2023-2024 Houston Methodist Pharmacy Annual Report

2023-2024

HOUSTON METHODIST POSTGRADUATE PHARMACY RESIDENCY & FELLOWSHIP CLASS

Houston Methodist Department of Pharmacy

The Department of Pharmacy at Houston Methodist collaborates with the health care team to provide innovative, personalized, cost-effective pharmaceutical care in a culture dedicated to quality and safety.

The pharmacy department’s vision is to be recognized as a global leader of pharmaceutical care in the health care setting. To that end, we strive to:

• Continuously improve the quality and safety of patient care and the medication management process.

• Cultivate an environment of collaboration and teamwork.

• Provide high-quality training and education to our technicians, student interns, residents and pharmacists.

• Maximize the use of automation and information technology.

• Maximize cost efficiencies and resource utilization.

2

Letter from Daniel L. Metzen, PharmD, MBA

System Director of Pharmacy Services, Houston Methodist

3 Letter from Michael G. Liebl, PharmD, BCPS

System Director of Clinical Pharmacy Services, Houston Methodist Hospital

4 Letter from Jill C. Krisl, PharmD, BCPS, BCTXP Chair of Pharmacy Research Committee

5 Pharmacy Research Committee Members

6

11

PGY1 Pharmacy Residency

Benjamin Deike, PharmD

Madeline Murphy, PharmD

Rachel Ou, PharmD

Nicholas Palma, PharmD

Priya Patel, PharmD

PGY1 International Graduates

Pharmacy Residency

Hsing-Yi Lin, PharmD

Mealis Taouk, PharmD

13

PGY1 Pharmacy Residency – Sugar Land

Alex Fan, PharmD

Stephanie Ngan, PharmD 15 PGY1 Pharmacy

Residency – Willowbrook

Faith Rutherford, PharmD

PGY1/PGY2 HealthSystem Pharmacy Administration Residency

Alexis Hyman, PharmD

Kaline Korzec, PharmD

Atra Mouser, PharmD

Luning Shi, PharmD 20

PGY1/PGY2 Pharmacy Informatics Residency

Akraam Abdel-Kerem, PharmD, MS, MBA

Haley Blanck, PharmD, MS

22 PGY2 Critical Care Pharmacy Residency

Aliya Abdulla, PharmD

Donna Barakeh, PharmD

24 PGY2 Infectious Diseases

Pharmacy Residency

Shemual Tsai, PharmD

25 PGY2 Internal Medicine

Pharmacy Residency

Christopher Nelson, PharmD

26

PGY2 Oncology

Pharmacy Residency

Duc Huynh, PharmD

Prakruti Gandhi, PharmD

Taylor Praska, PharmD

29 PGY2 Solid Organ Transplant

Pharmacy Residency

Erika Powe, PharmD

Zoe Tu, PharmD

LETTER FROM THE SYSTEM DIRECTOR OF PHARMACY SERVICES

Excellence. It’s been a central theme throughout the tenure of the Houston Methodist Pharmacy Research Committee (PRC) and this program year has been no different. As the program grows progressively across the HM system of hospitals, we couldn’t be prouder of our residents and pharmacy staff for their exceptional contributions to fostering patient-centered medication safety. The PRC is a vital component for clinical and administrative operations and works closely with leadership to focus on treatment optimization through solution-based research. The Pharmacy Research Committee has strived for continuity in the development of successful approaches to complex challenges and has had their efforts acknowledged both locally and nationally.

We celebrate the amazing research accomplishments of the PRC for 2023-2024 which includes 23 new publications regarding relevant subject matter that will assist in the improvement of quality of care and innovation in pharmacy practice. A few of the recent publications were:

• “Implementation and evaluation of an EHR-integrated perpetual inventory in a large tertiary hospital Oncology pharmacy”

• “Real-world data of cardio-oncology interventions for cardiovascular adverse events with oral oncolytics”

• “Descriptive analysis evaluating the use of direct oral anticoagulation therapy in heart and lung transplant recipients”

Moving forward, we are committed to the continued cultivation of talent and the promotion of the pursuit of excellence as a standard across Houston Methodist for the foreseeable future. Thank you to all who assist in this mission for your support and we are excited for what lies ahead.

Daniel L. Metzen, PharmD, MBA

System Director of Pharmacy Services, Houston Methodist

Alex Varkey, PharmD, MS, FAPhA, being swarn in as the President of the APhA

PGY2 Critical Care Pharmacy Residency, 2023 ASHP Residency Excellence Award Winner. Pictured (Left to Right): Donna Barakeh, PharmD, PGY2 Critical Care Resident; Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM; PGY2 Critical Care Residency Program Director; Aliya Abdulla, PGY2 Critical Care Resident

Hannah Chan, PharmD, BCCCP, 2024 New Preceptor Award

Punit Shah, PharmD, BCIDP, 2024 Established Preceptor Award

LETTER FROM THE DIRECTOR OF SYSTEM CLINICAL PHARMACY SERVICES

On behalf of the Houston Methodist Pharmacy System Clinical Leadership Team, I want to share our congratulations and appreciation to our 2023-2024 pharmacy resident graduates, our pharmacy research committee leaders, and our many preceptors who supported the research highlighted in this annal report. Each residency year presents our residents, preceptors, and departments with unique research opportunities. This academic year was no different. This year, Houston Methodist pharmacy successfully transitioned to a Centralized Pharmacist Order Verification (CPOV) model. This endeavor was greatly supported by our pharmacy residency programs. This year’s class, building on contributions of previous year’s residents, supported the design, implementation, measurement of outcomes, and the continual refinement of the program. Assessing the impact on the changing nature of pharmacy work toward a more virtual model was the focus of several resident research reports highlighted in this publication. These reports provide a glimpse of the innovation in care models being tested at Houston Methodist and will help define our future practice.

Our resident-led research advanced medical knowledge through several investigations related to medication outcomes in critical care, oncology, anticoagulation, transplant patient care, and infectious diseases. Furthermore, HM pharmacy residents’ continuous quality improvement investigations were again essential components of our proactive medication safety program that produces the highest quality, most reliable, and safest patient care.

Behind all our residents’ successes are our gifted, dedicated preceptors. This year we honored two who stand above the rest. Hannah Chan, PharmD, BCCCP (Clinical Specialist in Emergency Medicine – Houston Methodist Sugar Land) and Punit Shah, PharmD, BCIDP (Clinical Specialist in Infectious Diseases – Houston Methodist Sugar Land) were recognized as our 2024 New Preceptor Award and Established Preceptor Award respectively. The New Preceptor Award recognizes excellence in pharmacy resident precepting within the first 3-5 years of practice while the Established Preceptor Award recognizes preceptors with 8 or more years of exceptional precepting.

The Houston Methodist Division of Pharmacy’s members and programs continue to be recognized as leaders nationally. This academic year, Houston Methodist Hospital’s PGY2 Critical Care Pharmacy Residency was awarded the highest honor afforded to a pharmacy residency training program by the American Society of Health System Pharmacy (ASHP). Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM along with our 2023-2024 critical care residents accepted the honor at the 2023 ASHP Midyear Clinical Meeting. In March, our Houston Methodist Hospital Director of Pharmacy, Alex Varkey, PharmD, MS, FAPhA, became the President of the American Pharmacists Association (APhA), the largest pharmacy association in the US. Since his induction, Dr. Varkey has been on a literal world-wide tour advocating for the pharmacy profession and representing Houston Methodist along the way. We could not ask for a better ambassador for the pharmacy profession and Houston Methodist.

We were excited this year to expand the research report with a contribution from Houston Methodist Willowbrook’s inaugural PGY1 pharmacy resident, Faith Rutherford. Houston Methodist Willowbrook earned a full 8-year term of accreditation, the maximum available. The ASHP surveyors remark how unique Houston Methodist is regarding the level of system coordination among the training programs and services. Because of that purposeful alignment and consistently high standards, we understand that an award or accolade for one program is a reflection of all our programs. I look forward to the start of our Houston Methodist West program for the 2024-2025 academic year. With each residency program added, we foster professional engagement among our leaders and a resilient patient care service. We are capable of growing our own pharmacist experts who embrace our values, work-ethic, and passion to advance pharmacy.

Thank you,

Michael G. Liebl, PharmD, BCPS Director, System Clinical Pharmacy Services, Houston Methodist

LETTER FROM THE PHARMACY RESEARCH COMMITTEE CHAIR

Welcome to our Department of Pharmacy’s ninth edition of the Annual Research Report. This report serves to showcase the dedication to research and patient care of the pharmacy department across the Houston Methodist Hospital system.

The pharmacy department continues to strive towards the advancement of pharmacy practice and patient care across the hospital system. Over the course of the 20232024 residency year, members of our pharmacy department have lead research collaborations within internal medicine, infectious diseases, transplant, critical care, anticoagulation, and oncology patient populations, as well as research in informatics and pharmacy management. Department research has been presented at local and national platforms, including in our own hospital at the Seventh Annual Pharmacy Research Committee (PRC) Symposium in June 2024.

The mission of the PRC is to ensure excellence in the quality of research conducted and the research training provided by the Department of Pharmacy at Houston Methodist. The PRC has continued to optimize established programs including project development, project proposal approval, resident project alignment, support, education, visibility, and building a more robust research infrastructure and partnership with the Research Institute. Over recent years, we have enhanced our educational programming through collaboration with experts in the research field including manuscript writing and statistics. We look forward to applying additional innovative ways to our programming to enhance the research experience for our residents and our clinical teams.

The PRC continues to expand to meet our growing residency programs across the system. We are 15 committee members strong. Members of the PRC represent the pharmacy department across the system hospitals and clinical specialties. Our Department of Pharmacy preceptors, residents, and staff remain committed to high quality and innovative patient care, education, research, leadership and advocacy. As always, our goals are grounded in our mission to be unparalleled. I am forever grateful for the dedication and hard work of this committee and am proud to serve as its Chair.

Jill C. Krisl, PharmD, BCPS, BCTXP Chair, Pharmacy Research Committee

PHARMACY RESEARCH COMMITTEE MEMBERS

Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM Vice Chair

Punit Shah, PharmD, BCPS, BCIDP Education Lead

Chelsea Lopez, PharmD, BCCCP Project Development Lead

Hayley Brazeale, PharmD, BCPS Project Approval Lead

Godsfavor Umoru, PharmD, BCOP Project Alignment Lead

Alex Rogers, PharmD, BCPS Member

Will Musick, PharmD, BCIDP Member

Karen Abboud, PharmD, BCOP, BCPS Project Approval Support

Elsie Rizk, PharmD Project Support Lead

David R. Putney, PharmD, MPH, BCPS - AQ Cardiology Member

Phuong Duong, PharmD Member - Fellow

Dan Galipeau, PharmD, BCCP Project Approval Support

Reba Forbess, PharmD, PhD, CPPS Visibility Lead

Luma Succar, PharmD, BCCCP Member

Stephanie Bird, PharmD, BCCCP Member

Safety of Direct Oral Anticoagulation (DOAC) therapy for Patients Awaiting Kidney Transplantation

Benjamin Deike, PharmD; Allison Yun, PharmD; Alex W. Rogers, PharmD; Alyssa Chaplain, PharmD; Edward A Graviss, PhD, MPH; Erika Powe, PharmD; Eric Rubido, PharmD; Ramon Guardiola; Angelina Edwards, MD, FASN; Richard J. Knight, MD, FACS

PURPOSE

With the expanding use of DOAC therapy for various conditions, transplant centers are faced with increasingly complex decisions regarding bleeding risk at the time of transplant. Our goal for this project was to evaluate the safety of DOAC therapy in patients listed for kidney transplantation.

METHODS

A single-center, retrospective comparative cohort study was conducted in kidney transplant recipients between November 1, 2021 and December 31, 2022. Patients were excluded if they received a multi-organ transplant or were on any anticoagulation other than a DOAC prior to transplant. The primary endpoint was defined as graft-exploration incidence due to concerns for bleeding during the index admission. Statistical analyses were conducted using x² and Fisher’s exact test for categorical data and Kruskal Wallis test for continuous data. A p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 383 patients were analyzed during the study period. Of those patients, 20 of them were on a DOAC prior to admission. The most common indication for anticoagulation was treatment or prevention of venous thromboembolism. All 20 of the patients on a DOAC were taking apixaban. 9 (45%) received deceased donor transplants, while 11 (55%) received living donor transplants. No anticoagulation reversal agents were used in either cohort. The incidence of graft exploration was 0 (0%) in the DOAC cohort, and 8 (2%) in the control cohort. Of the 8 surgical explorations within the index admission, 5 (1%) were due to concerns for bleeding. Rates of blood products given, new thrombotic events, and anemia were similar between groups.

CONCLUSION

DOAC therapy in patients listed for kidney transplant appear to have a similar incidence of bleeding events requiring graft re-exploration compared to no anticoagulation use immediately prior to transplant.

Benjamin Deike, PharmD

Benjamin earned his Bachelor of Arts degree in economics from Syracuse University in 2012, and later completed his PharmD from Ohio Northern University in 2023. Following completion of his PGY1, Benjamin will be staying on to complete a PGY-2 in Solid Organ Transplant at Houston Methodist Hospital.

Primary project preceptor: Allison Yun, PharmD

Presented at Network 2023 Vizient Pharmacy Anaheim, CA, 2024 Midwest Pharmacy Residents Conference, Omaha, NE and 2024 American Transplant Conference, Philadelphia, PA

PGY1 PHARMACY RESIDENCY

Cefiderocol-containing Regimens Versus Best Available Therapy for Carbapenem-resistant Acinetobacter Spp. Infections

Madeline Murphy, PharmD; Punit J. Shah, PharmD, BCPS, BCIDP; Meghan Thibeaux, PharmD, BCPS

PURPOSE

Carbapenem-resistant Acinetobacter baumannii (CRAB) poses an urgent therapeutic challenge worldwide as there are few treatment options available. Cefiderocol is a novel siderophore cephalosporin that has shown potent invitro activity against A. baumannii. Published literature on the clinical use of cefiderocol for management of CRAB infections is limited with contradictory findings contributing to a lack of consensus on optimal treatment regimens for CRAB. The objective of this study was to compare mortality between patients treated with cefiderocol-containing regimens versus best available therapy (BAT) for infections caused by CRAB.

METHODS

This was a multi-center, retrospective, cohort study from November 2021 through June 2023. Adult patients with infection and isolation of CRAB who received at least 48 hours of active treatment against CRAB were included. Patients with CRAB isolated from a urinary source or concomitant gram-positive bacteremia or fungemia were excluded. The primary outcome was inpatient mortality or discharge to hospice.

RESULTS

Baseline characteristics were similar between the two groups except more patients that received cefiderocolcontaining regimens had bacteremia (21% vs 6%; P = 0.015, 95% CI 0.02 - 0.28) and were on vasopressors (42% vs 19%; P = 0.011, 95% CI 0.05 - 0.38). Patients with a CRAB infection treated with a cefiderocol-containing regimen had statistically significant higher rates of inpatient mortality or discharge to hospice compared to BAT (36% vs 14%; P = 0.005; 95% CI 0.06 - 0.38).

CONCLUSION

Patients treated with cefiderocol-containing regimens had higher rates of inpatient mortality or discharge to hospice compared to BAT. Higher rates of vasopressor use and more CRAB bacteremia in the cefiderocol-containing regimen group may suggest cefiderocol was used in higher acuity patients.

Madeline Murphy, PharmD

Madeline Murphy earned her Bachelor of Science in Biochemistry and Cell Biology from Rice University in 2019 and PharmD from the University of North Carolina at Chapel Hill in 2023. Following completion of her PGY1, Madeline will be working as a clinical pharmacist at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pennsylvania.

Primary project preceptor: Punit J. Shah, PharmD

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Outcomes of Vasopressin Discontinuation Strategies in Resolving Septic Shock

Rachel Ou, PharmD; Hala Halawi, PharmD; Mahmoud Sabawi, PharmD, BCCCP; Princess Odtohan, BSN, CCRN; Ahmed Mahmoud, PharmD, BCCCP

PURPOSE

In septic shock patients who are refractory to fluids and norepinephrine, current guidelines recommend the addition of vasopressin as an adjunctive agent for hemodynamic support. However, there is limited guidance regarding the optimal de-escalation approach of vasopressors. While catecholamine infusions are typically tapered off in patients recovering from septic shock, there is a lack of evidence available to guide the best cessation strategy of vasopressin.

METHODS

This was a retrospective single site study comparing the abrupt discontinuation of vasopressin to tapered discontinuation of vasopressin. The primary outcome was the incidence of hypotension within 24 hours of the initial decision to discontinue or wean vasopressin or continued requirement of vasopressin within 24 hours of the weaning attempt. Secondary outcomes included ICU length of stay, 28-day mortality, total number of days on vasopressin, total number of days on any vasoactive agent, midodrine use, steroid use, and sequential organ failure assessment (SOFA) score at the time of vasopressin de-escalation.

RESULTS

Sixty-nine patients underwent full analysis, of which 26 patients were in the abrupt discontinuation group and 43 patients in the tapered discontinuation group. There was no significant difference in the incidence of hypotension between the two groups (80.8% vs. 81.4%; p=0.95), and abrupt discontinuation was associated with a shorter intensive care unit (ICU) length of stay (4.2 days vs. 6.4 days; p=0.02).

CONCLUSION

In patients with resolving septic shock and weaned off catecholamines, tapered discontinuation was not associated with a decreased risk of hypotension.

Rachel Ou, PharmD

Rachel earned her PharmD from Rutgers University in 2023. Following completion of her PGY1, Rachel will complete a PGY2 in Critical Care at UT Southwestern Medical Center.

Primary project preceptor: Mahmoud Sabawi, PharmD, BCCCP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Investigating the Incidence of Beta-Lactam Antibiotic Dosing Discordance When Comparing Cystatin C versus Creatinine Based Equations in High-Risk Patients

Nicholas J. Palma, PharmD; Eileen Sullivan, PharmD, BCPS; Steffany Nguyen, PharmD, BCPS; Ahmed Mahmoud, PharmD, BCCCP

PURPOSE

Accurate estimation of renal function is essential to determine appropriate doses of antibiotics to maximize efficacy and minimize toxicities. Many methods exist to estimate renal function; however, measurement of serum creatinine (SCr) is the most widely utilized in clinical practice and regulatory studies. Cystatin C (CysC), a low molecular weight protein produced by all nucleated cells, is an endogenous biomarker that has been utilized for kidney function estimation. In contrast to SCr, CysC is independent from muscle mass and is affected less by age, sex, race, and nutritional status. The purpose of our study was to evaluate the potential difference in beta-lactam antibiotic dosing comparing the standard of care SCr-based dosing vs a CysCbased dosing in high risk hospitalized patients.

METHODS

This was a retrospective single site, descriptive study completed within Houston Methodist Hospital. The primary study objective was the percentage of antibiotic doses ordered that would have discordant dose recommendations when comparing the combined eGFR equation (CKD-EPI-SCr-CysC) and CockcroftGault equation-based estimations of renal function. A subgroup analysis of the primary outcome evaluated dose discordance based on specific risk factors (age, weight, BMI, corticosteroid use). Secondary objectives included dose discordance between the CKD-EPI-SCr-CysC combined equation compared to individual CKD-EPI-SCr and CKD-EPI-CysC equations, dose discordance between CKD-EPI combined equation and actual dose ordered and percentage of antibiotic doses changed within 24 hours of CysC result.

RESULTS

In total, 217 patients and 422 individual antibiotic doses were analyzed. Results of our primary outcome found that 97 of the 422 (23%) total doses of all antibiotics administered would have discordant dose recommendations when comparing renal function estimates calculated by the Cockcroft-Gault vs. CKDEPI-SCr-CysC equations. Of the 97 doses that had discordant dose recommendations, 35 (36%) would otherwise be dosed higher if the CKD-EPI-SCr-CysC equation was utilized. risk factors identified with the highest discordance rates were actual body weight greater than 150 kg, BMI greater than 40 kg/m², lower limb amputee status, and high-dose corticosteroid usage.

CONCLUSION

Our study underscores potential opportunities for optimizing renal dosing strategies for antibiotics by incorporating CysC alongside traditional creatinine-based estimations of renal function. Furthermore, it identifies potential risk factors that could help determine which patients might benefit from CysC level measurement. We hope this study encourages further research into clinical outcomes of patients with discordant antibiotic dose recommendations and the evaluation of other medication classes.

Nicholas J. Palma, PharmD

Nicholas earned his Bachelor of Science in Biochemistry from Texas A&M University in 2019 and PharmD from the University of Houston College of Pharmacy in 2023. Following completion of his PGY1, Nicholas will continue his training at Houston Methodist Hospital by completing a PGY2 in Critical Care

Primary project preceptor: Eileen Sullivan, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

PGY1 PHARMACY RESIDENCY

Evaluation of Bleeding and Thrombotic Outcomes of Anticoagulation Strategies Upon Intensive Care Unit Admission for Patients with Atrial Fibrillation on

Direct Oral Anticoagulants

Priya

J. Patel,

PharmD, Mariah I. Sigala, PharmD, Corey V. Dinunno, PharmD, BCPS; Laura M. Blackburn, PharmD, BCPS, BCCCP, FCCM, Kevin R. Donahue, PharmD, BCPS

PURPOSE

Direct oral anticoagulants (DOAC) have surpassed warfarin as the most commonly prescribed oral anticoagulants, and subsequently, critically ill adults are being admitted to intensive care units (ICU) with a recent history of DOAC therapy. Safe and effective anticoagulation management in this patient population remains complex given the multitude of risk factors that increase bleeding and clotting risks. No consensus guidance exists on optimal anticoagulation in critically ill adults with non-valvular atrial fibrillation (NVAF), and there is considerable variability in clinical practice. This study evaluated rates of major bleeding and thrombosis between two anticoagulation strategies for NVAF upon ICU admission: package insert (continuation of oral or parenteral anticoagulation per manufacturer recommendations) versus non-package insert approach (prophylactic dosing or delayed anticoagulation).

METHODS

This was a retrospective cohort study conducted from January 2019 to August 2023. NVAF patients with objective evidence of DOAC exposure within 48 hours of ICU admission were included. Those admitted to the ICU for a bleeding event or received anticoagulation for indications other than NVAF were excluded. The primary outcome was the composite of major bleeding defined by International Society of Thrombosis and Hemostasis criteria, stroke or transient ischemic attack, and systemic embolism. Secondary outcomes included individual components of the composite primary outcome.

RESULTS

A total of 353 patients met the inclusion criteria for our study (122 in the package insert group and 231 in the nonpackage insert group). There was no significant difference in the composite incidence of major bleeding and stroke or systemic embolism between groups (4.1% in package insert vs. 6.1% in non-package insert; p=0.437). Additionally, there was no difference in the individual components of major bleeding (0% vs. 2.2%, p=0.102), stroke (0.8% vs. 0.9%, p = 0.964) and systemic embolism (3.3% vs. 3.0%, p = 0.898). between both groups. Patients with a DOAC score of ≥ 6 were more susceptible to major bleeding events, while those with a CHA2DS2-VASc of ≥ 5 were more prone to development of an acute ischemic stroke.

CONCLUSION

Our findings suggest that tailoring an anticoagulation approach to individual patient profiles can be a viable strategy for managing anticoagulation in critically ill patients. Initiating VTE prophylactic dosing or delaying therapeutic anticoagulation may be safe in patients who are deemed by the treatment team to be at a higher risk of bleeding than thrombosis. The integration of current risk assessment tools, such as the DOAC and CHA2DS2-VASc scores, and DOAC specific anti-Xa levels can aid in guiding anticoagulation management strategies.

PGY1 PHARMACY RESIDENCY

Priya J. Patel, PharmD

Priya earned her PharmD from the University of Houston in 2023. Following completion of her PGY1, Priya will begin her PGY2 Critical Care residency at Houston Methodist Hospital.

Primary project preceptor: Kevin R. Donahue, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Impact of Meropenem Restriction Criteria Implementation on Prescribing Trends, Clinical Outcomes, and Resistance Patterns

Hsing-Yi Lin, PharmD; Nicole Alilaen, PharmD, BCIDP, AAHIVP; Oyejoke Fasoranti, PharmD, BCIDP

PURPOSE

Recent studies suggest that Antimicrobial Stewardship Program (ASP) driven implementation of restriction criteria improve meropenem prescribing patterns and clinical outcomes within academic medical centers and university hospitals with robust provider involvement in stewardship. The purpose of this study was to evaluate the impact of enforcing meropenem post-verification restriction criteria on overall prescribing trends and days of therapy, clinical outcomes including length of hospital stay, 30day readmission rate, and overall 30-day mortality, and resistance patterns of Pseudomonas and Enterobacterales species within a 358-bed community hospital.

METHODS

This is a retrospective, single-center, quasi-experimental study that included patients 18 years old and above who received at least 24 hours of empiric meropenem treatment and excluding perioperative prophylaxis between July 2022 to August 2023. Patients admitted before meropenem restriction criteria was utilized were categorized in the preimplementation group while patients admitted after were categorized in the post-implementation group. Primary outcome was the appropriateness of meropenem utilization in both groups based on restriction criteria. Secondary outcomes included meropenem prescribing trends, length of hospital and ICU stay, overall Clostridioides difficile rate, 30-day readmission rate, 30-day mortality, and meropenem resistance rates between groups.

RESULTS

The overall appropriateness of meropenem use improved from 46.76% to 51.85% (p=0.048) after implementation of ASP-driven meropenem restriction criteria. No statistically significant differences were seen in the average length of hospital stay (10.5 vs 9.88 days; p=0.161), ICU stay (1.47 vs 1.6 days; p=0.549), the overall C diff. infection (1.55% vs 0.74%; p=0.135), overall 30-day readmission rate (23.24% to 19.26%; p=0.058), infection-related 30-day readmission (12.11% vs 9.75%; p=0.14). The overall 30-day mortality reduced from 1.69% to 0.37% (p=0.009). Effect of the restriction criteria was also observed on carbapenem resistance. Carbapenem resistant Pseudomonas aeruginosa decreased from 18.5% to 11.9% (p=0.025). The number of carbapenem resistant Escherichia coli and Klebsiella pneumoniae declined from 0.8% to 0.2% % (p=0.017) and from 4.7% to 3.6% % (p=0.431), respectively.

CONCLUSION

ASP-driven implementation of meropenem restrictions reduced overall inappropriate use of meropenem, potentially leading to shorter hospital stays, fewer ICU stays, lower rates of C. difficile infection, and decreased 30-day readmission and mortality.

PGY1 PHARMACY RESIDENCY FOR INTERNATIONAL GRADUATES

Yuki Lin, PharmD

Yuki earned her Bachelor of Science from the Ohio State University in 2020 and PharmD from the University of California, San Francisco in 2023. Following completion of her PGY1, Yuki will be pursuing clinical specialist opportunities in Taiwan.

Primary project preceptors: Oyejoke Fasoranti, PharmD, BCIDP and Nicole Alilaen, PharmD, BCIDP, AAHIVP

Presented at 2024 Midwest Pharmacy Residents Conference, Omaha, NE and 2024 ASHP Pharmacy Futures, Portland, OR

Impact of Novel Tetracycline Derivatives on the Treatment of Mycobacterium Abscessus Pulmonary Infections Compared to Best Available Therapy

Mealis Taouk, PharmD; William Musick, PharmD BCIDP; Shivani Patel, PharmD BCIDP

PURPOSE

Mycobacterium abscessus is a rapidly growing pathogen associated with severe pulmonary infections, particularly in immunocompromised patients. It poses significant treatment challenges due to extensive drug resistance. This study evaluates the efficacy and safety of novel tetracycline-based therapies (NTT) in comparison to the best available therapy (BAT) for M. abscessus pulmonary infections.

METHODS

This retrospective cohort study included 46 patients with M. abscessus infections at Houston Methodist Hospital from May 2016 to December 2023. Patients received either NTT or BAT, with primary outcomes assessing microbiologic culture conversion rates at 12 months and secondary outcomes including adverse event frequency and 1-year all-cause mortality.

RESULTS

Culture conversion rates were significantly higher in the BAT group (70%) compared to the NTT group (43%). The BAT regimens demonstrated greater drug susceptibility, reduced adverse event incidence, and a lower one-year mortality rate (22%) compared to the NTT cohort (48%).

CONCLUSION

BAT demonstrated superior microbiologic efficacy, and a more favorable safety profile compared to NTT in the treatment of M. abscessus pulmonary infections. These findings underscore the need for further investigation into optimal therapeutic strategies and novel agents for this resistant pathogen.

PGY1 PHARMACY RESIDENCY FOR INTERNATIONAL GRADUATES

Mealis Taouk, PharmD

Mealis Taouk earned her Doctor of Pharmacy degree from the Lebanese American University in 2022. Following the completion of her PGY1, Mealis will pursue a PGY2 residency in Oncology at Houston Methodist Hospital for the 2025-2026 academic year.

Primary project preceptor: William Musick, PharmD, BCIDP

Presented at 2024 Midwest Pharmacy Residents Conference, Omaha, NE and ASHP Summer meeting Portland, Oregon

Impact of Remote Centralized Pharmacist Order Verification (CPOV) on Advancing Clinical Pharmacy Growth for Traditional Staff Pharmacists in a Community Hospital

Alex Fan, PharmD, MPH; Sapana Desai, PharmD, BCPS; Gordana Isajloska Jasmak, RPh, BCPS; Rajan Desai, PharmD, MBA

PURPOSE

Remote pharmacy services, like centralized pharmacist order verification (CPOV), have been adopted by institutions across the United States to circumvent constraints on onsite pharmacy workloads, as well as expand upon pharmacy services. The CPOV approach at Houston Methodist Sugar Land Hospital (HMSL) is part of a system-wide strategy to provide order verification services without the removal of onsite pharmacists. At HMSL, these onsite staff pharmacists were provided the opportunity to engage in patient-facing activities. This study aims to assess the efficiency of decentralized pharmacists (DCPs) upon the implementation of CPOV within a 10-month period.

METHODS

This study utilized the EPIC electronic medical record system to compare documented interventions (i-vents) of DCP tasks at HMSL during the pre-implementation period (December 2021 to September 2022) and the post-implementation period (November 2022 to August 2023). DCP tasks include antimicrobial stewardship, high-risk medication prescription reviews, prior authorizations, prescription generations, Code Blue responses, Code Stroke responses, discharge counseling, heparin consults, and vancomycin consults. Interventions from October 2022 were excluded from analyses as 24/7 CPOV services at HMSL were implemented during this time. The primary outcome of this project looks at the differences in proportions of documented DCP interventions between the two time periods. The secondary outcomes of length of stay (LOS) and 30-day readmission rates for patients with electronic prior authorization interventions performed by a DCP during the post-implementation period were analyzed using the student’s t-test and chi-square test.

RESULTS

A total of 5,592 documented interventions performed by a DCP were included in the analyses (1,150 interventions in the pre-

Alex Fan, PharmD, MPH

implementation phase vs. 4,442 in the post-implementation). This represents a 286% increase in interventions performed by a DCP during the post implementation phase (p-value <0.001). Post implementation, a statistically significance increase in the proportion of documented interventions was seen in the following DCP tasks: antimicrobial stewardship, Code Blue attendance, discharge counseling, heparin consults, high-risk medication review, prescription generation, and electronic prior authorizations and was not seen in Code Stroke attendance (p-value = 0.056) and vancomycin consults (p-value = 0.164). For the review of secondary outcomes, 330/882 (37%) unique patient encounters with a prior authorization had a DCP intervention, of which, 63 or 19.09% had a subsequent 30-day readmission as compared to 19.57% (108 of 552) in those without a DCP intervention. This difference was not seen to be statistically significant (p-value = 0.863). The average LOS amongst the 882 patient encounters was approximately 5.6 days. There was a significant difference in LOS between encounters with or without a DCP intervention (6.05 vs 5.38 days, respectively, p-value = 0.027). Furthermore, when looking at the average LOS amongst patients with or without a readmission, a significant difference was not seen (6.19 days vs 5.50 days, p-value = 0.057).

CONCLUSION

Among patients at HMSL during the defined pre- and post-implementation time periods, there was a significant increase in total DCP interventions. Though there was not a statistically significant difference supporting DCP intervention in readmission rates or LOS, these improvements in DCP task capture rates have and will continue to allow our entity to expand upon clinical services. This study suggests that implementation of similar models may help progress clinical pharmacy services and may improve 30-day readmission rates and LOS in patients requiring prior authorizations. Study findings will contribute to the literature describing the impact of CPOV on expansion of clinical pharmacy services.

Alex earned his Bachelor of Science and Arts in Biology in 2019 followed by his PharmD in 2023 from the University of Texas at Austin. Upon graduating with his pharmacy degree, Alex also concurrently earned his Master of Public Health degree from UTHealth Houston prior to beginning his PGY1 residency at Houston Methodist Sugar Land. Following completion of his PGY1, Alex will serve as the inaugural overnight pharmacy clinical specialist at Houston Methodist Sugar Land.

Primary project preceptor: Sapana Desai, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Alcalde Southwestern Conference, Round Rock, TX

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST SUGAR LAND

The Impact of Pharmacist-led Discharge Medication Review on Readmission Rates

Stephanie T. Ngan, PharmD; Brittany Yalamanchili, PharmD, BCPS; Gordana I. Jasmak, RPh, BCPS; Hannah Y. Chan, PharmD, BCCCP

PURPOSE

Transitions of care (TOC) involve the movement of patients between different settings. Specifically, the continuity of care between the inpatient and community setting is prone to medication errors. Aspects of continuity may include the communication between healthcare providers, adherence to follow-up care, patient education, and medication reconciliation. As medication experts, pharmacists play a unique role in the TOC process by proactively performing medication review and providing counseling. Few TOC studies have incorporated a designated pharmacist into the TOC related readmission risk-reduction model or have evaluated outcomes made by such pharmacists.

METHODS

This was a single-center, retrospective study conducted at Houston Methodist Sugar Land Hospital, a tertiary complex care community hospital. A quasi-experimental before and after analysis was conducted with a pre-implementation period from May 2020 to May 2021 and a postimplementation period from July 2021 to July 2022. During the post-implementation period, pharmacists utilized a novel real-time electronic medical record alert triggering selected high-risk medication review. Patients included in this analysis were 18 years or older with discharge orders for specific high-risk medications (rivaroxaban, apixaban, dabigatran, warfarin, insulin, and linezolid). The analysis excluded patients discharged to hospice. The primary endpoint was the rate of all-cause 30-day readmission of patients with accepted pharmacist interventions. The secondary endpoints were the

Stephanie Ngan, PharmD

rate of all-cause 30-day readmissions and total number of accepted pharmacists’ interventions on alerts-driven for highrisk medications.

RESULTS

During the pre-implementation phase, 65 pharmacy interventions were conducted out of 2,500 high-risk medication discharge orders processed, with providers accepting 99% of these interventions. Following implementation, out of 2,596 high-risk medication discharge orders, 438 interventions were made with a provider acceptance rate of 97.6%. In terms of the primary endpoint, the rate of all-cause 30-day readmission for patients with accepted pharmacist interventions decreased from 15.4% (10 out of 65) pre-implementation to 5.5% (24 out of 438) post-implementation. Similarly, the secondary endpoint of all-cause readmission decreased from 14% (351 out of 2,500) pre-implementation to 9.5% (247 out of 2,596) post-implementation.

CONCLUSION

This analysis demonstrated that the implementation of pharmacist-led high-risk discharge medication review decreased overall readmission rate. The findings highlight the benefit of a targeted pharmacist review of selected high-risk medications prior to hospital discharge and contribute to the current limited literature regarding targeted pharmacist involvement in the TOC process.

Stephanie Ngan earned her and PharmD from Roseman University Las Vegas College of Pharmacy in 2023. She completed her PGY1 residency at Houston Methodist Sugar Land Hospital.

Primary project preceptor: Brittany Yalamanchili, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Alcalde Conference, Austin, TX

The Impact of Pharmacy-Provided Discharge Services on Hospital Readmission Rates

Faith Rutherford, PharmD; Oyejoke Fasoranti, PharmD, BCIDP; Quintin Wright, PharmD, BCPS, BCACP

PURPOSE

Research demonstrates favorable effects of pharmacyprovided transition-of-care initiatives on reducing 30-day hospital readmissions. Most studies focus on individual elements of care transition. However, a limited number have investigated comprehensive programs that incorporate thorough medication review upon discharge with counseling and providing bedside medication delivery service (medsto-beds).

METHODS

In this single-center, retrospective study aiming to explore the impact distinct intervention categories have on 30day all-cause readmission rates: (1) no transition-of-care (TOC) pharmacy intervention (noTOC), (2) discharge medication reconciliation review plus pharmacy-provided bedside counseling (TOC review bedside counsel), and (3) discharge medication reconciliation review plus pharmacyprovided bedside counseling along with meds-to-beds service (TOC review+bedside counsel+M2B) in patients with high-risk disease states internally identified as atrial fibrillation/flutter (Afib), coronary artery disease requiring coronary artery bypass graft (CABG), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes mellitus type 2 (DM2), heart failure (HF), stroke. This study was deemed exempt from IRB review as a quality review.

RESULTS

In the study period 8,541 patients were identified who met inclusion criteria and remained after exclusion criteria was applied. For the primary outcome, all-cause 30-day readmission was 11.4% for noTOC, 10.1% for TOC review+bedside counsel and 11.3% for TOC review+bedside counsel+M2B (p=0.99).

CONCLUSION

This study did not show any statistical significance in the relationship of TOC services and patients being readmitted. However, this study did highlight areas for improvement in the facility's current work processes for the TOC team including a standardized patient review and education process along with a more intentional work process for identification of patients.

Faith Rutherford, PharmD

Faith Rutherford earned her Associates of Liberal Arts in 2009 and Associates of Science in 2017 from Lonestar College System. She earned her PharmD from Texas Southern University College of Pharmacy and Health Sciences in. Following completion of her PGY1, Faith will work as a PRN clinical pharmacist at Houston Methodist Willowbrook and at HCA Houston Healthcare Kingwood.

Primary project preceptor: Oyejoke Fasoranti, PharmD, BCIDP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST WILLOWBROOK

Evaluation of a Hybrid Remote Clinical Pharmacy Services Model

Alexis Hyman, PharmD, MBA; Engie Atia, PharmD, BCPS; David Putney, PharmD, MPH; Laura Blackburn, PharmD, BCPS, BCCCP, FCCM

PURPOSE

The purpose of this study was to compare the impact of implementing a hybrid remote care model compared to a traditional in-house pharmacy clinical services model.

METHODS

This retrospective, quasi-experimental study was conducted at a 979-bed tertiary academic medical center. The control phase compared our traditional in-house model with a 1:1 pharmacist-to-unit ratio to the intervention phase with a hybrid remote care model that divided work based on patient-facing and non-patient-facing tasks in a 3:1 pharmacist-to-unit ratio. The study timeframe consisted of a pilot proof-of-concept that led into the two-month intervention phase when the hybrid remote care model was implemented followed by a two-month traditional in-house staffing model serving as the control phase. The primary outcome assessed the number of patient-facing and non-patient-facing activities conducted by the clinical pharmacists. The secondary outcomes evaluated length of stay and patient satisfaction experience based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

RESULTS

Spanning four months, this study showed an increase in patient-facing activities documented rates from 108 notes per 1,000 patient days in the control phase to 77 notes per 1,000 patient days in the intervention phase (p = 0.017). Non-patient-facing activities did not show a significant difference in documentation rates which was 292 notes and 262 notes per 1,000 patient days, respectively (p = 0.13). The median length of hospital stay was reduced from 4.69 days in the control phase compared to 4.10 days in the intervention phase (p = 0.002). Higher positive responses in patient satisfaction were seen in the intervention phase compared to the control for the medication-domain questions of the HCAHPS survey (p = 0.009).

CONCLUSION

This study demonstrates that the implementation of a hybrid remote care model increases patient-facing activities leading to improved patient satisfaction and reduced lengths of stay thus suggesting a more efficient workflow for clinical pharmacists and better patient outcomes.

PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

Alexis Hyman, PharmD, MBA

Alexis earned her bachelor's degree in microbiology from Texas Tech University in 2019 and PharmD from Texas Tech University Health Sciences Center in 2023. Following completion of her PGY1, Alexis will continue at Houston Methodist as a PGY2 Health-System Pharmacy Administration & Leadership Resident.

Primary project preceptor: Engie Attia, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Alcalde Southwest Leadership Conference, Round Rock, TX

Expansion of Pharmacy Services Due to Centralized Pharmacy Order Verification

PURPOSE

To examine the impact of centralized pharmacy order verification (CPOV) services across a multi-hospital healthsystem after repurposing an operations pharmacist role at one entity into a new clinical triage pharmacist role. The new role has allowed for pharmacists to expand beyond traditional operational tasks and contribute to enhancement of patient care with existing staff resources. This study hopes to prove the effectiveness and value of centralized order verification and the impact it can have on expanding pharmacists’ direct patient care roles in the health-system setting.

METHODS

This quasi-experimental study aims to evaluate the implementation of a clinical triage pharmacist role at a single entity within a multi-hospital health-system, as a result of centralized order verification. The study design includes a six-month period from March to August 2022, which represents pre-implementation of the role, compared to March to August 2023, which represents the postimplementation phase of the role.

RESULTS

This new role centers around three unique responsibilities including monitoring clinical surveillance alerts, completing electronic prior authorization (ePA) requests, and leading a daily operational huddle to streamline escalation of issues. Preliminary metrics showed improvements in average

Kalina Korzec, PharmD; Niha Zafar, PharmD, MS; Alan Luu, PharmD, MS, BCPS; Sunny Bhakta, PharmD, MS, BCPS PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

percentage of acknowledged IV to PO conversion clinical surveillance alerts from 17% to 38%, with a slight decrease of alerts acknowledged within 24 hours from 100% to 98%. There was an increase from 11% to 65% of drug monitoring clinical surveillance alerts acknowledged. There was a decrease in ePAs approved from 57% to 44%, but there was an increase in number of ePA requests sent (42% increase) and completed (40% increase) between 2022 and 2023. There was also a reduction in average turnaround time of completion of ePA processing from 18.4 hours to 15 hours. Additionally, the new role has successfully taken on the responsibility of leading daily operational huddles amongst several pharmacy satellites and triaging and escalating patient care issues accordingly.

CONCLUSION

Based on results, development of this role as a result of centralized order verification has increased the number of patient care interventions, and decreased turnaround time for ePA processing. Expansion of services and scope of patient-centered activities can contribute to achieving departmental strategic initiatives and create new opportunities for the pharmacist career advancement ladder.

Kalina earned her PharmD from Northeastern University in 2023. Following completion of her PGY1, Kalina will continue to complete her 2-year residency at Houston Methodist Hospital as part of the Health-System Pharmacy Administration and Leadership program.

Primary project preceptor: Niha Zafar, PharmD, MS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and Alcalde Southwest Leadership Conference 2024, Round Rock, TX

Kalina Korzec, PharmD

Assessment of motivational factors that influence intentions regarding utilization of inventory function in automated dispensing cabinets

Atra Mouser, PharmD, MS; Engie Attia, PharmD, BCPS; Sunny Bhakta, PharmD, MS, BCPS; Amanda Beck, PharmD, MS; Alexis Hayes, PhD, MSN-Ed, APRN, FNP-BC; Amelia Sofjan, PharmD, BCPS; Kevin Garey, PharmD, MS, FASHP, FIDSA, FCCP

PURPOSE

Automated dispensing cabinet (ADC) vulnerabilities in relation to medication safety are present with its various functions, such as when the inventory function is used outside of the scope of the required weekly blinded controlled substance inventory audits. Use of the inventory function for non-controlled substances has implications for patient safety, medication waste, and medication security. The theory of planned behavior (TPB) was established with the intent to explain behaviors over which individuals can exert self-control. The purpose of this study is to understand factors that may influence behavioral intentions when utilizing the inventory function for non-controlled substances in an ADC.

METHODS

This was a single-center study consisting of two survey phases: 1) Focus groups with open-ended questions and 2) survey questionnaire with Likert-scale questions. The survey instrument was developed based on guidelines for TPB. Respondents were asked to evaluate their beliefs toward using the inventory function and their intention to use the function in an ADC. Predictors of intention were evaluated through descriptive statistics and logistic regression analysis.

RESULTS

Responses from nine out of the forty nurses contained usable data (23% effective response rate). Most respondents demonstrated low intention to use the inventory function for non-controlled substances. The TPB construct of perceived behavioral control had the most impact on intention, with nurses feeling that they were more enabled to use the function. The survey instrument is validated and can be used to collect additional responses from nurses for further analysis.

CONCLUSION

Perceived behavioral control was the most predictive of nurses’ intention to use the inventory function.

Atra Mouser, PharmD, MS

Atra earned her Bachelor of Science from The University of Texas at Austin in 2016 and PharmD from The University of Houston College of Pharmacy in 2022. She also earned her Master of Science in Pharmacy Leadership and Administration from the University of Houston in 2024. After completing her PGY1/PGY2 residency in Health-System Pharmacy Administration and Leadership, Atra will be staying on with Houston Methodist as a pharmacy manager.

Primary project preceptor: Engie Attia, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA, Alcalde Southwest Leadership Conference 2024, Round Rock, TX and Texas Society of Health System Pharmacists Annual Seminar 2024, Round Rock, TX

Publication citation: Mouser A, Attia E, Adeola M, Zafar N, Fuentes A. Impact of a patient risk scoring tool pilot on prioritization of pharmacy-conducted medication histories. J Am Pharm Assoc (2003). Published online April 16, 2024. doi:10.1016/j.japh.2024.102100.

Implementation and Evaluation of Robotics Intravenous Compounding Technology in a Tertiary Hospital Oncology Pharmacy

Luning (Luna) Shi, PharmD, MS, BCPS; Matthew Wanat, PharmD, BCPS, BCCCP, FCCM; Catherine Hatfield, PharmD, FNAP; Michael H. Le, PharmD; Adam Smith, PharmD, MS, BCPS

PURPOSE

The objective of this study was to compare the compounding efficacy, accuracy, and pharmacy technician repetitive strain injury risks between manual pharmacy technician compounding and robotic compounding processes.

METHODS

This quasi-experimental study at Houston Methodist Hospital Oncology Pharmacy analyzed three weeks of manual compounding data and three weeks of robotic compounding data. The primary endpoint was the medication turnaround time for both manual and robotic methods, calculated from the start to the completion of dose preparation. Secondary endpoints included medication rejection rates, number of doses compounded per technician hours, medication preparation time, and the risk of repetitive injuries for both compounding methods. Statistical analysis used included t-tests, segmented regression, and chi-square tests to evaluate preparation times, failure rates, and ergonomic risks.

RESULTS

A total of 447 medications were prepared manually and 200 doses were prepared via robotic compounding during the study period. The mean turnaround time for manual preparation was 26.6 minutes, compared to 29.0 minutes for robot preparation (95% CI, -5.1-0.1; P=0.053). A total

of 2.3% of doses were rejected in manual preparation and 1.5% of doses were rejected in robot preparation (P=0.118). The mean manual preparation time was 15.7 minutes versus the robot's mean preparation time of 6.9 minutes (95% CI, 8.0-9.6; P<0.0001). The compounding efficiency was 0.78 doses per technician hour, indicating a 14% increase in compounding efficiency. Regarding employee safety, for manual compounding, two observations fell in the medium risk range, and two observations were in the high-risk range. For robot compounding, all four observations were in the low-risk range. The Chi-Square Test of Independence was performed to examine the relationship between the method of compounding (robot vs. manual) and the risk of repetitive strain injury (low, medium, high). The result was X^2=8 with a significance level of P=0.018.

CONCLUSION

Robotic compounding shows comparable results in medication turnaround time. It also offers significant advantages in reducing the risk of repetitive strain injuries associated with manual compounding for pharmacy staff. Moreover, robotic compounding has a similar dose rejection rate compared with manual compounding. However, it faces technological limitations and requires future advancements in technology and workflow design to fully optimize automation in oncology pharmacy operations.

Luning Shi, PharmD, MS, BCPS

Luna Shi earned her PharmD degree from the University of Cincinnati College of Pharmacy in 2022. She completed her PGY1 residency at Houston Methodist Hospital. Following the completion of her PGY2 in Pharmacy Administration and Leadership residency, Luna will join the West Virginia University Medicine as a pharmacy oncology and ambulatory infusion manager.

Primary project preceptor: Adam Smith, PharmD, MS, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 TSHP Conference

Publication citation: Shi L, Wei W, Smith A, Abbasi G. Implementation and evaluation of an EHR-integrated perpetual inventory system in a large tertiary hospital oncology pharmacy. Am J Health Syst Pharm. 2024 Jan 31:zxae022. doi: 10.1093/ajhp/zxae022. Epub ahead of print. PMID: 38298005.

Evaluation of Pharmacy Unit Inspection Utilizing a Mobile Application with Smart Glasses

Aranzazu Calzado, RPh, MBA; Haley Blanck, PharmD, MS; Jane Scott, RPh; Ghalib Abbasi, PharmD, MS, MBA

PURPOSE

This study aimed to evaluate the impact of integrating smart glasses with pharmacy compliance mobile application on the efficiency and of pharmacy unit. The goal was to compare traditional inspection methods using a mobile application alone with a smart glasses-integrated approach, focusing on turnaround times, data accuracy, and user satisfaction.

METHODS

The study employed a quasi-experimental design with pre-implementation and post-implementation phases, each lasting 90 days. Ten pharmacy technicians participated, utilizing a mobile application alone during the preimplementation phase and integrating smart glasses during the post-implementation phase. Primary outcome was time for completion of a unit inspection. Secondary outcome included user satisfaction through a 5 point Likert survey.

RESULTS

The average time for completion of a unit inspection using a mobile application alone was 3.7 minutes (SD 5.3), compared to 2.6 minutes (SD 3.5) when using smart glasses. However, documentation completion time with smart glasses had a mean of 5.0 minutes and a median of 3.0 minutes, versus 1.1 and 1.0 minutes, respectively, for the mobile application alone. Survey responses indicated mixed satisfaction, with initial perceptions of the smart glasses contributing to a thorough and accurate unit inspection process decreasing from a pre-survey median of 4.0 to a post-survey median of 2.5.

CONCLUSION

Integrating smart glasses with mobile application did not enhance the efficiency of pharmacy unit inspections. Further refinement of smart glasses technology is needed to fully realize its potential benefits.

PGY1/PGY2 PHARMACY INFORMATICS RESIDENCY

Akraam Abdel-Kerem, PharmD, MS

Akraam earned his Bachelor of Science from Hamline University in 2019 and PharmD Masters of Science in Health Informatics from the University of Minnesota in 2023. Following completion of his PGY1, Akraam will complete a PGY2 in Pharmacy Informatics at Houston Methodist Hospital.

Primary project preceptor: Ghalib Abbasi, PharmD, MS, MBA

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Evaluation of Radio-Frequency Identification (RFID) Technology Tracking Systems For Optimization of Pharmacy Crash Cart Operations

Haley M. Blanck, PharmD, MS; Amanda Beck, PharmD, MS; Niaz Deyhim, PharmD, MS, BCPS

PURPOSE

Some may see Radio frequency identification (RFID) technology as modern invention; however, the roots of RFID technology can be traced all the way back to World War II. Historically, RFID has been leveraged to track real time locations of railroad cars, planes during war times, and most recently medical equipment and other assets within hospitals. There are two types of RFID technology; passive tags and active beacons. Passive tags can be encoded with data, but have no active signal, and require a reader to transmit data to a system. Active beacons emit an active signal that transmits data and information via serial numbers to a gateway. The gateway then communicates via Wi-Fi and Bluetooth connectivity to a real-time location system (RTLS) that displays the beacon's location. This describes how data from active RFID tagged crash carts with beacons can be utilized by hospital departments to optimize crash cart operation with RTLS and evaluates the impact on the rate of expired crash carts deployed on units.

METHODS

A total of 624 crash carts (adult, pediatric, neonatal carts) were identified across an eight-hospital system. All crash carts were tagged with active RFID beacons for real-time identification and tracking purposes. Pre-implementation data was collected, including all crash carts that had expired supplies, expired medications, or both. RFID beacon generated data was collected over three months.

The study’s objective was to evaluate the feasibility and implementation of RFID-based location tracking for emergency crash cart operations. The primary endpoint

Haley

was the rate of expired crash carts deployed across all hospital locations. Key secondary endpoints were the rate of RFID beacons not sending data to the RTLS per day, and the average beacon battery life over time compared to the expected battery life, and the rate of medication safety reports from expired carts.

RESULTS

This innovative study introduces an electronic based, systematic approach to hardwiring crash cart operations within health systems. Prior to implementation of RFID location tracking, the major study site showed an expired crash cart rate of 3.9%, compared to preliminary results of 3.95% post implementation. Many of the community hospital study sites did not have expired crash carts deployed pre or post implementation, as shown in results of the study. There was no significant difference found between the rate of expired crash carts deployed after implementation (Site 1, p = 0.8643; Site 5, p = 0.2724; Site 7, p = 0.4226). Visibility across all eight sites was 75% and above; reasons for less than 100% visibility were due to crash carts not having the ability to communicate with a beacon. These visibility issues have been corrected as of May 2024.

CONCLUSION

Based on these findings, opportunities for additional workflow and system enhancements as well as labor efficiency potential with electronic based visibility will be incorporated.

PGY1/PGY2 PHARMACY INFORMATICS RESIDENCY

M. Blanck, PharmD, MS

Haley earned her Doctor of Pharmacy and Master of Science in Health Informatics degrees from The University of Kansas in 2022. She completed her PGY1 residency at Houston Methodist Hospital in Houston, TX. Following completion of her PGY2, Haley will be working as a Willow Inpatient Analyst.

Primary project preceptor: Amanda Beck, PharmD, MS

Presented at 2024 Midwest Pharmacy Residents Conference, Omaha, NE and ASHP Futures in Portland, Oregon

Received $30,000 grant from ASHP Foundation

Incidence of thromboembolism post-oral anticoagulation reversal in intracranial hemorrhage patients

Aliya Abdulla, PharmD; Kevin R. Donahue, PharmD, BCPS; Courtney Hall, PharmD, BCCCP; Celia Morton, PharmD, BCCCP

PURPOSE

Rates of venous thromboembolism (VTE) in the intracranial hemorrhage (ICH) population range from 2-4% with rates of up to 10% reported post anticoagulation (AC) reversal. Current guidelines recommend the initiation of unfractionated heparin or low molecular weight heparin 2448 hours post-ICH; however, there is no mention regarding VTE prophylaxis post-reversal. This study aims to identify the incidence of thromboembolism post-oral AC reversal in patients presenting with ICH and describe VTE prophylaxis timing and agent selection.

METHODS

This was a retrospective, descriptive study conducted within a single health-system. Patients on oral AC admitted from January 2020 through July 2023 that received AC reversal agents 4-factor prothrombin complex concentrate (4F-PCC) with or without vitamin K, andexanet alfa, and/ or idarucizumab for AC-associated ICH were included. The primary outcome of the study was incidence of thromboembolism post-reversal. Secondary endpoints included incidence of AC initiation post-reversal, time to initiation of AC post-reversal, AC agent specification, hospital length of stay, and mortality.

RESULTS

The study included 207 patients who received reversal for oral AC, including warfarin, apixaban, and rivaroxaban post-ICH. There were 118 patients (57%) that received 4F-PCC and 89 patients (43%) that received andexanet alfa for reversal post-ICH. Of the overall group, 195 patients (94.2%) achieved hemostasis. Eight patients had incidence of thrombosis (3.9%) and of those, 6 patients (75%) were re-initiated on AC, all of which utilized prophylactic heparin. The median time from reversal to VTE was 55.9 days (IQR 21.2-72.4). For those initiated on AC, the median time to initiation from reversal was 3.98 days (IQR 2.5- 6.01), and for those with incidence of thrombosis, the median time to AC initiation was 6.4 days (IQR 2.6-13.1). Mortality occurred in 13 patients (6.3%).

CONCLUSION

This patient population is complex in that the need to achieve hemostasis with AC reversal must be balanced with the risk of VTE. Further studies are needed in order to determine the ideal timing and agent selection for VTE prophylaxis initiation post ICH reversal.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Aliya Abdulla, PharmD

Aliya Abdulla earned her PharmD degree from the University of Georgia College of Pharmacy in 2022. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 in Critical Care, Aliya will continue working at Houston Methodist Hospital as a Critical Care Clinical Specialist.

Primary project preceptor: Kevin R. Donahue, PharmD, BCPS

Presented 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Texas Medical Center Critical Care Research Forum, Houston, TX

Publication citation: Abdulla A, Williams CM, Branan TN, Smith SE. Optimal Dosing of Enoxaparin in Critically Ill Patients with Venous Thromboembolism. Innov Pharm. 2023 Oct 10;14(1):10.24926/iip.v14i1.5174.

Hawkins WA, Abdulla A, Hua X, Sikora A. Sedative Choice: The Chilling Confounder to Targeted Temperature Management. Innov Pharm. 2022 Apr 2;13(1):10.24926/iip.v13i1.4501.

Anthony Hawkins W, Smith SE, Stitt TM, Abdulla A, Branan TN, Hall RG. Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety. Innov Pharm. 2021 Sep 22;12(4):10.24926/iip.v12i4.4288.

Heart Rate Control Strategies in Patients on Veno-Venous Extracorporeal Membrane Oxygenation Support

Donna Barakeh, PharmD; Kevin R. Donahue, PharmD, BCPS; Diane Dreucean, PharmD, BCCCP; Prakruthi Voore, MD; Celia Morton, PharmD, BCCCP

PURPOSE

Despite veno-venous extracorporeal membrane oxygenation (VV-ECMO) support, refractory hypoxemia may occur due to intrapulmonary shunting or shunting of venous blood past the ECMO circuit into the diseased lung. The use of negative inotropic and chronotropic agents to reduce cardiac output (CO), thereby improving the ratio of ECMO flow to CO, is one strategy to decrease shunting. While beta blockers have shown promise in multiple case reports, larger studies are needed to gain a better understanding of the efficacy and safety of this approach in VV-ECMO patients. The objective of this study was to describe the utilization of HR control therapy in patients on VV-ECMO support.

METHODS

This was a single health system, retrospective, descriptive cohort study of adult patients requiring VV-ECMO cannulation between June 2019 and June 2023 that received at least one HR control agent within 10 days after cannulation. Efficacy outcomes included trends in CO, HR, arterial oxygen saturation (SaO2), ECMO flow, and ECMO and ventilator fraction of inspired oxygen (FiO2) following initiation of HR control therapy. Safety outcomes included the incidence of bradycardia or hypotension requiring intervention and digoxin toxicity.

RESULTS

Thirty-nine patients met criteria for inclusion in this study, with 92% having received a beta blocker as the initial HR control agent. The most common HR control strategy was the initiation of an esmolol infusion followed by transition to an oral beta blocker, with a median overlap period of 6 days. While patients experienced reductions in HR and CO, FiO2 requirements remained stable throughout the first 72 hours after HR control therapy initiation. Additionally, SaO2 and ECMO flow did not significantly vary during this period. There were minimal adverse events, with only 2 cases of hypotension requiring therapy discontinuation or initiation of vasopressor support.

CONCLUSION

Use of HR control agents, predominantly beta blockers, was well tolerated and yielded effective reductions in HR, however, these were not accompanied by significant improvements in oxygenation. Future prospective studies should be performed to further elucidate the impact of HR control strategies in a population of VV-ECMO patients with refractory hypoxemia in the setting of elevated CO.

Donna Barakeh, PharmD

Donna earned her PharmD from the Lebanese American University in 2020. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Donna will be joining Baylor University Medical Center as an ICU/ED Clinical Pharmacist.

Primary project preceptor: Celia Morton, PharmD, BCCCP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Texas Medical Center Critical Care Research Forum, Houston, TX

PGY2

Clinical Outcomes of Penicillin-Based Therapy for AmpicillinSusceptible, Penicillin-Elevated Phenotype in Enterococcus faecalis

Bloodstream Infections

PURPOSE

Historically, E. faecalis that were ampicillin (AMP) susceptible have been presumed penicillin (PCN) susceptible. However, there is a rise of AMP-susceptible, PCN-elevated (ASPE) E. faecalis isolates where the minimum inhibitory concentration (MIC) of PCN has increased. ASPE isolates, specifically in the context of isolates that display ampicillin susceptibility but penicillin resistance, have been linked with poor clinical outcomes and associated with increased expression of the relativelypenicillin resistant PBP4 which may lead to significantly elevated MICs to ß-lactams such as piperacillin. This aim of this study is to shed light on current practice and examine the clinical outcomes of infections due to ASPE E. faecalis bloodstream infections with penicillin MICs that remain susceptible but are near the susceptibility breakpoint.

METHODS

This retrospective observational study included adult patients between January 1, 2017 through July 30, 2023 who had E. faecalis bacteremia that had a PCN MIC of 4 or 8. Patient who received synergistic antimicrobial therapy were excluded. Patients who received a penicillin-based regimen, including ampicillin and piperacillin-tazobactam, were compared to patients who received a non-penicillin-based regimen, including vancomycin. The primary outcome was 30-day mortality. Secondary outcomes included the ASPE phenotype incidence, recurrence, length of stay, and readmission.

Shemual Tsai, PharmD; Shivani Patel, PharmD, BCPS; Will Musick, PharmD, BCIDP; Will Miller, MD; Truc Tran, PharmD PGY2 INFECTIOUS DISEASES PHARMACY RESIDENCY

Shemual Tsai, PharmD

RESULTS

385 patients met inclusion criteria and the most common sources of infection were line-associated (23%), followed by genitourinary (22%), then gastrointestinal (19%). There was no significant difference in 30-day mortality, recurrence, length of stay, or readmission between patients who received a penicillin-based regimen versus patients who did not receive a penicillin-based regimen. (6% versus 6%, p=0.95) There were no significant differences with the primary outcome of 30-day mortality and antimicrobial regimen in the subgroup of patients with an E. faecalis isolate that had a penicillin MIC of 8. (13% vs 4%, p=0.34). Penicillin MICs were on average four times higher than ampicillin MICs in E. faecalis, with 90% of isolates in our study displaying the ASPE phenotype with a penicillin MIC of 4 or 8.

CONCLUSION

Penicillin-based antimicrobial regimens may not have a significant impact on clinical outcomes compared to nonpenicillin-based regimens among patients with the ASPE phenotype in E. faecalis bacteremia. The ASPE phenotype is common among E. faecalis isolates with penicillin MICs higher relative to ampicillin MICs which warrants further research.

Shemual Tsai earned his BS and PharmD from Northeastern University in 2022. He completed his PGY2 residency at Banner – University Medical Center Tucson in Arizona. Following completion of his PGY2, Shemual will stay on at Houston Methodist Hospital in the Texas Medical Center as an Infectious Diseases and Antimicrobial Stewardship clinical pharmacist.

Primary project preceptor: Shivani Patel, PharmD, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Use of Angiotensin II in Cirrhosis: A Single-center Experience

Christopher Nelsen, PharmD; Chelsea N. Lopez, PharmD, BCCCP; Luma Succar, PharmD, BCCCP

PURPOSE

Hospitalized patients with cirrhosis are at high risk for decompensation and therefore often require vasoactive agents for hemodynamic support. Guidance for vasopressor selection and initiation in this population is extrapolated from standard of care for non-cirrhotic patients with vasodilatory shock. Angiotensin II is the newest agent available for the management of vasodilatory shock. However, patients with model for end-stage liver disease (MELD) scores of 30 or higher were excluded from the initial approval study, thereby limiting applicability in the respective clinical setting. Despite this, recent data has suggested that patients with advanced liver disease have impaired activation of the renin-angiotensin-aldosterone system, creating a potential role for angiotensin II in this patient subset. The purpose of this study is to describe the efficacy of angiotensin II in reducing overall norepinephrine equivalent (NEE) requirements in patients with decompensated cirrhosis.

METHODS

This was a single-center, retrospective, descriptive study evaluating the effect of angiotensin II in cirrhotic patients with concurrent shock. Patients were excluded if they received angiotensin II for less than 12 hours. The primary endpoint was reduction in NEE at 12 hours after initiation of angiotensin II (T0). Secondary outcomes included resolution of shock, change in mean arterial pressure (MAP) values from T0 to end of follow up (defined as the first occurrence of either discontinuation of angiotensin II, resolution of shock, patient expiration, liver transplantation, discharge from the intensive care unit, or 5 days from T0), and occurrence of new thrombotic events. Subgroup analyses were performed based on MELD score, sequential organ failure assessment (SOFA) score, and NEE requirements at T0

RESULTS

A total of 61 patients met inclusion criteria and the median MELD and SOFA scores at T0 were 37 and 15, respectively.

The median baseline NEE requirement was 0.41 mcg/kg/min and the majority of patients were on norepinephrine (89%) or vasopressin (98.4%) at time of angiotensin II initiation. The median dose of angiotensin II was 20 ng/kg/min at T0 and 40 ng/kg/min at T12. Most patients (59%) demonstrated a numerical reduction in NEE at T12 (0.053 mcg/kg/min; 95% CI [-0.03 – 0.16], p=0.2), but the difference did not reach statistical significance. However, when looked at separately, a significant reduction in norepinephrine doses was noted at T12 (4 mcg/min, 95% CI [0 – 10], p=0.03). Median MAP values increased from T0 to end of follow up by 2.5 mmHg. Additionally, median heart rates decreased by end of follow up (12 beats per minute; 95% CI [4 – 20], p=0.004). New thrombotic events occurred in 2 patients (3.3%). Based on the subgroup analysis, no differences in outcomes were noted among patients with MELD scores above or equal to 30, SOFA scores above or below the median, or in those requiring greater or less than 0.2 mcg/kg/min NEE at T0

CONCLUSION

In our evaluation of angiotensin II efficacy in cirrhotic patients with vasodilatory shock, we observed reductions in norepinephrine requirements and heart rates within 12 hours of therapy initiation. This is likely a reflection of the catecholaminesparing effect of angiotensin II, the role of which may have been limited by the clinical implementation practices, such as lower dosing and shorter durations of therapy. Additionally, thrombotic event rates were similar within our study compared to published literature; however, data on anticoagulant use was not available for assessment. Lastly, no differences were identified between subgroups, further suggesting that the hemodynamic responsiveness to angiotensin II is multifactorial. In order to develop a comprehensive approach to angiotensin II use in this high-risk population, future prospective studies should focus on identifying factors that can impact the efficacy of angiotensin II, as well elucidate optimal timing for initiation and duration of therapy.

Christopher Nelsen, PharmD

PGY2 INTERNAL MEDICINE PHARMACY RESIDENCY

Chris earned his Bachelor of Science in Neuroscience from The University of Texas at Dallas in 2015 and PharmD from The University of Texas College of Pharmacy in 2022. He completed his PGY1 Pharmacy Residency at Houston Methodist Hospital – Texas Medical Center. Following completion of his PGY2 Internal Medicine Residency, Chris will continue working at Houston Methodist Hospital as an Internal Medicine Clinical Pharmacy Specialist.

Primary project preceptor: Chelsea N. Lopez, PharmD, BCCCP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Outcomes of Alemtuzumab or Post Transplant Cyclophosphamidebased GVHD Prophylaxis in Adult Patients with Allo-HSCT

Duc N. Huynh, PharmD; Jacqueline Rios, MD; Ibrahim N. Muhsen, MD; Breanna Hinman, PharmD, BCOP; James Cox, PharmD, BCOP; Godsfavour Umoru, PharmD, BCOP; Premal Lulla, MD, MBBS; LaQuisa Hill, MD

PURPOSE

Graft-versus-host disease (GVHD) presents a significant challenge in allogeneic HCT (allo-HCT), affecting mortality and quality of life, particularly in unrelated donor transplants. While alemtuzumab has demonstrated efficacy in reducing GVHD occurrence and associated mortality, concerns persist regarding its potential impact on immune reconstitution and overall survival. A significant gap exists in literature regarding a standardized approach integrating alemtuzumab into GVHD prophylaxis protocols. Posttransplant cyclophosphamide (PTCy) has also been shown to lower the incidence of GVHD after unrelated allo-HCT.

METHODS

This study aims to describe the clinical outcomes in patients undergoing allo-HCT from either a matched-unrelated donor (MUD) or mismatched-unrelated donor (MMUD), and who received either alemtuzumab or PTCy GVHD prophylaxis. The primary endpoint is to evaluate the GVHD/relapse or progression-free survival (GFRS) of patients receiving the regimens described above.

RESULTS

A total of 133 patients in the alemtuzumab group and 7 patients in the PTCy group were evaluated. The 1-year GFRS was 51.7% with alemtuzumab and 42.9% in the PTCy group. Mean OS (mOS) was 45.1 months (95% CI, 39.8 – 50.4) in the alemtuzumab group and 15.4 months (95% CI, 5.1 – 25.7) in the PTCy. The cumulative incidence of grade II–IV acute GVHD for both alemtuzumab and PTCy group was approximately 28%. 11 events (8%) of Grade III–IV were observed in the alemtuzumab group while none was documented in the PTCy.

CONCLUSION

Overall, the recipients of alemtuzumab demonstrated encouraging survival outcomes comparable to current GVHD prophylaxis standards, warranting prospective trials to establish its utilization in unrelated allo-HCT.

Duc Huynh, PharmD

Duc Huynh earned his PharmD from University of Houston College of Pharmacy in 2022. He completed his PGY1 residency at Houston Methodist Sugar Land Hospital. Following completion of his PGY2, Duc has accepted a position as a Thoracic/Head & Neck Clinical Pharmacy Specialist at MD Anderson Cancer Center.

Primary project preceptor: Breanna Hinman, PharmD, BCOP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA, 2024 Midwest Pharmacy Residents Conference, Omaha, NE and Hematology/Oncology Pharmacy Association (HOPA) Annual Conference

Publication Citation: Huynh DN, Shah PJ, Greenlee SB, Long SW, Alsafadi MY. Evaluation of computerized clinical decision support system to reduce unnecessary nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) testing. Infect Control Hosp Epidemiol. 2024;45(4):537-539. doi:10.1017/ice.2023.256.

Characterization of Treatment Outcomes with Secondary Induction Regimens in TP53-Mutated Newly Diagnosed Acute Myeloid Leukemia (AML) Patients

Prakruti Gandhi, PharmD; Eleanor Hobaugh, PharmD, BCOP; Solmaz Karimi, PharmD, MS

PURPOSE

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy characterized by a clonal expansion of myeloid hematopoiesis. TP53 mutations, reported in 5-15% of all AML cases, are associated with unfavorable risk, poor response rates, and poor overall survival (OS). Recent data has shown promising results in terms of complete response (CR) and variable OS with hypomethylating agents, either as monotherapy or in combination with venetoclax in TP53mutated AML. The purpose of this study was to describe the treatment outcomes of subsequent induction regimens in terms of CR and/or CR with incomplete hematologic recovery (CRi) in newly diagnosed TP53-mutated AML patients.

METHODS

This was a single-center, retrospective cohort study that included adult patients with TP53-mutated AML who received induction chemotherapy at Houston Methodist between June 1, 2016 and June 1, 2023. Patients were excluded if they had concurrent malignancies requiring active therapy, acute promyelocytic leukemia with PMLRARA or t(15;17), received investigational agents, or

transferred care to another institution. Primary objective was response rates in terms of CR/CRi to secondary induction regimens. Secondary objectives included response rates to primary induction regimens, event free survival (EFS) at 6 months, OS at 6 months, and duration of response (DOR) for those who achieved CR/CRi.

RESULTS

A total of 36 patients met eligibility criteria for inclusion. CR/CRi was 22.2% with secondary induction regimens and 33.4% with conventional cytarabine-based induction regimens. 77.8% of patients experienced treatment failure, recurrence, death, or loss to follow up within the first 6 months after receiving an induction regimen yielding an EFS of 22.2%. OS at 6 months was 16.7% and the DOR was 6.1 months for patients who achieved CR/CRi.

CONCLUSION

Our study highlights the unmet need for new therapies that can effectively treat newly diagnosed, treatment-naïve TP53-mutated AML.

Prakruti Gandhi, PharmD

Prakruti Gandhi earned her PharmD from The University of Texas at Austin College of Pharmacy in 2022. She completed her PGY1 residency at Dell Seton Medical Center in Austin, Texas. Following completion of her PGY2, Prakruti has accepted a position as a Clinical Pharmacy Specialist in Leukemia at MD Anderson Cancer Center.

Primary project preceptor: Eleanor Hobaugh, PharmD, BCOP

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA, 2024 Midwest Pharmacy Residents Conference, Omaha, NE and Hematology/Oncology Pharmacy Association (HOPA) Annual Conference

Real-World Outcomes Associated with Subsequent-Line Therapy for Metastatic Renal Cell Carcinoma

Taylor Praska, PharmD; Karen Abboud, PharmD, BCOP, BCPS; Godsfavour Umoru, PharmD, BCOP; Emily Allen, PharmD; Jun Zhang, MD

PURPOSE

Renal cell carcinoma (RCC) accounts for approximately 3% of adult cancers with 60-80% being of clear cell histology. Current first line treatment includes immune checkpoint inhibitor (ICI)/tyrosine kinase inhibitor (TKI) combinations or dual ICI therapy; however, limited evidence exists to establish the preferred second-line regimen upon progression through first-line treatment. The purpose of this study is to describe the efficacy and safety outcomes associated with subsequent systemic therapy in patients with metastatic RCC upon progression through first-line immunotherapy-based combination treatment.

METHODS

This single-center, retrospective, observational study included 25 patients that received at least one dose of second-line treatment following progression on first-line immunotherapy-based combination treatment between January 1st, 2019 to August 31st, 2023. Exclusion criteria included metastatic RCC of non-clear cell histology, receipt of first-line regimen without immunotherapy, and transfer of care to an outside institution without shared electronic medical records. The primary outcome was 6-month progression-free survival (PFS) and secondary outcomes assessed the tolerability and adverse effects experienced on second-line therapy.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Taylor Praska, PharmD

RESULTS

In this study, the 6-month PFS with second-line therapy was 32.0% with the most common TKI toxicities of diarrhea (25%), stomatitis (25%), and hypertension (25%). The 6-month PFS was 50% with axitinib/pembrolizumab (n=4), 37.5% cabozantinib (n=8), 40% ipilimumab/ nivolumab (n=5), and 33.3% cabozantinib/nivolumab (n=3). The 6-month PFS was 38.5% for ICI-based treatment compared to 25.0% for non-ICI-based treatment in the second-line setting (p=0.379).

CONCLUSION

Overall, this study suggests a trend towards improved 6-month PFS with continuing ICI therapy vs non-ICI based therapy following progression on previous ICIbased treatment. However, the results were not statistically significant. Future studies should evaluate the benefit of ICI retreatment following progression on ICI.

Taylor earned her PharmD from North Dakota State University in Fargo, ND in 2022. She completed her PGY1 residency at Mayo Clinic Hospital in Phoenix, AZ. Following completion of her PGY2, Taylor will be starting as an Oncology Clinical Pharmacist at Banner MD Anderson in Phoenix, AZ.

Primary project preceptor: Karen Abboud, PharmD, BCOP, BCPS

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA, 2024 Midwest Pharmacy Residents Conference, Omaha, NE and HOPA Annual Conference, Tampa, FL

Incidence of Breakthrough CMV Infection in High Risk Recipients

Receiving Low-dose Valganciclovir Prophylaxis Following Kidney Transplantation

Erika B. Powe, PharmD; Allison N. Yun, PharmD, BCTXP; Eric Rubio, PharmD, BCTXP; Edward A. Graviss, PhD, MPH, FIDSA; Alyssa Chaplain, PharmD; Benjamin J. Deike, PharmD; Alex W. Rogers, PharmD; Richard J. Knight, MD, FACS

PURPOSE

Cytomegalovirus (CMV) is a common pathogen following solid organ transplantation that is associated with significant morbidity and mortality. Valganciclovir is the standard of care for CMV prophylaxis following solid organ transplantation. The standard dose is 900 mg daily adjusted for renal function and the side effect profile includes severe leukopenia, neutropenia, and thrombocytopenia. Due to these side effects, many transplant centers have elected to use low dose valganciclovir 450 mg daily, to help limit these complications. Studies have found in the intermediate risk population the use of low dose valganciclovir was associated with less leukopenia and comparable rates of CMV infection. To date, there remains a paucity of data describing the risk factors for breakthrough infection in high-risk recipients (D+/R-). The purpose of this study is to describe the incidence of breakthrough CMV infection in high-risk recipients on low dose valganciclovir prophylaxis following kidney transplant.

METHODS

This was a single-center, retrospective cohort study of kidney transplant recipients at Houston Methodist. Adult patients transplanted between January 1st,2021 through December 31st, 2022 who received low dose valganciclovir prophylaxis for 6-12 months pending seroconversion were included. Patients who received a multi-organ transplant or were CMV low/moderate risk were excluded. All patients were screened for CMV by plasma PCR at 1-, 3-, 6-, 9-, and 12-months post-transplant.

Erika B. Powe, PharmD

Data was collected for up to one year following transplant. The primary outcome was the incidence of breakthrough CMV infection. Key secondary outcomes included the incidence of CMV disease, CMV outcomes at one year, incidence of ganciclovir resistant infections, incidence of biopsy proven acute rejection (BPAR), graft loss and death. Safety endpoints included the development of leukopenia or neutropenia.

RESULTS

The incidence of breakthrough infection occurred in 11 (18.3%) patients. Median time to infection was 74 (58-169) days. Five patients (45.4%) that had a breakthrough infection developed CMV disease. There was one case of genotype confirmed ganciclovir-resistant infection, however this occurred after the completion of primary prophylaxis. Following the cessation of prophylaxis therapy, 10 (16.7%) additional cases of CMV infection were observed, totaling 21 (35%) cases within 1 year following transplant. Thirty-three patients (55%) developed leukopenia and 11 (18.3%) patients had BPAR. One death occurred and one patient had graft loss.

CONCLUSION

This study found a notable incidence of breakthrough CMV infection among high-risk recipients on low dose valganciclovir prophylaxis, which is consistent with current published literature. Despite this notable incidence, there was a low incidence of ganciclovir resistant infections.

Erika earned her Bachelor of Science from Miami University in 2018 and PharmD from Cedarville University in 2022. She completed her PGY1 residency at University Hospitals Cleveland Medical Center in Cleveland, Ohio. Following completion of her PGY2, Erika will join the team at UT Southwestern as an inpatient and outpatient transplant clinical specialist.

Primary project preceptor: Alex W. Rogers, PharmD

Presented at 2023 Vizient Pharmacy Network, Anaheim, CA and 2024 Midwest Pharmacy Residents Conference, Omaha, NE

Publication citation: Stouffer M, Wandling E, Dickson L, Lin, S., Duan, H., Powe, E., Jean-Louis, D., Tiwari, A.K., Amos, S. Gedunin modulates cellular growth and apoptosis in glioblastoma cell lines. Cancer Rep (Hoboken). 2024;7(5):e2051. doi:10.1002/cnr2.2051.

Powe E, Parschauer D, Istifan J, et al. Luteolin enhances erlotinib's cell proliferation inhibitory and apoptotic effects in glioblastoma cell lines. Front Pharmacol. 2022;13:952169. Published 2022 Sep 19. doi:10.3389/ fphar.2022.952169.

PGY2 SOLID ORGAN TRANSPLANT RESIDENCY

Terbutaline for Chronotropic Incompetence Management in Orthotopic Heart Transplant Recipients

Zoe H. Tu, PharmD; Allison N. Yun, PharmD; Jill C. Krisl, PharmD, BCPS, BCTXP; Arvind Bhimaraj, MD, MPH, FACC, FHFSA

PURPOSE

Orthotopic heart transplantation (OHT) is a life-saving therapy option for patients with end-stage heart disease. Vagal nerve denervation during the OHT procedure results in higher resting heart rates in OHT recipients compared to the general population. Chronotropic incompetence (CI) is a common post-operative complication that is often temporary and reversible but can be exaggerated in the setting of graft rejection. CI may be managed with agents like oral terbutaline; however, little data exists on the efficacy, safety, and necessity of long-term terbutaline use post-OHT.

METHODS

This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating terbutaline use in patients who received a heart transplant and were initiated on terbutaline for CI management during their index transplant admission. The primary outcome was time to terbutaline discontinuation post-transplant. Secondary outcomes included reason for terbutaline discontinuation, adverse event rates, and permanent pacemaker (PPM) placement rates.

RESULTS

The median time (IQR) to terbutaline discontinuation was 56 (20, 96) days from first dose. In most cases, terbutaline was successfully tapered off outpatient due to resolution of CI. Tachyarrhythmias occurred in 29 (12.7%) patients without long term sequelae. At 3 months post-transplant, PPMs had been placed for CI management in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant.

CONCLUSION

To our knowledge, this is the largest study to date in published literature investigating oral terbutaline use post heart transplantation. Our overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a PPM device. We conclude that terbutaline can be used safely early post heart transplant. If patients require long-term chronotropic support, the risk-benefit of PPM placement versus continued terbutaline should be considered.

PGY2 SOLID ORGAN TRANSPLANT RESIDENCY

Zoe Tu, PharmD

Zoe Tu earned her BA in chemistry from Princeton University in 2018 and her PharmD from The University of North Carolina at Chapel Hill in 2022. She completed her PGY1 acute care residency at Houston Methodist Hospital where she stayed on to complete her PGY2 in solid organ transplant. Following completion of her PGY2, Zoe will join the transplant team at Vanderbilt University Medical Center in Nashville, Tennessee as a heart transplant clinical pharmacist.

Primary project preceptor: Jill C. Krisl, PharmD, BCPS, BCTXP

2023 Vizient Pharmacy Network, Anaheim, CA, 2024 Midwest Pharmacy Residents Conference, Omaha, NE and 2024 American Transplant Congress, Philadelphia, PA

Publication citation: Tu ZH, Pierce BJ, Pasley T, Hutchins A, Huang H. Immune outcomes of lung transplant recipients with different cytochrome P450 3A5 phenotypes after discontinuation of voriconazole antifungal prophylaxis. Clin Transplant. 2024;38(1):e15235. doi:10.1111/ctr.15235.

Tu ZH, Perez AD, Diaz TE, Loop MS, Clarke M. Safety and Efficacy of Direct Oral Anticoagulants vs Warfarin in Patients With Obesity and Venous Thromboembolism: A Retrospective Analysis. Tex Heart Inst J. 2024;51(1):e238260. doi:10.14503/THIJ-23-8260.

Abbasi, G. Effect of COVID-19 on Pharmacy Technology. PP&P. 2020;17(6):2-4.

Abbasi, G. Deliver Pharmacy Services via Novel Technologies. PP&P. 2022;19(2):8-11.

Abboud, K., Umoru, G., Esmail, A., Abudayyeh, A., Murakami, N., AlShamsi, H. O., Javle, M., Saharia, A., Connor, A. A., Kodali, S., Ghobrial, R. M., & Abdelrahim, M. (2023). Immune checkpoint inhibitors for solid tumors in the adjuvant setting: Current progress, future directions, and role in transplant oncology. Cancers, 15(5), 1433.

Abboud, K., Umoru, G., Trachtenberg, B. et al. Real-world data of cardio-oncologic interventions for cardiovascular adverse events with oral oncolytics. Cardio-Oncology 10, 22 (2024). https://doi. org/10.1186/s40959-024-00221-5

Abdelrahim M, Mamlouk O, Lin H, Lin J, Page V, Abdel-Wahab N, Swan JT, Selamet U, Yee C, Diab A, Suki WN, Abudayyeh A. “incidence, predictors, and survival impact of acute kidney injury in patients with melanoma treated with immune checkpoint inhibitors: a 10-year singleinstitution analysis” OncoImmunology 2021;10(1):e1927313

Abdelrahim, M., Esmail, A., Umoru, G., Westhart, K., Abudayyeh, A., Saharia, A., & Ghobrial, R. M. (2022). Immunotherapy as a neoadjuvant therapy for a patient with hepatocellular carcinoma in the pretransplant setting: A case report. Current Oncology, 29(6), 4267–4273.

Abdelrahim M, Esmail A, Xu J, Umoru G, Al-Rawi H, Saharia A, Abudayyeh A, Victor D, McMillan R, Kodali S and Ghobrial RM (2022). Gemcitabine Plus Cisplatin Versus Non-Gemcitabine and Cisplatin Regimens as Neoadjuvant Treatment for Cholangiocarcinoma Patients Prior to Liver Transplantation: An institution Experience. Front. Oncol. 2022 Jun 2;12:908687.

Abdelrahim, M., Al-Rawi, H., Esmail, A., Xu, J., Umoru, G., Ibnshamsah, F., Abudayyeh, A., Victor, D., Saharia, A., McMillan, R., Al Najjar, E., Bugazia, D., Al-Rawi, M., & Ghobrial, R. M. (2022). Gemcitabine and cisplatin as neo-adjuvant for cholangiocarcinoma patients prior to liver transplantation: Case-series. Current Oncology, 29(5), 3585–3594.

Abdelrahim, M., Esmail, A., Xu, J., Umoru, G., Al-Rawi, H., & Saharia, A. (2022). P-168 Combination of gemcitabine plus cisplatin compared to non-gemcitabine and cisplatin regimens as neo-adjuvant treatment in liver transplant recipients with cholangiocarcinoma. Annals of Oncology, 33, S309–S310.

Abdelrahim, M., Esmail, A., Xu, J., Umoru, G., Saharia, A., McMillan, R., & Ghobrial, R. M. (2022). Gemcitabine plus cisplatin versus non-gemcitabine and cisplatin regimens as neoadjuvant treatment for cholangiocarcinoma patients prior to liver transplantation. Journal of Clinical Oncology, 40(16_suppl), e16202–e16202.

Adeola M, Azad R, Kassie GM, et al. Multicomponent interventions Reduce High-Risk Medications for Delirium in Hospitalized Older Adults. J Am Geriatr Soc. 2018;66:1638-45.

Ajewole BV, Cox JE, Swan JT, et al. Incidence of chemotherapyinduced peripheral neuropathy within 12 weeks of starting neurotoxic chemotherapy for multiple myeloma or lymphoma: a prospective, single-center, observational study. Supportive Care Cancer. 2020 Apr;28(4):1901-1912.

Al-Saadi MA, Heidari B, Donahue KR, Shipman EM, Kinariwala KN, Masud FN. Pre-existing right ventricular dysfunction as an independent risk factor for post intubation cardiac arrest and hemodynamic instability in critically ill patients: a retrospective observational study. Journal of intensive Care Medicine. 2022 2023 Feb;38(2):169-178. Epub 2022 Jul 3. PMID: 35786053.

Allen E, Brown EN, De La Torre R, Murthy A. Retrospective study on the efficacy and tolerability of dose modification of PD-1 and PD-L1 inhibitors in hospital-system community outpatient cancer clinics. J Oncol Pharm Pract. 2023 May 22; 10781552231177209. Online ahead of print.

Allen, E., Umoru, G., Ajewole, V., & Bernicker, E. (2023). Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease. Frontiers in Oncology, 13, 1283360. https://doi.org/10.3389/fonc.2023.1283360

Attia E, Fuentes, Vassallo M, Dobbs S, Nguyen P, Baker K. Establishing a multidisciplinary taskforce to improve anticoagulation safety at a large health system. AJHP. Volume 79, Issue 4, 15 February 2022, Pages 297–305

Awuah A, Shah PJ, Farheen T. Delayed hemolysis with parenteral artesuante. Hosp Pharm. 2023; 58(3):229-262

Badheeb, M., Abdelrahim, A., Esmail, A., Umoru, G., Abboud, K., AlNajjar, E., Rasheed, G., Alkhulaifawi, M., Abudayyeh, A., & Abdelrahim, M. (2022). Pancreatic tumorigenesis: Precursors, genetic risk factors and screening. Current Oncology, 29(11), 8693–8719.

Baigi T, Brown EN, De La Torre R, Abu-Shahin FI. Atezolizumabassociated myositis in a patient with unresectable hepatocellular carcinoma. J Oncol Pharm Pract. 2023 Jun 6; 10781552231180876

Online ahead of print.

Berry J, Liebl MG, Todd P, Brownewell V. Rapid Operationalization of Covid-19 Monoclonal Antibody infusion Clinics. Vol. No. | March 29, 2021

Bhakta SB, Colavecchia AC, Haines L, et al. A systematic approach to optimize electronic health record medication alerts in a health system. Am J Health Syst Pharm. 2019;76(8):530-6.

Bhakta SB, Colavecchia AC, Coffey W, et al. Implementation and Evaluation of a Sterile Compounding Robot in an Oncology Satellite Pharmacy. Am J Health Syst Pharm. 2018;75(11 Supplement 2): S51-7.

Bhakta SB, Deyhim N, Zafar N, Abbasi GA. Implementation and evaluation of an EHR-integrated mobile dispense tracking technology in a large academic tertiary hospital. Am J Health Syst Pharm. 2022 Sep 7;79(18):1562-1569.

Bookstaver PB, Akpunonu P, Nguyen HB, Swan JT, Howington GT. “Administration of rabies immunoglobulin: improving evidence-based guidance for wound infiltration.” Pharmacotherapy. Aug;41(8):644-648. Epub 2021 Jul 5.

Brazeale HS, Fuentes A, Adeola M. Analysis of Direct Oral Anticoagulant Therapy with Concomitant Use of interacting Antiretroviral Agents. Journal of Pharmacy Practice. August 2021.

Bugazia, D., Al-Najjar, E., Esmail, A., Abdelrahim, S., Abboud, K., Abdelrahim, A., Umoru, G., Rayyan, H. A., Abudayyeh, A., Al Moustafa, A.-E., & Abdelrahim, M. (2024). Pancreatic ductal adenocarcinoma: The latest on diagnosis, molecular profiling, and systemic treatments. Frontiers in Oncology, 14, 1386699. https://doi.org/10.3389/ fonc.2024.1386699

Bui LN, Swan JT, Shirkey BA, et al. Chlorhexidine bathing and Clostridium difficile infection in a surgical intensive care unit. J Surg Res.2018;228:107-11.

Bui LN, Swan JT, Perez KK, et al. Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical intensive Care Unit. J Surg Res. 2020;250:161-171.

Bui NA, Adeola M, Azad R et al. Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students. J Pharm Pract. 2020 Feb;33(1):21-29; Epub 2018 Jun 18

Burns, E. A., Muhsen, I. N., Anand, K., Xu, J., Umoru, G., Arain, A. N., & Abdelrahim, M. (2021). Hepatitis b virus reactivation in cancer patients treated with immune checkpoint inhibitors. Journal of Immunotherapy, 44(3), 132–139.

Burns, E. A., Ensor, J. E., Anand, K., Gentille, C., Guerrero, C., Kieser, R. B., Umoru, G., Shah, S. S., Petkova, J. H., Ganguly, S., Rice, L., & Pingali, S. R. K. (2021). Opportunistic infections in patients receiving daratumumab regimens for multiple myeloma(Mm). Blood, 138(Supplement 1), 4740–4740.

Burns, E. A., Gee, K., Kieser, R. B., Xu, J., Zhang, Y., Crenshaw, A., Muhsen, I. N., Mylavarapu, C., Esmail, A., Shah, S., Umoru, G., Sun, K., Guerrero, C., Gong, Z., Heyne, K., Singh, M., Zhang, J., Bernicker, E. H., & Abdelrahim, M. (2022). Impact of infections in patients receiving pembrolizumab-based therapies for non-small cell lung cancer. Cancers, 15(1), 81.

Burns, E., Xu, J., Kieser, R., Muhsen, I., Shah, S., Umoru, G., Mylavarapu, C., Zhang, Y., Crenshaw, A., Sun, K., Esmail, A., Guerrero, C., Gong, Z., Gee, K., Heyne, K., Singh, M., Zhang, J., Bernicker, E., & Abdelrahim, M. (2022). 480 Impact of infections in patients with advanced or metastatic non-small cell lung cancer (Nsclc) receiving pembrolizumab-based therapies. Regular and Young Investigator Award Abstracts, A501–A501.

Chen J, Ekaney I, Shah PJ. Comparison of antimicrobial utilization metrics: Food for thought for an antimicrobial stewardship programme. Int J Antimicrob Agents. 2022;60(5-6):106681

Chen J, Nguyen S, Ruegger M, Samuel L, Salazar E, Dunne I. Evaluation of outcomes with apixaban use for venous thromboembolism in hospitalized patients with end-stage renal disease receiving renal replacement therapy. Journal of Thrombosis and Thrombolysis. 2022 Aug;54(2):260-267. Epub 2022 Apr 16

Christensen PA, Olsen RJ, Perez KK, et al. Real-time Communication with Health Care Providers Through an Online Respiratory Pathogen Laboratory Report. Open Forum infect Dis. 2018;5(12):ofy322.

Chung C. Current targeted therapies in lymphomas. Am J Health Syst Pharm. 2019;76(22):1825-1834.

Chung C. Driving toward precision medicine for B cell lymphomas: Targeting the molecular pathogenesis at the gene level. J Oncol Pharm Pract. 2020;26(4):943-966.

Chung C. New Therapeutic Targets and Treatment Options for Thrombotic Microangiopathy: Caplacizumab and Ravulizumab. Ann Pharmacol. 2021 Mar;55(3):330-343. Epub 2020 Jul 25.

Chung C. Oral Targeted Therapies for B-Cell Lymphoma. US Pharm. 2020;45(2)(Specialty&Oncology suppl) Pages11-16

Chung C. Restoring the switch for cancer cell death: Targeting the apoptosis signaling pathway. Am J Health Syst Pharm. 2018;75: 945-52.

Chung C. From oxygen sensing to angiogenesis: Targeting the hypoxia signaling pathway in metastatic kidney cancer. Am J Health Syst Pharm. 2020 Dec 4;77(24):2064-2073.

Chung C. Predictive and prognostic biomarkers with therapeutic targets in colorectal cancer: A 2021 update on current development, evidence, and recommendation. J Oncol Pharm Pract. 2022 Jun;28(4):850-869. Epub 2021 Apr 9

Chung C. Targeting the Myeloid Lineages and the Immune Microenvironment in Myelodysplastic Syndromes: Novel and Evolving Therapeutic Strategies. Ann Pharmacother. 2022 Apr;56(4):475-487. Epub 2021 Jul 30

Chung C. Pharmacologic management of cancer-related pain. US Pharmacist. 2021; 46 (3), HS1-HS10.

Chung C. Focus on anemia in managing lower-risk myelodysplastic syndromes. US Pharmacist. 2021; 46 (19), 39-44

Chung C. A Promising Future for Precision Epigenetic Therapy for Follicular and Diffuse Large B-Cell Lymphoma? Blood Lymphat Cancer. 2022 Aug 4;12:99-106.

Chung C. Current therapies for classic myeloproliferative neoplasms: A focus on pathophysiology and supportive care. Am J Health Syst Pharm. 2023 Aug 9:zxad181. Epub ahead of print.

Chung, C. On the Forefront of Hematology and Oncology: A Clinical Pharmacist’s Perspective. Cambridge Scholars, UK. 2023

Chung C, Allen E, Umoru G. Paraneoplastic syndromes: A focus on pathophysiology and supportive care. American Journal of HealthSystem Pharmacy. 2022 Nov 7;79(22):1988-2000.

Chung C, Kim S, Bubalo J. Instilling value, quality, and safety through hematology and oncology stewardship. Am J Health Syst Pharm. 2019. 2019;76(9):617-621.

Chung C, Rome A, Desai M, Abanonu F, De la Casas C. Optimizing Multidisciplinary Treatment-Related Adverse Effects Detection and Reduction in Patients Undergoing Active Cancer Treatments in Ambulatory Infusion Centers. JCO Oncol Pract. 2022 Sep;18(9):e1553-e1561.

Chung C, Umoru G, Abboud K, Hobaugh E. Sequencing and combination of current small-molecule inhibitors for chronic lymphocytic leukemia: Where is the evidence? Eur J Haematol. 2023 Jul;111(1):1528

Chung, C., Umoru, G., Abboud, K., & Hobaugh, E. (2023). Sequencing and combination of current small-molecule inhibitors for chronic lymphocytic leukemia: Where is the evidence? European Journal of Haematology, 111(1), 15–28. https://doi.org/10.1111/ejh.13973

Chung C, Umoru G. Prognostic and predictive biomarkers with therapeutic targets in nonsmall-cell lung cancer: A 2023 update on current development, evidence, and recommendation. Journal of Oncology Pharmacy Practice. 2024;0(0). doi:10.1177/10781552241242684

Chung C, Yeung VTY, Wong KCW. Prognostic and predictive biomarkers with therapeutic targets in breast cancer: A 2022 update on current developments, evidence, and recommendations. J Oncol Pharm Pract. 2022 Aug 15:10781552221119797.

Connor AA, Adelman MW, Mobley CM, Moaddab M, Erhardt AJ, Hsu DE, Brombosz EW, Sanghvi M, Cheah YL, Simon CJ, Hobeika MJ, Saharia AS, Victor DW 3rd, Kodali S, Basra T, Graviss EA, Nguyen DT, Elsaiey A, Moore LW, Nigo M, Drews AL, Grimes KA, Arias CA, Li XC, Gaber AO, Ghobrial RM. Single-center Outcomes After Liver Transplantation With SARS-CoV-2-Positive Donors: An Argument for Increased Utilization. Transplant Direct. 2024 Mar 7; 10(4): e1590.

Connor AA, Huang HJ, Mobley CM, Graviss EA, Nguyen DT, Goodarzi A, Saharia A, Yau S, Hobeika MJ, Suarez EE, Moaddab M, Brombosz EW, Moore LW, Yi SG, Gaber AO, Ghobrial RM. Progress in Combined Liver-lung Transplantation at a Single Center. Transplant Direct. 2023 Apr 20; 9(5): e1482.

Cooper M, Dunne I, Kuten S, Curtis A, et al. Impact of Protease inhibitor-Based Antiretroviral Therapy on Tacrolimus intrapatient Variability in HIV-Positive Kidney Transplant Recipients. Transplant Proc. 2021 Apr;53(3):984-988.

Cooper MH, Christensen PA, Salazar E, et al. Real-world assessment of 2,879 COVID-19 patients treated with monoclonal antibody therapy: A propensity score-matched cohort study. Open Forum Infect Dis. 2021 Oct 8;8(11):ofab512

Davis ML, Sparrow HG, Ikwuagwu JO, et al. Multicentre derivation and validation of a simple predictive index for healthcare-associated Clostridium difficile infection. Clin Microbiol infect. 2018;24(11): 190-4.

Desai M, Blewett M, Yaniv A, Smith A, Patel P, Loughran C, Rahman O. Evaluating Pharmacist Preferences: Preparation of a Novel On-Body Delivery System vs. High-Resistance, Manual Syringes for LargeVolume Subcutaneous Drugs. JPP. Acceptance June 2024.

Deyhim N, Beck A, Balk J, Liebl M. Impact of sugammadex versus neostigmine/glycopyrrolate on perioperative efficiency. ClinicoEconomics and Outcomes Research. 2020;12:69-79.

Deyhim N, Bhakta S, Varkey A et al. Systemization of a pharmacy technician career ladder in a multi-hospital system. Exploratory Research in Clinical and Social Pharmacy. 2021 Jun 18;2:100036.

Deyhim N, Dunne IE, Nguyen PA, Fasoranti OO, Crew CM, Liebl MG. Process and outcomes from systemization of a longitudinal advanced pharmacy practice experience (LAPPE) program. American Journal of Health-System Pharmacy. 2023;81(7):e186-e192. doi:https://doi. org/10.1093/ajhp/zxad307

Deyhim N, Saini A, Beck A, Everett NS, Agbara EI. A hospital within a hospital: An innovative pharmacy model to improve the continuum of care. Am J Health Syst Pharm. 2023 Jun 6:zxad131.

Dinnuno CV, Lopez CN, Succar L, Nguyen DT, Graviss EA, Salazar E, Donahue KR. Directo oral to paretneral anticoagulant transitions: role of factor xa inhibitor specific anti xa concentrations. Pharmacotherapy Oct;42(10):768-779

Donahue KR, Gossai T, Succar L, et al. Second victim syndrome and the pharmacy learner. Journal of the American Pharmacists Association. 2020; 60(4):e14-e17.

Dreucean D, Harris JE, Voore P, Donahue KR. Approach to sedation and analgesia in COVID-19 patients on venovenous extracorporeal membrane oxygenation. Ann Pharmacother. 2022 Jan;56(1):73-82

Dreucean D, Nguyen SN, Donahue KR, Salazar E, Ruegger MC. Evaluation of characteristics and dosing regimens in patients with new or recurrent thrombosis on apixaban and rivaroxaban. Journal of Thrombosis and Thrombolysis 2021 52(1), 161-169

Duhon B, Varkey AC, Woodruff AL, et al. Chapter 16: Resiliency and Well-Being. ASHP Preceptors Handbook 4th edition. December 2019. U6263; ISBN: 978-1-58528-626-3

Ecabert D, Pham C, Pierce BJ, Musick ML, Nguyen DT, Graviss EA. Safety of valganciclovir dosed 450 mg three times weekly for cytomegalovirus prophylaxis in solid organ transplant recipients requiring hemodialysis. Open Forum Infect Dis. 2021 Aug 20;8(10):ofab436..

Ekinci E, Nathoo S, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence? J Cancer Surviv. 2018;12(3):348-356.

Esmail, A., Xu, J., Umoru, G., Al-Rawi, H., Saharia, A., & Abdelrahim, M. P-169 Feasibility of gemcitabine plus cisplatin as neo-adjuvant in cholangiocarcinoma patients prior to liver transplantation. Annals of Oncology. 2022; 33, S310.

Fong G, Skoglund EW, Phe K, et al. Significant Publications on infectious Diseases Pharmacotherapy in 2016. J Pharm Pract. 2018;31(5):469-80.

Fida N, Eagar TN, Yun AN, Rogers AW, Nguyen DT, Graviss EA, Ishaq F, DiPaola NR, Kim J, Janardhana G, Kassi M, Yousefzai R, Suarez EE, Bhimaraj A, Krisl JC, Guha A. Effectiveness of combined plasma cell therapy and costimulation blockade based desensitization regimen in heart transplant candidates. Clin Transplant. 2024 Feb;38(2):e15249. doi: 10.1111/ctr.15249. PMID: 38369810.

Friemel M, Marlow B, Peek GK, Bhakta SB. Impact to Site of Care Trends: An introduction and Strategy to Identify the Issues with the infusion Center Enterprise. ASHP Section of Pharmacy Practice Managers’ Advisory Group on Management of the Pharmacy Enterprise. June 2018.

Fuentes A, Truong M, Saldivar V, Adeola M. Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education. Patient Safety Journal (2022)

Gohil S, Deyhim N, Mgbere O, Essien EJ. Predictors of opioid prescription among outpatients with osteoarthritis in the United States. Journal of Opioid Management. 2023;19(3):205-223.

Haddad N, Paranjpe R, Rizk E, et al. Value of pharmacy services in an outpatient, preoperative, anesthesia clinic J Am Pharm Assoc (2003). 2020 Nov-Dec;60(6):e264-e278. Epub 2020 Apr 15.

Halawi H, Sabawi MM, Rizk E, Mahmoud AA, Petkova JH, Hui SR, Srour N, Donahue KR. Bleeding outcomes in critically ill patients on heparin with discordant aPTT and anti-Xa activity. J Thromb Thrombolysis. 2024 Oct 5

Haque, E., Muhsen, I. N., Esmail, A., Umoru, G., Mylavarapu, C., Ajewole, V. B., & Abdelrahim, M. (2022). Case report: Efficacy and safety of regorafenib plus fluorouracil combination therapy in the treatment of refractory metastatic colorectal cancer. Frontiers in Oncology, 12, 992455.

Highsmith EA, Morton C, Varnado S, Donahue KR, Sulhan S, Lista A. Outcomes associated with 4-factor prothrombin complex concentrate administration to reverse oral factor xa inhibitors in bleeding patients. The Journal of Clinical Pharmacology. 61(5). 598-605

Hill B, Narayanan N, Palavecino E, et al. The Role of an Antimicrobial Stewardship Team in the Use of Rapid Diagnostic Testing in Acute Care: An official Position Statement of the Society of infectious Diseases Pharmacists. Infect Control Hosp Epidemiol. 2018;39(4):473-5.

Hinman, B., Cox, J., Umoru, G., Kamble, R., & Musick, W. (2023). Extended duration letermovir in allogeneic hematopoietic stem cell transplant. Transplant Immunology, 81, 101936. https://doi. org/10.1016/j.trim.2023.101936

Hinman B, Umoru G, Burns E, Rahi CE, Zhang J (2023) Utilization of Dual Immunotherapy for Metastatic Pulmonary Pleomorphic Giant Cell Carcinoma: A Case Report. Clin Oncol Case Rep 6:4

Hoang J, Krisl J, Moaddab M, Nguyen DT, Graviss EA, Hussain I, Kassi M, Yousefzai R, Kim J, Trachtenberg B, Bhimaraj A, Guha A. Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection. Clin Transplant. 2022 Apr;36(4):e14571. doi: 10.1111/ctr.14571. Epub 2022 Jan 6. PMID: 34964505

SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2024

Holyk A, Belden V, Sirimaturos M, et al. Volume-based feeding enhances enteral delivery by maximizing the optimal rate of enteral feeding (FEED MORE). JPEN. 2020; 44(6):1038-46.

Honarmand K, Sirimaturos M, Hirshberg EL, Bircher NG, Agus MSD, Carpenter DL, Downs CR, Farrington EA, Freire AX, Grow A, Irving SY, Krinsley JS, Lanspa MJ, Long MT, Nagpal D, Preiser JC, Srinivasan V, Umpierrez GE, Jacobi J. Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024. Crit Care Med. 2024 Apr 1;52(4):e161-e181. doi: 10.1097/ CCM.0000000000006174. Epub 2024 Jan 19. PMID: 38240484.

Howington GT, Nguyen HB, Bookstaver PB, Akpunonu P, Swan JT. “Rabies postexposure prophylaxis in the United States: opportunities to improve access, coordination, and delivery.” PLOS Neglected Tropical Diseases. 2021;15(7):e0009467.

Hughes CG, Mailloux PT, Devlin JW, Swan JT, Sanders RD, Anzueto A, Jackson JC, Hoskins AS, Pun BT, Orun OM, Raman R, Stollings JL, Kiehl AL, Duprey MS, Bui LN, O’Neal HR Jr, Snyder A, Gropper MA, Guntupalli KK, Stashenko GJ, Patel MB, Brummel NE, Girard TD, Dittus RS, Bernard GR, Ely EW, Pandharipande PP; MENDS2 Study investigators. Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. N Engl J Med. 2021 Apr 15;384(15):1424-1436.

Huynh, D.N., Shah, P.J., Greenlee, S.B., Long, S.W., Alsafadi, M.Y. Evaluation of computerized clinical decision support system to reduce unnecessary nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) testing. Infection Control and Hospital Epidemiology, 2024, 45(4), pp. 537–539

Hwang, G, Rutugandha, P, et al. Oral endocrine therapy agent, race/ ethnicity, and time on therapy predict adherence in breast cancer patients in a large academic institution. Clin Breast Cancer. 2020 Clin Breast Cancer. 2020 Dec;20(6):520-526.. Epub 2020 Jun 13

Gong, Z., Umoru, G., Monge, J. et al. Adverse effects and non-relapse mortality of BCMA directed T cell therapies in multiple myeloma: an FAERS database study. Blood Cancer J. 14, 36 (2024). https://doi. org/10.1038/s41408-024-01023-9

Iso T, Rizk E, Harris JE, et al. Viable Hemostasis Obtained with Prothrombin Complex Concentrate in Patients Who Refuse Standard Allogeneic Blood Transfusion and Undergo Complex Cardiac Surgery: A Case Series, A & A Practice. 2020;14(9):e01276

Iso T, Yuan F, Rizk E, Tran AT, Saldana RB, Boyareddigari PR, Nguyen NA, Espino D, Benoit JS, Swan JT. Avoidable emergency department visits for rabies vaccination. Am J Emerg Med. 2022;54:242-248.

Iso T, Yuan F, Rizk E, Tran AT, Saldana RB, Boyareddigari PR, Nguyen NA, Espino D, Swan JT. Wound characteristics and infiltration with immune globulin for rabies postexposure prophylaxis in the emergency department. Am J Emerg Med. 2022 Dec;62:55-61. Epub 2022 Oct 7.

Jakowenko N, Nguyen S, Ruegger M, Dinh A, Salazar E, Donahue KR. Apixaban and rivaroxaban anti-xa level utilization and associated bleeding events within an academic health system. Thrombosis Research 196,276-282

Jones N, Shah PJ. Challenges in antimicrobial susceptibility testing interpretation: Fluoroquinolone susceptibility discordance. Am J Health Syst Pharm. 2022;79(11):829-30

Kieser, R. B., Xu, J., Burns, E., Muhsen, I., Shah, S. M., Umoru, G., Mylavarapu, C., Sun, K., Zhang, Y., Crenshaw, A., Esmail, A., Guerrero, C., Gong, Z., Gee, K., Heyne, K., Singh, M., Zhang, J., Efstathiou, E., Bernicker, E., & Abdelrahim, M. (2022). Outcomes of patients with advanced urothelial cancer who develop infection while on treatment

with pembrolizumab. Journal of Clinical Oncology, 40(16_suppl), 4573–4573.

Klasek R, Kuten SA, Patel SJ, et al. Unexplained fever after pancreas transplantation. Clin Transplant 2018;32(9):e13351.

Knight RJ, Graviss EA, Nguyen DT, et al. Conversion from tacrolimusmycophenolate mofetil to tacrolimus-mToR immunosuppression after kidney-pancreas transplantation reduces the incidence of both BK and CMV viremia. Clin Transplant 2018;32(6):e13265.

Koh L, Shah PJ, Aly S. Patient Case Report Daptomycin Holiday-A Daptomycin Dosing Strategy for Asymptomatic Increases in Creatine Phosphokinase Levels. J Pharm Pract. 2022;35(1):148-51

Krisl J. Potential Benefit or Risk of Harm?: Use of Herbal Supplements in Patients with Heart Failure, Texas Chapter of American College of Cardiology Heart Failure Blog. Oct 2018

Lai L, Alvarez G, Koh L, et al. The effect of gender disparity on migraine pharmacotherapy: a propensity score-matched cohort study. J Pharm Health Serv Res. 2018;9:191-7.

Lista AD, Sirimaturos M. Pharmacokinetic and pharmacodyamic principles for toxicology. Critical Care Clinics. 2021:37(3): 475-86.

Liu L, Brown EN, Abu-Shahin FI. Capecitabine-induced leukoencephalopathy in a patient with triple-negative breast cancer: A Case Report and Review of the Literature. Journal of Oncology Pharmacy Practice. October 2021.

Lopez CN, Fuentes A, Dhala A, Balk J. Ramelteon for Decreasing Delirium in Surgical intensive Care Unit Patients. Clinical Medicine insights: Psychiatry. January 2020.

Lopez CN, Succar L, Varnado S, Donahue KR. Direct oral to parenteral anticoagulants: strategies for inpatient transition. J Clin Pharmacol. 2020, 0(0) 1-9.

Lopez CN, Sulaica E, Donahue KR, Wanat MA. Updates in Hemodynamic Monitoring: A Review for Pharmacists. J Pharm Pract. 2022 Oct;35(5):762-768. Epub 2021 Mar 26.

Mason MJ, McDaneld PM, Musick WL, Kontoyiannis DP. Serum Levels of Crushed Posaconazole Delayed Release Tablets. Antimicrob Agents Chemother. 2019;63(5).pii: e02688-18.

Molina TL, Kricl JC, Donahue KR, Varnado S. Gastrointestinal Bleeding in Left Ventricular Assist Device: Octreotide and Other Treatment Modalities. ASAIO 2018; 64(4):433-9.

Monroig-Bosque PDC, Balk J, Segura F, et al. The utility of therapeutic plasma exchange for amphotericin B overdose. Transfus Apher Sci. 2018 Dec;57(6):756-8.

Morton C, Lista A, Jakowenko N, Salazar E, Donahue KR. Apixaban and rivaroxaban anti xa level utilization for guidance of administration of andexanet alfa: a case series. J Thromb Thrombolysis. 2022 Jan;53(1):235-239

Muhsen I, Burns E, Umoru G et al. Hepatitis B reactivation with pembrolizumab, atezolizumab, and nivolumab: A pharmacovigilance study and literature review. J Clin Oncol 38: 2020 (suppl; abstr e15127)

Mysore KR, Ghobrial RM, Kannanganat S, et al. Longitudinal assessment of T cell inhibitory receptors in liver transplant recipients and their association with posttransplant infections. Am J Transplant. 2018;18(2):351-63.

Narasimhan B, Lorente-Ros M, Aguilar-Gallardo JS, Lizardo CP, Narasimhan H, Morton C, Donahue KR, Aronow WS. Anticoagulation

in Covid-19, a review of current literature and guidelines. Hosp Pract (1995). 2021 Dec;49(5):307-324

Nazer LH, Lopez-Olivo MA, Brown AR, Cuenca JA, Sirimaturos M, Habash K, AlQadeeb N, May H, Milano V, Taylor A, Nates JL. A systematic review and meta-analysis evaluating geographical variation in outcomes of cancer patients treated in ICUs. Critical Care Explorations 2022 Sep 13;4(9):e0757.

Nguyen PAA, Enwere E, Gautreaux S, et al. Impact of a pharmacydriven transitions-of-care program on postdischarge healthcare utilization at a national comprehensive cancer center. Am J Health Syst Pharm. 2018;75(18):1386-93.

Nguyen SN, Ruegger MC, Salazar E, Dreucean D, Tatara AW, Donahue KR. Evaluation of anti xa apixaban and rivaroxaban levels with respect to known doses in relation to major bleeding events. J Pharm Pract. 2022 Dec;35(6):836-845. Epub 2021 Apr 12.

Oh M, Alkhushaym N, Fallatah S, et al. The association of BRCA1 and BRCA2 mutations with prostate cancer risk, frequency, and mortality: A meta-analysis. Prostate. 2019 Jun;79(8):880-95.

Padmani, B., Abbasi, G., Hirave, B., Crooks, M., & Yassine, M. Management of Medication Preparation with Dynamic Processing. US Patent 20160210437.

Padmani, B., Olsen, G., Abbasi, G., Dooley, C., Leech, D., Armstrong, C., & White, R. Automated Exchange of Healthcare information for Fulfillment of Medication Doses. US Patent 20160117472.

Padmani, B., Valentine, M., Bender, J., Crooks, M., Hirave, B., Yassine, M., Abbasi, G., & Yevseyeva, K. Management of Medication Preparation with Formulary Management. US Patent 20160092638.

Padmani, B., Valentine, M., Bender, J., Crooks, M., Hirave, B., Yassine, M., Abbasi, G., & Yevseyeva, K. Management of Medication Preparation with Formulary Management. US Patent 11107574 B2.

Pai A, Swan JT, Wojciechowski D, Qazi Y, Dholakia S, Shekhtman G, Abou-Ismail A, Kumar D. “Clinical rationale for a routine testing schedule using donor-derived cell-free DNA after kidney transplantation.” Annals of Transplantation. 2021; 26: e932249

Patel SJ, Knight RJ, Kuten SA, et al. Ciprofloxacin for BK viremia prophylaxis in kidney transplant recipients: Results of a prospective, double-blind, randomized, placebo-controlled trial. Am J Transplant. 2019;19(6):1831-7.

Pevehouse R, Shah PJ, Chou N, Oolut P, Nair S, Ahmed R. Evaluating the utility of procalcitonin and a clinical decision support tool to determine duration of antimicrobial therapy for respiratory tract infections. Am J Health Syst Pharm. 2024 Aug 19;81(Supplement_4):S137-S143. doi: 10.1093/ajhp/zxae072. PMID: 38488695.

Pham C, Bilgili E, Krisl J. Tocilizumab in Thoracic Transplant Recipients. ISHLT Pulse Newsletter [online publications 2019]

Pham C, Pierce BJ, Yau SW, Youssef GJ, Goodarzi A, Huang HJ. Belatacept dosing in lung transplantation: is there a method to the madness? OBM Transplantation. 2021;5(3).

Pham C, Pierce B, Nguyen DT, Graviss EA, Huang HJ. Assessment of carfilzomib treatment response in lung transplant recipients with antibody mediated rejection. Transplantation Direct. 2021;7:e680.

Pham C, Kuten SA, Knight RJ, Nguyen DT, Graviss EA, Gaber AO. Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti-thymocyte globulin vs basiliximab. Transpl infect Dis. 2020;00:e13257

Pritchard ER, Murillo JR Jr, Putney D, Hobaugh EC. Single-

center, retrospective evaluation of safety and efficacy of direct oral anticoagulants versus low-molecular-weight heparin and vitamin K antagonist in patients with cancer. J Oncol Pharm Pract. 2019;25(1):52-9.

Qin Q, Ajewole VB, Sheu TG, et al. Successful treatment of a stage IIIC small-cell carcinoma of the ovary hypercalcemic subtype using multi-modality therapeutic approach. Ecancermedicalscience. 2018;12:832.

Rambaran KA, Huynh HA, Zhang Z, Robles J. The Gap in Electronic Drug information Resources: A Systematic Review. Cureus. 2018 Jun 22;10(6):e2860.

Rana I, von Oehsen W, Nabulsi NA, Sharp LK, Donnelly AJ, Shah SD, Stubbings J, Durley SF. A comparison of medication access services at 340B and non-340B hospitals. Research in Social and Administrative Pharmacy. 2021;17(11):1887-1892.

Rizk E, Haas EM, Swan JT. Opioid-Sparing Effect of Liposomal Bupivacaine and intravenous Acetaminophen in Colorectal Surgery. J Surg Res. 2021;259:230-241.

Rizk E, Swan JT. Development, Validation, and Assessment of Clinical Impact of Real-time Alerts to Detect inpatient As-Needed Opioid Orders with Duplicate indications: Prospective Study. J Med internet Res. 2021;23(10):e28235.

Rizk E, Swan JT, Cheon O, et al. Quality indicators to measure the effect of opioid stewardship interventions in hospital and emergency department settings. Am J Health-Syst Pharm. 2019; 76:225-35.

Rizk E, Tran AT, Soto F, Putney DR, Fuentes A, Swan JT. Alteplase for the treatment of midline catheter occlusions: a retrospective, singlecohort descriptive study. Br J Nurs. 2022;31(14):S6-S16.

Rizk E, Tajchman S, Fink E, Aryal DK, Iso T, Flores E, Brown AE, Chokshi SP, Desai SN, Dewan AK, Kazzaz SA, Guevara M, Nagaraj S, Robben CP, Vittone V, Swan JT. Quality indicators for osteoarthritis pain management in the primary care setting. BMC Musculoskelet Disord. 2023 Jun 30;24(1):538

Rizk E, Wilson AD, Murillo MU, Putney DR. Comparison of Antifactor Xa and Activated Partial Thromboplastin Time Monitoring for Heparin Dosing in Vascular Surgery Patients: A Single-Center Retropective Study. Ther Drug Monit 2018 Feb; 40(1): 151-5.

Rizk E, Yuan F, Zheng F, Fink E, Kaur N, Tran AT, Iso T, Mohyuddin NG, Thekdi AA, Jackson GL, Wanat MA, Thornton JD, Swan JT. Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery. Otolaryngol Head Neck Surg. 2023 Jul;169(1):176-184

Rubido ED, Cooper MH, Donahue KR, Krisl J. Descriptive analysis evaluating the use of direct oral anticoagulation therapy in heart and lung transplant recipients. Clin Transplant. 2023 Feb;37(2):e14897. Epub 2023 Jan 11.

Ruder TL, Donahue KR, Colavecchia AC, et al. Hemodynamic Effects of Dexmedetomidine in Adults with Reduced Ejection Fraction. Journal of intensive Care Medicine. J Intensive Care Med. 2021 Aug;36(8):893899. Epub 2020 Jun 17. .

Salazar E, Perez KK, Ashraf M, Chen J, Castillo B, Christensen PA, Eubank T, Bernard DW, Eagar TN, Long SW, Subedi S, Olsen RJ, Leveque C, Schwartz MR, Dey M, Chavez-East C, Rogers J, Shehabeldin A, Joseph D, Williams G, Thomas K, Masud F, Talley C, Dlouhy KG, Lopez BV, Hampton C, Lavinder J, Gollihar JD, Maranhao AC, Ippolito GC, Saavedra MO, Cantu CC, Yerramilli P, Pruitt L, Musser JM. Treatment of Coronavirus Disease 2019 (COVID-19) Patients with Convalescent Plasma. Am J Pathol. 2020 Aug;190(8):1680-1690.

Salgado BC, Fida N, Krisl J, Berens PM, Graviss EA, Nguyen DT, Hussain, I, et al. Remote versus early corticosteroid wean outcomes in heart transplant recipients in the contemporary era. Clin Transplant. 2021 Aug;35(8):e14382.

Santalo O, Farano J, Igwe J, Deyhim N. Survey of health-system pharmacy administration and leadership residencies. American Journal of Health-System Pharmacy. 2020;77(6):449-456.

Seo H, Lopez CN, Succar L, Donahue KR. Inhaled alprostadil for hospitalized adult patients. Ann Pharmacother. 2022 Jun;56(6):671678. Epub 2021 Sep 5.

Shah PJ, Halawi H, Kay J, Akogun A, Wise S, Daoura N, Putney D. A Single-Center, Retrospective Cohort Study Evaluating the Use of Probiotics for the Prevention of Hospital-Onset Clostridioides difficile Infection in Hospitalized Patients Receiving Intravenous Antibiotics. Hosp Pharm. 2023; 58(1):57-61

Shah PJ, Koshy J, Everett N, Attia E. Severe Plasmodium falciparum Malaria Treated with investigational Artesunate in the United States. J Pharm Pract. 2018 Jan 1:897190018782367. Epub ahead of print.

Shi L, Wei W, Smith A, Abbasi G. Implementation and evaluation of an EHR-integrated perpetual inventory system in a large tertiary hospital oncology pharmacy. AJHP. 2024 June 15;81(12):546–554. doi. org/10.1093/ajhp/zxae022

Sigala MI, Dreucean D, Harris JE, et al. Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus NonSARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO. Ann Pharmacother. 2023 Sep;57(9):1005-1015. Epub 2023 Jan 13.

Sirimaturos M, Gotur DB, Patel SJ, et al. Clinical Outcomes Following Tocilizumab Administration in Mechanically Ventilated Coronavirus Disease 2019 Patients. Crit Care Explor. 2020;2(10):e0232.

Smith AT, Kennerly-Shah JM, Kusoski CL. Development of a tool to allocate inpatient specialized pharmacy resources at a comprehensive cancer center. Journal of Oncology Pharmacy Practice. 2020;26(7):1686-1694.

Smith A, Begnoche B, Mellett J, Hafford A, Rodis JL, Jordan TA. Defining, capturing, and validating pharmacists’ patient profile reviews in the electronic medical record, Am J Health Syst Pharm. 2022 Nov 22;79(23):2166-2173.

Solomon JM, Ajewole VB, Schneider AM, et al. Evaluation of the prescribing patterns, adverse effects, and drug interactions of oral chemotherapy agents in an outpatient cancer center. 2019 Oct;25(7):1564-1569. Epub 2018 Aug 31.

Sparrow HG, Swan JT(co-primary), Moore LW, et al. Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1. Kidney int. 2019;95(4):905-13.

Srour N, Dasnadi S, Korulla A, Shah PJ. Early-onset neonatal ventriculomeningitis due to Streptococcus gallolyticus: A case report. Pediatr Neonatol. 2022;63(4):430-31

Srour N, Succar L, Nguyen P, Lopez CN. Vancomycin Dosing in High Intensity Continuous Renal Replacement Therapy: A Retrospective Cohort Study. Pharmacotherapy. May 2023.

Steere EL, Eubank TA, Cooper MH, Greenlee SB, Drake TC. Impact of Hypoalbuminemia on Ceftriaxone Treatment Failure in Patients With Enterobacterales Bacteremia: A Propensity-Matched, Retrospective Cohort Study. Open Forum Infect Dis. 2023 Feb 27;10(3):ofad102.

Succar L, Sulaica EM, Donahue KR, Wanat MA. Management of Anticoagulation with Impella Percutaneous Ventricular Assist Devices and Review of New Literature. J Thromb Thrombolysis (2019). 2019 Aug;48(2):284-291.

Succar L, Donahue KR, Varnado S, Kim JH. Use of Tissue Plasminogen Activator Alteplase for Suspected Impella Thrombosis. Pharmacotherapy. 2020;40(2):169-173

Succar L, Lopez CN, Victor D, Lindberg S, Saharia A, Sheth S, Mobley C. Perioperative Cangrelor in Patients with Recent Percutaneous Coronary intervention Undergoing Liver Transplantation: A Case Series. Pharmacotherapy. 2022 Mar;42(3):263-267. Epub 2022 Feb 3.

Sullivan E, Ruegger M, Dunne I, Sutaria N, Towers W. Comparison of effectiveness and safety of sodium polystyrene sulfonate and sodium zirconium cyclosilicate for treatment of hyperkalemia in hospitalized patients. AJHP. 2023 Jun 19.

Swan JT, Iso T, Rizk E, et al. Defining Vasoplegia Following Durable, Continuous Flow Left Ventricular Assist Device Implantation ASAIO J. 2022 Jan 1;68(1):46-55.

Swan JT, Rizk E, Kwak N, Guastadisegni J, Thompson-Moore N, Liebl MG. Publication of Pharmacy Residency Research: A 12-Year Cohort From an Academic Medical Center J Pharm Pract. 2022 Dec;35(6):1025-1033.

Swan JT, Moore LW, Sparrow H, Frost A, Gaber AO, Suki WN. “Optimization of acute kidney injury (AKI) time definitions using the electronic health record: a first step in automating in-hospital AKI detection.” Journal of Clinical Medicine. 2021:10(15):3304.

Thomas T, Fuentes A, Xu Q, Donahue K. Evaluation of heparin induced thrombocytopenia using probability scores in a mechanical circulatory support population. J Thromb Thrombolysis 2019, 48(1):134-140.

Towers W, Nguyen SN, Ruegger MC, Salazar E, Donahue KR. Apixaban and Rivaroxaban anti xa level monitoring versus standard monitoring in hospitalized patients with acute kidney injury. Ann Pharmacother. 2022 Jun;56(6):656-663.

Tran AT, Rizk E, Aryal DK, Soto FJ, Swan JT. Incidence of midline catheter complications among hospitalized patients. J Infus Nurs. 2023 Jan-Feb 01;46(1):28-35.

Tran AT, Rizk E, Haas EM, Naufal G, Zhong L, Swan JT. Real-World Data on Liposomal Bupivacaine and inpatient Hospital Costs After Colorectal Surgery. J Surg Res. 2022;272:175-183. doi:10.1016/j. jss.2021.12.002

Tu ZH, Pierce BJ, Pasley T, Hutchins A, Huang H. Immune outcomes of lung transplant recipients with different cytochrome P450 3A5 phenotypes after discontinuation of voriconazole antifungal prophylaxis. Clin Transplant. 2024 Jan;38(1):e15235. doi: 10.1111/ctr.15235. PMID: 38289893

Umoru GO, Shah PJ, Tariq F. A Case Report of Neurotoxicity After Prolonged Doses of Acyclovir in a Patient with Renal Dysfunction. J Pharm Pract. 2020; 33(2):217-221.

Umoru G, Taitano M, Beshay S et al. Pulmonary arterial hypertension in breast cancer patients on HER2-targeted therapy: a review of FDA Adverse Events Reporting System data. ERJ Open Res. 2020; 6(2):00199-2020.

Umoru GO, Zaghloul H, El-Rahi C, Ensor JE. Evaluation of efficacy and safety of pegfilgrastim when given less than two weeks from dosedense chemotherapy regimens. 2021 Jul;27(5):1119-1124. Epub 2020 Aug 12.

Wanat MA, Fitousis K. Comment: Critical Care Pharmacists and Medication Management in an ICU Recovery Center. Ann Pharmacother. 2019;53(1):105.

Wang H, Brong M, Pham S, Dreucean D. Highlights of Clinical Practice Guideline for the Management of Community-Acquired Pneumonia. Infect Dis Clin Pract. 2020; 28(4):188-190.

Wang H, Charles CV. A Review of Newly Approved Antibiotic Treatment for Community-Acquired Bacterial Pneumonia: Lefamulin. Sr Care Pharm. 2020;35(8):349-354.

Wei W, Coffey W, Adeola M, Abbasi G. Impact of smart pumpelectronic health record interoperability on patient safety and finances at a community hospital. Am J Health Syst Pharm. 2021 Jul 14:zxab287.

Wei W, Felippi R, Abbasi G, Pinn T, St. Rose K, Rana I. The Impact of Electronic Health Record Interventions on Patient Access to PostHospital Discharge Prescriptions. Hosp Pharm. 2023 Apr;58(2):212218. doi: 10.1177/00185787221130689. Epub 2022 Oct 31.

Xia R, Kachru N, Tuazon, DM, et al. Evaluation of Neuromuscular Blockade Reversal on Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population. J Cardiothorac Vasc Anesth. 2019 Dec;33(12):3348-3357.

Xia R, Varnado S, Graviss EA, Nguyen, DT, Cruz-Solbes A, Guha A, Krisl JC. Role of thromboelastography in predicting and defining pump thrombosis in left ventricular assist device patients. Thrombosis Research 2020;192:29-35

Yang T, Cutshall BT, Tatara A, Ruegger M. Combined insulin and GLP1 Receptor Agonists: Simplifying Treatment or Adding Obstacles? J Pharm Pract. 2018. Aug;32(4):447-449.

Yang T, Murillo M, Vadharyia A, et al. Direct oral anticoagulants versus aspirin for venous thromboembolism after orthopedic surgery. Am J Health-Syst Pharm. 2019; May 17;76(Supplement_2):S55-S60.

Yassine D, Brown EN, Putney D, Fasoranti O. Evaluation of the efficacy and safety of apixaban and rivaroxaban in cancer patients receiving concomitant active anti-neoplastic therapy at an outpatient cancer setting. Journal of Oncology Pharmacy Practice. 2020;26(7): 1650-1656.

Yazji A, Brown EN, De La Torre R, Umoru GO. Immune checkpoint blockade effect on immunologic and virologic profile of five cancer patients living with human immunodeficiency virus (HIV) infection. Journal of Oncology Pharmacy Practice. 2024;0(0). doi:10.1177/10781552241264258

Yi Rogers AW, Saharia A, et al. Early Experience with COVID-19 and Solid Organ Transplantation at a US High-volume Transplant Center. Transplantation. 2020. Nov;104(11):2208-2214.

Yuan F, Iso T, Rizk E, Saldana RB, Tran AT, Nguyen NA, Boyareddigari PR, Espino D, Swan JT. Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin. JAMA Netw Open. 2022 Jun 1;5(6):e2216631.

Zhang, Y., Xu, J., Burns, E., Muhsen, I., Shah, S. M., Umoru, G., Mylavarapu, C., Sun, K., Crenshaw, A., Esmail, A., Kieser, R. B., Guerrero, C., Gong, Z., Gee, K., Heyne, K., Singh, M., Zhang, J., & Abdelrahim, M. (2022). Infections and their impact on patients on pembrolizumab-based therapies for head and neck cancer. Journal of Clinical Oncology, 40(16_suppl), 6035–6035.

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