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Background: To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential benefits of treating low-dose alteplase, as opposed to standard-dose alteplase, prior to MTE among patients with LVO-AIS.Aim: The aim of the study was to compare outcomes of low- vs. standard-dose of bridging intravenous alteplase before MTE among LVO-AIS patients.Methods: We performed a retrospective analysis of LVO-AIS patients who were treated with either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in Northern Vietnam. Multivariable logistic regression models, accounting for potential confounding factors including comorbidities and clinical factors (e.g., stroke severity), were used to compare the outcomes between the two groups. Our primary outcome was functional independence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondary outcomes included any ICH incidence, early neurological improvement, recanalization rate, and 90-day mortality.Results: We analyzed data of 107 patients receiving bridging therapy, including 73 with low-dose and 34 with standard-dose alteplase before MTE. There were no statistically significant differences between the two groups in functional independence at 90 days (adjusted OR 1.02, 95% CI 0.29–3.52) after accounting for potential confounding factors. Compared to the standard-dose group, patients with low-dose alteplase before MTE had similar rates of successful recanalization, early neurological improvement, 90-day mortality, and ICH complications.Conclusion: In the present study, patients with low-dose alteplase before MTE were found to achieve comparable clinical outcomes compared to those receiving standard-dose alteplase bridging with MTE. The findings suggest potential benefits of low-dose alteplase in bridging therapy for Asian populations, but this needs to be confirmed by further clinical trials.

Background: This study investigated COVID-19 related psychological distress among expectant and new mothers, with and without infection, in metropolitan New York. It also examined the trajectories of participants' distress during pregnancy and postpartum, and the moderating effect of socioeconomic status (SES). Methods: An online survey was conducted April through June 2020 among expectant and new mothers with infants (<12 months) (N=642). Associations between infection status and psychological symptoms, suicidal ideation, and substance use were examined. Changes in distress related to COVID-19 infection and SES were then examined. Results: We found elevated anxiety and depression among infected compared to uninfected women. Similarly, infected, compared to uninfected women, had elevated risk for suicidal thoughts (quite often, AOR=3.97, sometimes AOR=13.2), and for substance use [alcohol (AOR=3.30); tobacco (AOR=4.54); cannabis (AOR=7.01); heroin (AOR=7.09); cocaine (AOR=10.05)]. Differences in trajectories of distress across pregnancy between the two groups were significant. Among infected women, distress was consistently high throughout. Among uninfected women, it started low and intensified toward the end of pregnancy. SES further moderated the impact of infection on distress. During earlier trimesters, infected/low SES women had greatest, and uninfected/high SES women had lowest, levels of distress. Their trajectories converged nearing childbirth.Conclusions: New and expectant mothers, especially those infected, have suffered substantial psychological distress due to the pandemic. Moreover, SES moderated the trajectory of distress. Infected women who also had low SES experienced the highest distress levels among all groups. Mitigating strategies are imperative to alleviate this distress.

Objective Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. Methods A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. Results Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. Conclusion The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.

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Pharmacists in the community and ambulatory settings are primed for collaboration that can optimize care. Now is the time to capitalize on the momentum and positive disruption of the COVID‐19 pandemic that propelled pharmacists and their organizations to respond with agility to deliver care in new ways, pivot to develop new partnerships, and leverage technology. The growth of collaborative practice agreements within ambulatory care settings, the enhancement of clinically integrated networks, and the growth in professional organization support create an environment ripe for implementation of pharmacist‐to‐pharmacist collaborations. The American College of Clinical Pharmacy 2022 Clinical Practice Affairs B Committee sought out literature, as well as prepublication contemporary examples, demonstrating models of intraprofessional collaboration among pharmacists in community and ambulatory settings. The committee formulated six key recommendations to optimize pharmacist collaborations in the community and ambulatory settings and formed a framework for practical implementation strategies at the levels of individual pharmacists, organizations, and educational institutions and for legislative advocacy.

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