Introduction: Thrombocytopenia is a common and potentially severe adverse effect of linezolid, but the time to onset during treatment has varied substantially across studies. Moreover, the time to recovery after linezolid withdrawal has not been examined in a larger patient sample. Objective: The first objective of this study was to measure the mean time to linezolid-induced thrombocytopenia (LIT) and the second was to measure the mean time to recovery after linezolid discontinuation. Methods: A retrospective observational cohort study was conducted between January 2017 and December 2022 at Dammam Medical Complex using the medical records of hospitalized adults with normal baseline platelet counts receiving intravenous linezolid for a minimum of 48 hours. All patients included in the analyses received daily platelet count monitoring for up to 14 days after linezolid initiation and 14 days after discontinuation. Thrombocytopenia was defined as a drop in platelet count to < 150 × 10 9 /L or < 50% of baseline within 14 days. The dose duration–risk relationship and recovery rate were analyzed by constructing Kaplan–Meier survival curves. Results: In total, 334 patients met study inclusion criteria. The mean time to develop thrombocytopenia after starting linezolid was five days, and the mean time of recovery was also 5 days. The cumulative risk of thrombocytopenia reached 100% by day six of therapy, and cumulative recovery reached 100% by day six after linezolid withdrawal, with half of the study population recovering by day four. Conclusion: Thrombocytopenia can develop rapidly during linezolid treatment, but recovery after discontinuation is also rapid. Rapid thrombocytopenia is a common adverse effect of linezolid that must be considered prior to prescription, and routine monitoring of platelet count is recommended so that linezolid treatment can be discontinued, if thrombocytopenia occurs. Keywords: linezolid, thrombocytopenia, induced, recovery
Saudi Arabia is one of the countries facing the emergence of antimicrobial resistance (AMR). The pharmacist is an important stakeholder in the healthcare system who plays a crucial role in avoiding AMR and implementing antimicrobial stewardship (AMS).A cross-sectional design was used in this study. The online questionnaire collected data regarding the enablers that have helped in preparing pharmacists to handle AMR and the barriers faced by pharmacy personnel in handling AMR, as well as the strategies used to overcome the identified barriers.A total of 109 participants were included in the study. Just under two thirds (62.4%) of participants were female and the majority (70.6%) worked as pharmacists. Just under half (41.7%) had between 6 and 10 years of work experience. Three quarters (74.3%) had antimicrobial stewardship in place and around the same number (73.4%) were involved in handling infectious disease management during the COVID-19 pandemic. Pharmacists have found that preparatory items/tasks, pharmacy college curriculum, pharmacy rotation, years of experience and self-education related to AMR handling to be natural, with a mean of 3.2. The participants found all the barriers - insufficient background, in site education and training, limited time, limited CPD activities, limited educational tools and no free access to relevant clinical journals - to be relevant, with a mean of 4.05. The participants found all the enablers - CPD activities, funded educational programs, allowing time for self-education, accessible educational resources and tools, annual evolution of competencies - to be relevant, with a mean of 4.12.The study concluded that the barriers preventing the handling of AMR could be overcome through allowing pharmacists more time for self-directed continuous education, providing access to tools and online educational resources, and offering pharmacists funded courses to equip them with the knowledge, skills and competencies needed to handle AMR.
Background: Diversity in clinical practice may become a problem and increase the risk of errors. Several tools have been suggested to reduce this diversity and improve unification in clinical practice. These tools include the clinical pathway, clinical guidelines, and practice protocol. They have been proven effective. However, there are different barriers to their application. Methods and Data Analysis: A cross-sectional survey in the Eastern Province of the Kingdom of Saudi Arabia aimed to identify the availability of the clinical pathway, clinical guidelines, and practice protocol and their benefits, as well as barriers in their development and utilization. Both quantitative and qualitative analyses were used to evaluate the study results. Findings are presented as numbers and percentages. Results: Clinical pathway, clinical guidelines, and practice protocol are available to a large extent in the Eastern Province. The study showed some difficulties in the development and implementation of these tools, such as insufficient training and leader support. It also provided some suggestions to overcome these barriers. Conclusion: The availability of clinical pathway, clinical guidelines, and practice protocol has helped unify practice and reduce errors in the clinical setting. The barriers can be overcome by different solutions.
Hospital at Home (H@H) is a method of healthcare delivery, where hospital level interventions are conducted in the patient's usual place of residence, offering an alternative to hospital admission. This often includes the ability to perform point of care diagnostics and treat conditions using a range of treatments traditionally associated with hospital admission, including intravenous medicines and oxygen. H@H services have been established worldwide but there is a wide variation in definition and delivery models and currently no documented evidence supporting the delivery of medicines and medicines management within the H@H model. Therefore, this study aims to 1) describe how medication management in H@H is conceptulised, 2) describe and identify key components of medication management in H@H and 3) describe and identify variability in the implementation of medication management services within H@H models.We will search a range of databases (PubMed, Medline, Embase, CINAHL), publicly accessible documents and expert recommendations. Studies, reports and policy documents published between 1st January 2000 and 31st January 2022 will be included. Two independent reviewers will 1) screen and select studies based on a priori inclusion/exclusion, 2) conduct quality assessment using the Mixed Methods Appraisal Tool on included studies and 3) extract data. Inductive thematic analysis (objectives 1 and 2), the SEIPS 2.0 model (objective 2) and the Consolidated Framework for Implementation Research (objective 3) will be used to synthesise data.This systematic review will use secondary data sources from published documents, and as such research ethical approval was not required. We will disseminate the findings of this study in a peer-reviewed journal and national/international conference(s).PROSPERO registration number: CRD42022300691. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300691.
There is a strong imperative to support people with dementia to live independently in their homes for as long as possible. A starting point is to understand how they manage medications on a daily basis.
Abstract Introduction Hospital at Home (H@H) is a method of healthcare delivery, where hospital level interventions are conducted in the patient’s usual place of residence, offering an alternative to hospital admission. This often includes the ability to perform point of care diagnostics and treat conditions using a range of treatments traditionally associated with hospital admission, including intravenous medicines and oxygen. H@H services have been established worldwide but there is a wide variation in definition and delivery models and currently no documented evidence supporting the delivery of medicines and medicines management within the H@H model. Therefore, this study aims to 1) describe how medication management in H@H is conceptulised, 2) describe and identify key components of medication management in H@H and 3) describe and identify variability in the implementation of medication management services within H@H models Methods and Analysis We will search a range of databases (PubMed, Medline, Embase, CINAHL), publicly accessible documents and expert recommendations. Studies, reports and policy documents published between 1 st January 2000 and 31 st January 2022 will be included. Two independent reviewers will 1) screen and select studies based on a priori inclusion/exclusion, 2) conduct quality assessment using the Mixed Methods Appraisal Tool on included studies and 3) extract data. Inductive thematic analysis (objectives 1 and 2), the SEIPS 2.0 model (objective 2) and the Consolidated Framework for Implementation Research (objective 3) will be used to synthesise data. Ethics and dissemination This systematic review will use secondary data sources from published documents, and as such research ethical approval was not required. We will disseminate the findings of this study in a peer-reviewed journal and national/international conference(s). PROSPERO registration number CRD42022300691 Strengths and limitations of this study The search will be performed on a comprehensive range of databases and relevant information sources to capture a global perspective relating to Hospital at Home (H@H). A wide range of search terms will be used in our search, however due to the changing nature of H@H, some terms may be unintentionally missed. Only published literature will be synthesized in this systematic review, and it is recognised that in a rapidly changing environment not all practices will be captured in written form. A combination of thematic synthesis, a work systems model (Systems Engineering Initiative for Patient Safety 2.0) and the Consolidated Framework for Implementation Research will be used to provide a system-level analysis of studies. The study team consists of four pharmacists from a range of practice and research backgrounds and a H@H consultant, therefore, will benefit from different perspectives on the topic area.
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