Purpose The available literature has shown that the presence of an Emergency Medicine Pharmacist (EMP) is associated with decreased time to medication procurement, a reduction in medication errors, and overall cost avoidance. However, there is limited literature that systematically evaluates the impact of EMPs in the treatment of critically ill trauma patients presenting to the emergency department (ED). Methods This study was a retrospective chart review evaluating 1082 adult patients presenting to the critical care area (CCA) of the ED at the University of Louisville Hospital in Louisville, Kentucky for trauma evaluation from July 2014 to December 2014. The study group consisted of patients presenting to the CCA when an EMP was present. Primary outcomes included time to administration of antibiotics, analgesia medication, sedation medication, rapid sequence intubation (RSI), and anticoagulation reversal. Secondary outcomes included time to administration of appropriate antibiotics at an appropriate dose and vaccination administration. Results The presence of an EMP was associated with a statistically significant decreased median time from triage to the administration of an analgesic medication (11 minutes [interquartile range (IQR) 8‐27] vs 13 minutes [IQR 8.5‐20], P = 0.04). There was no statistically significant difference in triage time to antibiotic administration, RSI, sedation medication administration, or anticoagulation reversal. Patients in the EMP group were more likely to receive appropriate empiric antibiotics compared with the control group (80.7% vs 52.2%, P = 0.01). Conclusion The presence of an EMP was associated with decreased time to analgesia medication administration as well as an increased likelihood of the administration of appropriate empiric antibiotics in critically ill trauma patients.
Domestic violence (DV) is a pervasive public health issue due to its high prevalence and the adverse effects it can have on individuals. Standardized measures can fail to account for within-group differences that are salient among diverse populations. The current review aims to systematically review and organize the psychometric studies of culturally responsive DV measures. The goal of the review is to inform researchers and practitioners about the validity and reliability of the existing measures to facilitate measure selection. Studies were included if they were validation studies of a DV measure, published in English in a peer-reviewed journal, demonstrated cultural responsivity, and provided evidence of validity or reliability. A total of seven studies were identified. Findings from this review showed that most participants were from South Asia or were South Asian immigrants. Some culturally specific tactics included being treated like a servant, eating last, being burned, and in-laws abuse. Most measures included in this review demonstrated compelling evidence of validity and reliability. More research is needed to develop and validate culturally responsive measures with distinctly diverse populations. Valid and reliable culturally responsive measures can be helpful for DV and non-DV service providers to precisely assess DV and provide appropriate services while documenting accurate DV prevalence rates.
Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4-20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.
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