International journal of clinical pharmacy
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Background Italy has been the first non-Asian country affected by Coronavirus Disease 19 (COVID-19) pandemic. Community pharmacies are essential services authorized to continue their activity during the emergency. To date, a clear image is lacking of the critical issues Italian community pharmacists had to face and of how they responded in their daily work.. ⋯ In Red Zones, there was a higher use of FFP2 and FFP3 masks by pharmacists, where customers were mainly interested in gaining information about specific classes of medications. Conclusion Community pharmacists adapted to lockdown measures by implementing a number of measures. There was an overall increase in pharmacists' personal protective equipment in Red Zones possibly linked to increased risk perception.
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Observational Study
Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States.
Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. ⋯ The 30 day readmission rates did not differ between patients with and without pharmacist review (27.4% vs. 26.2%, p = 0.38). Conclusion: Pharmacist review of discharge prescriptions resulted in clinically significant interventions but did not impact readmission rates. An incremental increase in the number of discharge prescriptions was associated with pharmacist intervention.
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Review Meta Analysis
Duloxetine for the reduction of opioid use in elective orthopedic surgery: a systematic review and meta-analysis.
Background Duloxetine is currently approved for chronic pain management; however, despite some evidence, its utility in acute, postoperative pain remains unclear Aim of the review This systematic review and meta-analysis is to determine if duloxetine 60 mg given perioperatively, is safe and effective at reducing postoperative opioid consumption and reported pain following elective orthopedic surgery. Method CINAHL, Medline, Cochrane Central Registry for Clinical Trials, Google Scholar, and Clinicaltrials.gov were searched using a predetermined search strategy from inception to January 15, 2019. Covidence.org was used to screen, select, and extract data by two independent reviewers. ⋯ Adverse effects included an increase in insomnia with duloxetine but lower rates of nausea and vomiting. Meta-analysis revealed statistically significant [mean difference (95% CI)] lower total opioid use with duloxetine postoperatively at 24 h [- 31.9 MME (- 54.22 to - 9.6), p = 0.005], 48 h [- 30.90 MME (- 59.66 to - 2.15), p = 0.04] and overall [- 31.68 MME (- 46.62 to - 16.74), p < 0.0001]. Conclusion These results suggest that adding perioperative administration duloxetine 60 mg to a multimodal analgesia regimen within the orthopedic surgery setting significantly lowers total postoperative opioid consumption and reduces pain without significant adverse effects.
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Background Pharmacists have a key role to play in identifying and responding to emerging clinical problems with prescribed opioids. A pilot study in Australia examined the implementation of screening and brief intervention (Routine Opioid Outcome Monitoring [ROOM]) to identify and respond to opioid-related problems in community pharmacies. In this implementation study, the rate of screening varied considerably between pharmacies. ⋯ A multivariable analysis revealed that each additional decade practicing, lower knowledge of naloxone and lower confidence in identifying unmanaged pain were all independently associated with reduced engagement in screening after controlling for other variables. Conclusion Findings from this pilot study identified potential barriers to implementing opioid outcome monitoring. Further studies could test different groups of community pharmacists' experience of different barriers when implementing monitoring outcomes with prescribed opioids, to inform future implementation and clinical practice.
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Background Concurrent opioid and benzodiazepine use ("double-threat") and opioid, benzodiazepine, and muscle relaxant use ("triple-threat") are linked to increased adverse events compared to opioid use alone. Objectives To assess prevalence of double-threat and triple-threat in the US and to measure association between double- and triple-threat and emergency department visits. Setting Nationally representative, 2-year health database of the United States. ⋯ Double-threat patients had increased emergency department visit probability with ORs of 4.57 (95% CI 4.56-4.58) in 2013, 6.66 (95% CI 6.65-6.68) in 2014, and 4.49 (95% CI 4.48-4.50) for 2013-2014 analysis compared to non-users. Conclusions Concurrent opioid and benzodiazepine use and opioid, benzodiazepine, and muscle relaxant use increased probability of emergency department visit. Amplified efforts in surveillance, prescribing, and default follow-up for concurrent opioid, benzodiazepine, muscle relaxant use are needed to reduce this public health concern.