. PERT was associated with a sustained reduction in mortality through 6 months (6-month mortality rates of 14% post-PERT vs 24% pre-PERT, unadjusted hazard ratio of 0.57, Relative Risk Reduction of 43%, p = 0.025). There was a reduced length of stay following PERT implementation (9.1 vs 6.5 days, p = 0.007). Time from triage to a diagnosis of PE was independently predictive of mortality, and the risk of mortality was reduced by 5% for each hour earlier that the diagnosis was made. In conclusion, this study is the first to demonstrate an association between PERT implementation and a sustained reduction in 6-month mortality for patients with high-risk PE.


Assuntos
Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Equipe de Assistência ao Paciente/normas , Embolia Pulmonar/terapia , Terapia Trombolítica/normas , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/mortalidade , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
3.
Crit Care Med ; 49(2): e200-e201, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33438982
4.
Am J Emerg Med ; 45: 233-236, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33046300

RESUMO

PURPOSE: Evaluate the appropriateness of the timing of serum samples collected in the emergency department (ED) for tacrolimus (TAC) measurement. METHODS: Single-center, retrospective review of TAC samples collected in the ED from September 1 to October 31, 2017. The primary evaluation was incidence of inappropriate sample collection for TAC measurement, defined as samples not collected 12 h (±2 h; 10-14 h) after the last dose, or within 2 h of the next dose if last known dose time was not documented. Incidence of repeat TAC measurements obtained within 24 h of ED presentation (if initial sample collection inappropriate), inappropriate TAC regimen adjustments, and healthcare costs of inappropriate TAC measurements was evaluated. Data collection included patient demographics, ED visit information, TAC measurement and timing related to last or next dose, changes to TAC regimen, and ED disposition. Descriptive data are reported. RESULTS: Sixty-two patients were included. Forty-one (66%) initial TAC measurements were collected inappropriately in the ED. No patients had a regimen adjustment as a result of inappropriate concentration collection, but 32 patients (78%) did require a repeat measurement within 24 h of ED presentation due to initial inappropriate collection. Costs associated with incorrectly collected TAC measurements were $2,647.78 for the two-month time period and this is extrapolated to an estimated $15,886.68 annual expense for patients. CONCLUSIONS: Inappropriate sample collection for TAC measurements was common in the ED, resulting in frequent repeat laboratory draws and increased healthcare costs.


Assuntos
Monitoramento de Medicamentos , Serviço Hospitalar de Emergência , Imunossupressores/sangue , Tacrolimo/sangue , Transplantados , Monitoramento de Medicamentos/economia , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Prehosp Emerg Care ; 25(4): 588-592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32776812

RESUMO

The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of the trauma patient in both the prehospital and hospital setting.


Assuntos
Serviços Médicos de Emergência , Ketamina , Consenso , Serviço Hospitalar de Emergência , Hospitais , Humanos
6.
Ann Pharmacother ; 55(5): 605-610, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32969238

RESUMO

BACKGROUND: Intracranial hemorrhage (ICH) exclusion criteria in the landmark four-factor prothrombin complex concentrate (4F-PCC) trial have not been incorporated into clinical practice and incremental predictive ability is unknown. OBJECTIVES: Evaluate the association of meeting at least 1 ICH exclusion criterion with the composite end point in-hospital mortality and modified Rankin Scale [mRS] score 5 or 6. Determine the number and combination of criteria associated with poor outcomes. METHODS: Retrospective review of adult ICH patients who received 4F-PCC for anticoagulant reversal. Patient demographics, ICH exclusion criteria, in-hospital mortality, disability, and disposition were collected. χ2 Analysis and logistic regression were used to assess differences between patients with and without ICH exclusion criteria. RESULTS: Data from 167 patients were analyzed: 103 (61.7%) met at least 1 ICH exclusion criterion. The composite end point occurred more in those with at least 1 ICH exclusion criterion (74.8% vs 39%; P < 0.0001). Presence of 2 or more ICH exclusion criteria was associated with higher odds of the composite end point, higher mRS score, and long-term care facility disposition (P < 0.0001). Glasgow Coma Scale score <7 and at least 1 other ICH exclusion criterion had negative effects on composite end point and mortality: 95% to 100% and 85% to 100%, respectively. CONCLUSION AND RELEVANCE: Patients meeting at least 1 ICH exclusion criterion had greater death/disability compared with those who did not. More ICH exclusion criteria were associated with higher rates of death, disability, and worse disposition. These data may aid in developing optimal 4F-PCC use criteria.


Assuntos
Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/administração & dosagem , Pessoas com Deficiência , Mortalidade Hospitalar/tendências , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Am J Nurs ; 120(12): 48-52, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33214374

RESUMO

PURPOSE: The aim of this quality improvement (QI) project was to increase the coprescription of naloxone kits at patient discharge as a harm reduction strategy to combat the opioid epidemic. An interdisciplinary team identified hospitalized medical patients who were at high risk for an opioid overdose or opioid-related adverse event. METHODS: Led by a physician champion, an interdisciplinary QI team composed of physicians (MDs and doctors of osteopathic medicine), advanced practice providers (NPs and physician assistants), RNs, care coordinators, social workers, and pharmacists developed and implemented a naloxone distribution program on one medical unit at an academic tertiary care center. The team developed and implemented criteria to identify high-risk patients, workflow for patient screening, staff and patient education programs, and processes for naloxone kit delivery to the patient's bedside. Data on naloxone kit distribution from the seven months prior to implementation (March 2018 to September 2018) and the seven months after implementation (October 2018 to April 2019) were evaluated and are reported descriptively. RESULTS: Two patients preimplementation and 64 patients postimplementation received a naloxone kit at discharge. In the postimplementation group, common reasons for identifying a patient as at high risk for an overdose or adverse event were a prescription for a pain medication at a daily dosage greater than or equal to 50 morphine milligram equivalents (50% of patients), concomitant opioid and benzodiazepine use (19%), history of substance use disorder (11%), and medication-assisted treatment (9%). Most patients in the postimplementation group (86%) received a naloxone kit at a personal cost of $1 or less. CONCLUSION: This unit-based pilot project was successful in identifying patients at high risk for an opioid overdose or opioid-related adverse event and in providing naloxone kits and education at hospital discharge.


Assuntos
Analgésicos Opioides/uso terapêutico , Overdose de Drogas/prevenção & controle , Hospitais , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Alta do Paciente , Melhoria de Qualidade , Analgésicos Opioides/efeitos adversos , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Educação de Pacientes como Assunto , Projetos Piloto , Estudos Retrospectivos , Fatores de Risco
10.
Am J Health Syst Pharm ; 77(16): 1284-1335, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32766731

RESUMO

PURPOSE: To summarize recently published research reports and practice guidelines on emergency medicine (EM)-related pharmacotherapy. SUMMARY: Our author group was composed of 14 EM pharmacists, who used a systematic process to determine main sections and topics for the update as well as pertinent literature for inclusion. Main sections and topics were determined using a modified Delphi method, author and peer reviewer groups were formed, and articles were selected based on a comprehensive literature review and several criteria for each author-reviewer pair. These criteria included the document "Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009)" but also clinical implications, interest to reader, and belief that a publication was a "key article" for the practicing EM pharmacist. A total of 105 articles published from January 2011 through July 2018 were objectively selected for inclusion in this review. This was not intended as a complete representation of all available pertinent literature. The reviewed publications address the management of a wide variety of disease states and topic areas that are commonly found in the emergency department: analgesia and sedation, anticoagulation, cardiovascular emergencies, emergency preparedness, endocrine emergencies, infectious diseases, neurology, pharmacy services and patient safety, respiratory care, shock, substance abuse, toxicology, and trauma. CONCLUSION: There are many important recent additions to the EM-related pharmacotherapy literature. As is evident with the surge of new studies, guidelines, and reviews in recent years, it is vital for the EM pharmacist to continue to stay current with advancing practice changes.


Assuntos
Medicina de Emergência/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Papel Profissional
11.
Thromb Res ; 194: 158-164, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32788109

RESUMO

INTRODUCTION: Prothrombin complex concentrates (4F-PCC) for anticoagulation reversal pose a risk of thromboembolism although data are limited. This study aims to quantify thromboembolic events (TE) and describe associations. MATERIALS AND METHODS: Retrospective, two-center, study of patients receiving 4F-PCC between September 2013 and December 2017 for warfarin or direct oral anticoagulant (DOAC) reversal. Primary outcome was in-hospital TE incidence and secondary outcomes were to describe characteristics associated with TE. Data are reported descriptively and analyzed with bivariate and multivariate analyses. RESULTS: 542 patients were included (mean age 73 ± 14 years, 58% male, 76.6% warfarin/23.4% DOAC reversal). Most had intracranial hemorrhage (68.5%) or were undergoing an emergent procedure (13.4%). Fifty patients (9.2%) experienced in-hospital TE and most (62%) occurred within 7 days of 4F-PCC. Younger age (66 vs. 74 years, p < 0.01), presence of a hypercoagulable risk factor (46% vs. 26%, p < 0.01), indication for anticoagulation (p = 0.008), higher 4F-PCC dose (2148 vs. 2000 units, p < 0.01), and longer hospital length of stay (LOS) (21.5 vs. 7 days, p < 0.01) were associated with TE following bivariate analysis. Multivariate analysis identified anticoagulation indication of venous thromboembolism or "other" (e.g., antiphospholipid syndrome, Factor V Leiden) were independently associated with higher incidence of TE compared to receiving anticoagulation for atrial arrhythmia (p = 0.05). Hospital LOS ≥ 7 days was associated with threefold greater odds of TE compared to <7 days (p = 0.003). CONCLUSIONS: In-hospital TE following 4F-PCC was 9.2%, most events occurred within 7 days, and younger age, indication for anticoagulation, and LOS were independently associated with TE which may influence treatment selection.


Assuntos
Fatores de Coagulação Sanguínea , Tromboembolia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fatores de Coagulação Sanguínea/uso terapêutico , Feminino , Humanos , Incidência , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboembolia/induzido quimicamente , Tromboembolia/tratamento farmacológico , Tromboembolia/epidemiologia
12.
Am J Health Syst Pharm ; 77(19): 1619-1624, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32814962

RESUMO

OBJECTIVES: Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and make recommendations for future practice. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.


Assuntos
Cuidados Críticos , Serviço de Farmácia Hospitalar , Estado Terminal , Humanos , Farmacêuticos , Papel Profissional , Melhoria de Qualidade
13.
Crit Care Med ; 48(9): 1375-1382, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826489

RESUMO

OBJECTIVES: Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.


Assuntos
Cuidados Críticos/organização & administração , Estado Terminal , Unidades de Terapia Intensiva/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Humanos , Melhoria de Qualidade , Sociedades Médicas , Sociedades Farmacêuticas
14.
Crit Care Med ; 48(9): e813-e834, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826496

RESUMO

OBJECTIVES: To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS: There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS: Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.


Assuntos
Cuidados Críticos/organização & administração , Estado Terminal , Unidades de Terapia Intensiva/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Melhoria de Qualidade , Sociedades Médicas , Sociedades Farmacêuticas
16.
Prehosp Disaster Med ; 35(3): 272-275, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32279692

RESUMO

INTRODUCTION: The opioid epidemic has led to the wide-spread distribution of naloxone to emergency personnel and to the general public. Recommended storage conditions based on prescribing information are between 15°C and 25°C (59°F and 77°F), with excursions permitted between 4°C and 40°C (39°F and 104°F). Actual storage likely varies widely with potential exposures to extreme temperatures outside of these ranges. These potentially prolonged extreme temperatures may alter the volume of naloxone dispensed from the nasal spray device, which could result in suboptimal efficacy. STUDY OBJECTIVE: The aim of this study was to assess the naloxone volume deployed following nasal spray device storage at extreme temperatures over an extended period of time. METHODS: Naloxone nasal spray devices were exposed to storage temperatures of -29°C (-20°F), 20°C (68°F), and 71°C (160°F) to simulate extreme temperatures and a control for 10 hours. First, the density was measured under each temperature condition. Following the density calculation part of the experiment, the mass of naloxone dispensed from each nasal spray device at each temperature was captured and used to calculate volume: calculated volume (microliter, µl) = spray mass (mg converted to g)/mean density (g/mL). Measurements and calculations are reported as means with standard deviation and standard error, and a one-way ANOVA was used to evaluate mean dispensed volume differences at different temperatures. RESULTS: There was no difference in the mean volume deployed at -29°C (-20°F), 20°C (68°F), and 71°C (160°F), and measurements were 101.44µl (SD = 9.56; SE = 5.52), 99.01µl (SD = 6.31; SE = 3.64), and 108.28µl (SD = 2.04; SE = 1.18), respectively; P value = .289, F-statistic value = 1.535. CONCLUSION: The results of this study suggest that naloxone nasal spray devices will dispense the appropriate volume, even when stored at extreme temperatures outside of the manufacturer's recommended range.


Assuntos
Naloxona/química , Antagonistas de Entorpecentes/química , Administração Intranasal , Armazenamento de Medicamentos , Desenho de Equipamento , Temperatura Alta , Humanos , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Sprays Nasais
17.
Infect Dis Clin North Am ; 34(1): 109-127, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32008694

RESUMO

Given the large number of patients seen in the emergency department (ED) and concerns with antibiotic overprescribing, the ED is an important setting to target for antimicrobial stewardship (AS) initiatives. The ED is positioned between ambulatory and inpatient settings, making AS collaboration with clinicians and other health care providers in the hospital, long-term care facilities, and ambulatory settings critical to success. This article details ED-focused AS strategies on empiric antimicrobial selection, prompt administration, preventing ED return and readmissions, suggested collaborations between ED AS leadership and other key partners, and potential future strategies for expansion.


Assuntos
Gestão de Antimicrobianos/métodos , Serviço Hospitalar de Emergência , Pessoal de Saúde , Colaboração Intersetorial , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Prescrições de Medicamentos/normas , Medicina de Emergência/métodos , Medicina de Emergência/organização & administração , Humanos
18.
Am J Emerg Med ; 38(12): 2564-2569, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31932132

RESUMO

PURPOSE: Evaluate opioid prescribing before and after emergency department (ED) renal colic guideline implementation focused on multi-modal pain management. METHODS: Retrospective study of ED patients who received analgesia for urolithiasis before and after guideline implementation. The guideline recommends oral acetaminophen, intravenous (IV) ketorolac, and a fluid bolus as first line, IV lidocaine as second line, and opioids as refractory therapy to control pain. Opioid exposure, adverse effects, length of stay (LOS), and ED representation were evaluated. Comparisons were made with univariate analyses. Backwards stepwise binomial multivariate logistic regression to identify factors related to opioid use was performed. RESULTS: Overall, 962 patients were included (451 pre- and 511 post-implementation). ED and discharge opioid use decreased; 65% vs. 58% and 71% vs. 63% in pre- and post-implementation groups, respectively. More post-implementation patients received non-opioid analgesia (65% vs. 56%) and non-opioid analgesia prior to opioids (50% vs. 38%). A longer ED LOS and higher initial pain score were associated with ED opioid administration. Guideline implementation, receiving non-opioid therapy first, and first renal colic episode were associated with decreased ED opioid administration. Seventeen adverse events (1.8%) were reported. There was no difference in change in ED pain score between groups, but patients in the post-implementation group were admitted more and had a higher 7-day ED representation (11% vs. 7%). CONCLUSIONS: A multimodal analgesia protocol for renal colic was associated with decreased opioid prescribing, higher rates of admission to the hospital, and a higher 7-day ED representation rate.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Cetorolaco/uso terapêutico , Lidocaína/uso terapêutico , Cólica Renal/tratamento farmacológico , Administração Intravenosa , Administração Oral , Adulto , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Cólica Renal/etiologia , Cálculos Urinários/complicações
19.
J Pharm Pract ; 33(1): 63-73, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29558852

RESUMO

PURPOSE: Review selected sexually transmitted infections (STIs) and treatment recommendations for pharmacists and providers practicing in the acute care setting. SUMMARY: In 2015, the Centers for Disease Control and Prevention (CDC) published an updated guideline on the treatment of STIs with an emphasis on prevention and new diagnostic strategies to combat the growing problem of STIs in the United States. Despite this guidance, the incidence of infection has continued to grow. In October 2016, an in-depth analysis reported that 20 million new infections occur annually in the United States. With this growing burden of disease, it is pertinent that health-care providers optimize their treatment strategies to improve upon the management of STIs. Focusing on identification of asymptomatic- and symptomatic-infected persons, treatment, education, effective follow-up, and counseling for patients and sexual partners, emergency medicine pharmacists and providers can help minimize the negative long-term health consequences of STIs. CONCLUSION: In the emergency department setting, clinical pharmacists and providers can play a crucial role in preventing and treating STIs and should continue to expand and keep current their knowledge of this topic.


Assuntos
Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/epidemiologia , Chlamydia , Aconselhamento , Serviço Hospitalar de Emergência , Epididimite , Feminino , Gonorreia , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Masculino , Doença Inflamatória Pélvica , Farmacêuticos , Profilaxia Pós-Exposição , Gravidez , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Simplexvirus , Sífilis , Tricomoníase , Estados Unidos , Vaginose Bacteriana
20.
West J Emerg Med ; 22(2): 297-300, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33856315

RESUMO

INTRODUCTION: Opioid exposure has been identified as a contributing factor to the opioid epidemic. Reducing patient exposure, by altering heavy opioid prescribing patterns but appropriately addressing patient pain, may represent one approach to combat this public health issue. Our goal was to create and implement an opioid education program for emergency medicine (EM) interns as a means of establishing foundational best practices for safer and more thoughtful prescribing. METHODS: This was a retrospective study at an academic, urban emergency department (ED) comparing ED and discharge opioid prescribing practices over a 12-week time period for two 14-intern EM classes (2016 and 2018) to evaluate an early opioid reduction education program. The education program included opioid prescribing guidelines for common ED disease states associated with moderate pain, clinician talking points, and electronic education modules, and was completed by EM interns in July/August 2018. Opioid prescription rates per shift were calculated and opioid prescribing best practices described. We used chi-squared analysis for comparisons between the 2016 and 2018 classes. RESULTS: Overall, ED and discharge opioid orders prescribed by EM interns were fewer in the 2018 class that received education compared with the 2016 class. ED opioid orders were reduced by 64% (800 vs 291 orders, rate per shift 1.8 vs 0.7 orders) and opioid discharge prescriptions by 75% (279 vs 70 prescriptions, rate per shift 0.7 vs 0.2 prescriptions). The rate of prescribing combination opioid products compared to opioids alone was decreased for ED orders (32% vs 16%, P < 0.01) and discharge prescriptions (91% vs 74%, P < 0.01) between the groups. Also, the median tablets per discharge prescription (14.5 vs 10) and total tablets prescribed (4305 vs 749) were reduced, P < 0.01. There were no differences in selection of opioid product or total morphine milligram equivalents prescribed when an opioid was used. CONCLUSION: An opioid reduction education program targeting EM interns was associated with a reduction in opioid prescribing in the ED and at discharge. This may be an effective way to influence early prescribing patterns and best practices of EM interns.


Assuntos
Analgésicos Opioides/efeitos adversos , Educação Médica Continuada/métodos , Medicina de Emergência/educação , Prescrição Inadequada/prevenção & controle , Dor/tratamento farmacológico , Alta do Paciente , Padrões de Prática Médica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Centros Médicos Acadêmicos , Analgésicos Opioides/administração & dosagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
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