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A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care.

There is currently no evidence to support or refute the routine use of closed-system drug transfer devices in addition to safe handling of infusional hazardous drugs, as there is no evidence of differences in exposure or financial benefits between CSTD plus safe handling versus safe handling alone (very low-quality evidence). None of the studies report health benefits.Well-designed multicentre randomised controlled trials may be feasible depending upon the proportion of people with exposure. The next best study design is interrupted time-series. This design is likely to provide a better estimate than uncontrolled before-after studies or cross-sectional studies. Future studies may involve other alternate ways of reducing exposure in addition to safe handling as one intervention group in a multi-arm parallel design or factorial design trial. Future studies should have designs that decrease the risk of bias and enable measurement of direct health benefits in addition to exposure. Studies using exposure should be tested for a relevant selection of hazardous drugs used in the hospital to provide an estimate of the exposure and health benefits of using CSTD. Steps should be undertaken to ensure that there are no other differences between CSTD and control groups, so that one can obtain a reasonable estimate of the health benefits of using CSTD.

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The short-lived relief of pain in acute exudative pharyngitis in children with suspected infectious mononucleosis may suggest that a single oral dose of dexamethasone may not be sufficient and that additional doses may be necessary for ensuring lasting relief.

ObjectivesThe objectives of this study were to review economic data on the use of closed system drug transfer devices (CSTDs) for preparing and administering hazardous drugs, and to evaluate the quality of data reporting as defined by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).MethodsAll references from a recent Cochrane review about CSTDs were evaluated for inclusion. A literature review was also conducted. Articles containing economic data about the use of CSTDs were retained for analysis. Two researchers independently graded the articles according to the 24-item CHEERS checklist.ResultsOf the 138 articles identified initially, 12 were retained for analysis. Nine of these studies did not report acquisition costs or did not detail acquisition costs. Six studies reported economic benefits associated with the used of CSTDs, all related to extending the beyond-use date. The mean number of CHEERS criteria fulfilled by the included articles was 9.2 (SD 2.4).ConclusionsCSTDs are costly to acquire. However, few studies have examined the economic impact of these devices, and the existing studies are incomplete. As a result, hospitals planning to implement these devices will be unable to make a sound economic evaluation. Robust economic evaluation of CSTDs is needed.

INTRODUCTION: Difficult separation from bypass (DSB) is an important issue in cardiac surgery and has been associated with increased postoperative complications. However the impact of DSB on overall mortality is unknown. Furthermore there are no consensus on the definition of DSB. Therefore the impact of DSB on mortality was studied through a retrospective database analysis on two cohorts of patients from two major cardiac surgical centers in the province of Quebec over a 9-year period. In addition a consensus of the definition of DSB was obtained and validated prospectively. METHODS: For quality assurance and research, the Montreal Heart Institute (MHI) and the Quebec Heart & Lung Institute (QHLI) maintain a database of all their patients operated on. The first studied cohort consists of 4993 consecutive patients operated between 1995 to 1999 at the MHI. The MHI definition for DSB was the use of vasoactive agents (noradrenaline >15 µg/min, milrinone, dobutamine, dopamine >5 µg/min), intraaortic balloon pump (IABP) or return on CPB for hemodynamic reasons. The primary end-point was mortality. The importance of DSB was also studied on the second cohort, which consisted of 5000 patients operated at the QHLI from 2001 to 2004. RESULTS: In the first cohort, 179 deaths occurred (3.6%). DSB was significantly associated with mortality (OR: 3.11;

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