Background:Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with high rates of mortality and morbidity. Vancomycin is widely used for the treatment of pneumonia and bacteremia due to MRSA, despite treatment failure rates between 21% and 50%. Given the high rates of treatment failure with vancomycin, it is hypothesized that such failure may add a substantial burden to the health care system. Objectives:To estimate the hospital costs for patients treated with vancomycin for MRSA pneumonia and/or bacteremia, comparing costs between those who experienced treatment failure and those who experienced treatment success. Methods:This retrospective cohort study involved patients admitted to a Canadian hospital between 2014 and 2018 with MRSA pneumonia and/or bacteremia who were treated with vancomycin. Direct and indirect hospital costs and additional clinical data were obtained from the hospital database. All costs were inflated to 2024 Canadian dollars using the Consumer Price Index. A generalized linear model was used to estimate the adjusted difference in hospital costs between patients with and without treatment failure. Results:A total of 128 patients were included in the cohort, of whom 43 (34%) were identified as having treatment failure. Treatment failure was associated with significantly higher costs than treatment success, with an adjusted mean difference in total cost of $43 082 (95% confidence interval $2065 to $84 098). Those with treatment failure had higher rates of vasopressor use, greater need for intensive care, higher sequential organ failure assessment scores, greater need for mechanical ventilation, and higher rates of nephrotoxicity. Conclusions:Failure of vancomycin treatment for MRSA pneumonia and/or bacteremia significantly increased hospital costs.
Background:Hypotension is common among preterm and term neonates in the neonatal intensive care unit, particularly those with very low birth weight, sepsis, or hypoxic-ischemic encephalopathy. Some remain hypotensive despite volume expansion and vasopressors, possibly due to relative adrenal insufficiency. Hydrocortisone is proposed as adjunct therapy, but its effect on mortality is uncertain. Objective:To evaluate whether IV hydrocortisone reduces all-cause mortality in neonates with hypotension. Methods:The MEDLINE, Embase, CENTRAL, and Scopus databases were searched up to March 30, 2025, for randomized controlled trials (RCTs) that compared IV hydrocortisone with placebo and reported mortality. Two reviewers independently screened the studies, extracted data, and assessed bias. A fixed-effects Mantel-Haenszel meta-analysis was used, based on the degree of heterogeneity. Results:Five RCTs (with a total of 239 neonates) were included. Heterogeneity was low (I 2 = 0%). Hydrocortisone significantly reduced mortality (odds ratio 0.48, 95% confidence interval 0.24-0.96). Conclusions:IV hydrocortisone may reduce mortality in refractory neonatal hypotension. However, larger trials are needed to confirm this finding.
Background:To foster equity for vulnerable populations, hospital pharmacists should be motivated to acquire new knowledge in geriatrics. No tool specifically designed to assess their motivation in this area exists. Objectives:To assess the motivation of clinical pharmacists in Quebec university hospital centres who are not experts in geriatrics to participate in a knowledge transfer strategy developed by geriatric experts. Methods:A survey, constructed using a Delphi method, was conducted from July to October 2022. The topics covered by the survey included participants' perceptions, barriers faced, and openness to participating in a knowledge transfer strategy in geriatrics. Results:Of the 703 pharmacists invited to participate, 202 (28.7%) responded to the questionnaire. The average motivation score was 78.9/108 (standard deviation 5.8). No statistically significant difference was observed between pharmacists in critical care and those in other sectors, nor were there differences related to year of graduation. Conclusions:Clinical pharmacists working in Quebec university hospital centres seemed motivated to improve their knowledge in geriatrics.
Background:Involvement of pharmacists in discharge medication reconciliation (DMR) reduces readmissions when DMR is delivered as part of a medication management bundle. With current staffing and workload, pharmacists are unable to complete DMR for every inpatient. Consequently, it is necessary to prioritize patients for DMR interventions according to clinical need and risk. Objectives:To describe how pharmacists prioritize patients for DMR at a tertiary hospital; to identify facilitators of and barriers to pharmacist involvement in DMR; and to compare pharmacists' patient-priority assessment with scores derived using the Epic risk-of-unplanned-readmission, PRIME, and PADR-EC risk assessment tools. Methods:Pharmacists involved in DMR participated in focus groups to explore their DMR practices, including factors considered in patient prioritization, as well as facilitators of and barriers to their involvement in DMR. For patients on their service with an expectation of discharge within 48 hours, pharmacists used a questionnaire to rank DMR priority and indicate their intent to complete DMR. For each patient, the Epic, PRIME, and PADR-EC scores were collected and compared with the pharmacist's assessment. Results:A total of 13 pharmacists participated in 2 focus groups, and 11 of these pharmacists completed the questionnaire (for a total of 110 patients). Twenty-two unique factors and 27 subfactors for patient prioritization were identified. The top 5 factors were complex medication regimen, high-risk medications, medication changes, medication access, and length of stay. Facilitators and barriers were categorized into 6 themes: team dynamics, pharmacist workload, prior pharmacist involvement, process for DMR, discharge planning, and technology. Pharmacists' assessments appeared to differ from scores obtained with the 3 risk assessment tools. Conclusions:Pharmacists at the study institution lacked a consistent approach to prioritizing patients for DMR. Next steps will include developing and piloting a standardized process for prioritization.
