No abstract

Background: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

Objective: Domestic antimicrobial usage is the third-highest among the OECD countries, and the incidence of adverse drug reactions (ADRs) due to the use of antimicrobials is reported to be higher than other drug groups. Considering the high antimicrobial usage in Korea, this study aimed to investigate the incidence and risk factors of major antimicrobial-related ADRs in Korean medical environment. Methods: The data were retrospectively collected among 998 randomly selected hospitalized patients, who were prescribed one or more antimicrobials from January 1, 2017 to March 31, 2017. We defined the signals that reflect allergic reaction, hematologic toxicity (neutropenia, thrombocytopenia), nephrotoxicity, hepatotoxicity, antimicrobial-induced diarrhea, and Clostridium difficile-associated diarrhea (CDAD). Patients with abnormal signals were assessed for causality by retrospective review of the medical records and risk factors were analyzed. Results: In 998 patients, 118 (11.8%) experienced at least one antimicrobial-related ADRs. The most common type of ADRs was CDAD (3.7%), followed by thrombocytopenia (3.2%), nephrotoxicity (3.1%), hepatotoxicity (2.1%), antimicrobial-induced diarrhea (1.5%) and neutropenia (1.5%). The risk factors for antimicrobial related ADRs were age over 65, renal disease, diabetes, cancer, duration of hospitalization over 14 days, average duration of antimicrobial uses over 14 days, and intensive care unit admission. Conclusion: By investigating the incidence of antimicrobial-related ADRs in single institute, we could identify the risk factors of antimicrobial-related ADRs. When antimicrobials are used in the patients with identified risk factors, careful attention should be paid to prevent antimicrobial-related ADRs.

This report describes a dog diagnosed with insertional biceps tendinopathy that was palliated with intra-articular triamcinolone acetonide injections. The patient was a 6-year-old spayed female Chihuahua dog that had left thoracic limb lameness for 3 months before presentation. On physical examination, moderate pain was elicited by performing the biceps test and isolated full elbow extension on the left thoracic limb.Gait analysis showed asymmetrical peak vertical force and vertical impulse between thoracic limbs. Computed tomography (CT) revealed enthesophyte formation on the ulnar tuberosity of the left elbow joint. Ultrasonography showed a heterogeneous fibre pattern at the biceps tendon insertion site on the left elbow joint. These findings confirmed insertional biceps tendinopathy based on physical examination, CT and ultrasonography results. The dog received an intra-articular triamcinolone acetonide injection with hyaluronic acid in the left elbow joint. Clinical signs improved after the first injection, including a range of motion, pain and gait. A second injection was given in the same manner because of recurring mild lameness 3 months later. No clinical signs were observed during the follow-up period.