Background: Hospital pharmacists participate in activities that may be considered diagnostic. Two reasoning approaches to diagnosis have been described: non-analytic and analytic. Of the 6 analytic traditions, the probabilistic tradition has been shown to improve diagnostic accuracy and reduce unnecessary testing. To the authors' knowledge, pharmacists' attitudes toward having a diagnostic role and their diagnostic knowledge and skills have never been studied.
Background:Posttransplant lymphoproliferative disorder (PTLD) is a major complication following kidney transplantation.Objective:We undertook this study to characterize PTLD in kidney transplant patients in British Columbia with regard to incidence, patient and graft survival, histological subtypes, treatment modalities, and management of immunosuppression.Design:Retrospective cohort analysis.Setting:British Columbia.Patients:All adult patients who underwent kidney transplantation in British Columbia between January 1, 1996, and December 31, 2012, were included. Patients less than 18 years of age at the time of first transplant and multiple organ transplant recipients were excluded from analysis.Measurements:Patients with lymphoproliferative disorders that occurred subsequent to kidney transplantation were considered to have developed PTLD.Methods:Cases of PTLD were identified by cross-referencing data abstracted from the provincial transplant agency’s clinical database with the provincial cancer agency’s lymphoma registry. Patients were followed up for the development of PTLD until December 31, 2012, and for outcomes of death and graft failure until December 31, 2014. Data collection was completed via an electronic chart review.Results:Of 2217 kidney transplant recipients, 37 (1.7%) developed PTLD. Nine cases were early-onset PTLD, occurring within 1 year of transplant; of these cases, 6 were known/presumed Epstein-Barr virus mismatch, compared with only 2 of 28 late-onset cases. Patient survival for early-onset PTLD was 100% at 2 years post diagnosis. Late-onset PTLD had survival rates of 71.4% and 67.9% at 1 and 2 years, respectively. PTLD was associated with significantly decreased patient survival (P = .031) and graft survival (uncensored for death, P = .017), with median graft survival of PTLD and non-PTLD patients being 9.5 and 16 years, respectively. Immunosuppressant therapy was reduced in the majority of patients; additional therapies included rituximab monotherapy, CHOP-R, radiation, and surgery.Limitations:Limitations to this study include its retrospective nature and the unknown adherence of patients to prescribed immunosuppressant regimens. In addition, cumulative doses of immunosuppression received and the degree of immunosuppression reduction for PTLD management were not effectively captured.Conclusions:The incidence of PTLD in British Columbia following kidney transplantation was low and consistent with rates reported in the literature. The incidence of late-onset PTLD and its association with reduced patient and graft survival warrant further analysis of patients’ long-term immunosuppression.
Background: The Opioid Stewardship Program (OSP) was created to promote safe and rational prescribing of opioids, where the risks associated with providing opioids for patients must be balanced against the risk of patients experiencing uncontrolled pain. The pharmacist-led OSP was established at 2 Fraser Health Authority (FHA) sites, British Columbia, to provide clinical services through patient referrals and screening. The rate of acceptance of OSP pharmacists’ recommendations has been high, but there was a need to assess clinicians’ perceptions of the program. Objectives: To assess the perceptions of health care professionals at FHA hospitals offering the OSP regarding various aspects of the program and to identify areas of the program that could be modified to further optimize service delivery. Methods: A prospective cross-sectional survey was distributed to about 250 targeted health care professionals, who answered questions regarding their perceptions of the OSP. Data were analyzed using simple descriptive statistics. Results: A total of 71 respondents initiated the survey, of whom 59 were included in the final analyses. Most participants indicated that the OSP pharmacists’ suggestions were valuable for optimizing pain management (52/57, 91%) and preventing adverse events (49/56, 88%). Most participants were satisfied with the quality of communication (51/56, 91%), timeliness to consults (51/52, 98%), and recommendations provided (52/55, 95%). Increasing knowledge transfer, improving communication about intentions for patient follow-up, and expanding services at current sites and to other sites were recommended to improve the OSP. Conclusions: Clinicians responding to the survey reported a high level of satisfaction with and positive views of the pharmacist-led OSP. Providing more education and clarifying intentions for patient follow-up are modifications that could be made to improve the program. RÉSUMÉ Contexte : L’Opioid Stewardship Program (OSP) [programme de gestion des opioïdes] a été mis sur pied pour encourager la prescription sûre et rationnelle d’opioïdes qui permet de peser les risques associés à leur délivrance contre les risques que le patient ressente une douleur incontrôlée. L’OSP, dirigé par les pharmaciens, a été mis en place sur 2 sites de la Fraser Health Authority (FHA) (Colombie-Britannique) afin de fournir des services cliniques par l’entremise de l’aiguillage et du dépistage des patients. Le taux d’acceptation des recommandations des pharmaciens de l’OSP était élevé, mais il était nécessaire d’évaluer la perception des cliniciens à l’égard du programme. Objectifs : Évaluer les perceptions des professionnels de la santé dans les hôpitaux de la FHA offrant l’OSP à l’égard de divers aspects du programme et cerner ceux qui pourraient être modifiés pour optimiser la prestation de services. Méthodes : Une enquête prospective transversale a été distribuée à environ 250 professionnels de la santé ciblés, qui ont répondu à des questions portant sur leur perception de l’OSP. Les données ont été analysées à l’aide de statistiques descriptives simples. Résultats : Au total, les réponses de 71 répondants ont fait l’objet d’analyses. La plupart des participants ont indiqué que les suggestions des pharmaciens de l’OSP étaient utiles pour optimiser la gestion de la douleur (52/57, 91 %) et prévenir les événements indésirables (49/56, 88 %). La plupart des participants étaient satisfaits de la qualité de la communication (51/56, 91 %), de la rapidité des consultations (51/52, 98 %) et des recommandations fournies (52/55, 95 %). Les recommandations suivantes ont été formulées pour améliorer l’OSP : amélioration du transfert des connaissances; amélioration de la communication sur les intentions de suivi des patients; et élargissement des services sur les sites actuels et à d’autres sites. Conclusions : Les cliniciens qui ont répondu au sondage ont fait état d’un niveau élevé de satisfaction et d’opinions positives à l’égard de l’OSP dirigé par les pharmaciens. Une formation accrue et la clarification des intentions quant au suivi des patients sont des modifications qui pourraient être apportées en vue d’améliorer le programme.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.