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Ortmann MJ, Johnson EG, Jarrell DH, Bilhimer M, Hayes BD, Mishler A, Pugliese RS, Roberson TA, Slocum G, Smith AP, Yabut K, Zimmerman DE. ASHP Guidelines on Emergency Medicine Pharmacist Services. Am J Health Syst Pharm 2021; 78:261-275. [PMID: 33480409 DOI: 10.1093/ajhp/zxaa378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Daniel H Jarrell
- Department of Pharmacy, Banner - University Medical Center Tucson, Tucson, AZ.,Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ
| | - Matt Bilhimer
- Department of Pharmacy, Olathe Medical Center, Olathe, KS
| | - Bryan D Hayes
- Department of Emergency Medicine, Harvard Medical School, Boston, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Aimee Mishler
- Department of Pharmacy, Valleywise Health, Phoenix, AZ
| | - Robert S Pugliese
- Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA.,Department of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor A Roberson
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, OH
| | - Giles Slocum
- Department of Pharmacy and Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Andrew P Smith
- Department of Pharmacy, Scripps Mercy Hospital, San Diego, CA
| | - Katie Yabut
- Department of Pharmacy, Legacy Mount Hood Medical Center, Portland, OR
| | - David E Zimmerman
- Department of Pharmacy, Duquesne University School of Pharmacy, Pittsburgh, PA.,Department of Pharmacy, UPMC-Mercy, Pittsburgh, PA
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Kasturiratne A, Lalloo DG, Janaka de Silva H. Chronic health effects and cost of snakebite. Toxicon X 2021; 9-10:100074. [PMID: 34355162 PMCID: PMC8321925 DOI: 10.1016/j.toxcx.2021.100074] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
The burden of disability among survivors and the socio-economic impact of snakebite have not been adequately researched. We reviewed original research articles, case reports and small case series relating to chronic physical, mental and psycho-social disability and economic burden of snakebite. Both physical and psychological health problems seem common in snakebite survivors and can lead to disability and loss of productivity. Chronic physical health effects, musculoskeletal disability being the commonest, can be largely attributed to limited and delayed access to optimal treatment of acute envenoming. The economic burden is considerable, and includes health system costs, out-of-pocket expenditure and opportunity costs, with regional variations. Health systems should be more responsive to needs and circumstances of bite victims, and a more holistic approach should be developed in the treatment of snakebite which incorporates the management of chronic health effects. Limited attention has been paid to chronic disability and the socio-economic impact of snakebite. Physical and psychological health problems occur in snakebite survivors leading to disability and loss of productivity. Chronic health effects can be largely attributed to limited and delayed access to optimal treatment of acute envenoming. Economic burden includes health system costs, out-of-pocket expenditure and opportunity costs. Health systems should be responsive to needs and circumstances of bite victims including care of chronic health effects.
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Cocchio C, Johnson J, Clifton S. Review of North American pit viper antivenoms. Am J Health Syst Pharm 2020; 77:175-187. [PMID: 31974558 DOI: 10.1093/ajhp/zxz278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE For the first time in nearly 20 years, 2 antigen-binding fragment (Fab) antivenoms are available to treat patients who incur North American pit viper snakebites: Crotalidae polyvalent immune Fab (ovine), or simply FabAV; and Crotalidae immune F(ab')2 (equine), or simply F(ab')2. Pharmacists are in a key position for the selection, dosing, reconstitution, administration, and monitoring of antivenom therapy; however, they encounter inconsistent exposure and experience with these drugs. Thus, an updated review of the literature is necessary. METHODS The search strategy and selection incorporated both controlled vocabulary terms and keywords to describe concepts relevant to the search. Retrieval was limited to literature published from 1997 to the present in English, Portuguese, or Spanish. RESULTS Given the paucity of available prospective literature, the authors elected to include all prospective evidence to best describe the role of antivenom. For the primary literature review, manuscripts were excluded if they were observational studies, conference abstracts, narrative or opinion articles, letters to the editor, or in-progress studies. CONCLUSION While there is limited evidence-based guidance on the superiority of F(ab')2 to FabAV, or vice versa, individual and regional considerations should contribute to formulary decisions. Pharmacists must play a role in the development of clinical pathways to ensure appropriate evaluation, supportive care, and antivenom procurement, administration, and monitoring.
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Affiliation(s)
| | - Jami Johnson
- Oklahoma Center for Poison and Drug Information, Oklahoma City, OK, and University of Oklahoma College of Pharmacy, Oklahoma City, OK
| | - Shari Clifton
- Reference & Instructional Services, Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Quintana-Castillo JC, Estrada-Gómez S, Cardona-Arias JA. Economic Evaluations of Interventions for Snakebites: A Systematic Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:547-554. [PMID: 32982344 PMCID: PMC7509330 DOI: 10.2147/ceor.s259426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
Background Snakebite is an often-neglected event with a high rate of mortality and is concentrated in poor areas. We aimed to assess the economic impact and health effects of the implementation of interventions for snakebites through a systematic review of the scientific literature. Methods Thirty search strategies were conducted in seven databases, applying PRISMA’s identification, screening, selection, and inclusion phases. The reproducibility of the selection of studies and the extraction of information were guaranteed. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. Qualitative synthesis and meta-analysis were performed for determining the average cost-effectiveness (ACE) for each death and disability-adjusted life years (DALY) avoided. Results Six cost-effectiveness studies were included for the supply of antivenom (AV), taken as outcomes on days of hospitalization or in ICU, death and DALYs avoided. All studies only included institutional costs, and majority of them did not specify the analytical model or economic evaluation parameters and did not perform uncertainty analyses. The management protocol standardization with interdisciplinary attention improves ACE of AV. Cost-effectiveness ratio (CER) of treatment with AV was USD 1253 (constant value for the year 2017, adjusted by purchasing power parity) for each death avoided and USD 51 per DALY avoided. Conclusion High cost-effectiveness of the AV treatment for snakebites was evidenced, which shows that the allocation of resources for this event should be a healthcare priority in addition to implementation of strategies that improve the access to, opportunity, and quality of hospital and pre-hospital care and reduce the cost of AV.
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Anderson VE, Gerardo CJ, Rapp-Olsson M, Bush SP, Mullins ME, Greene S, Toschlog EA, Quackenbush E, Rose SR, Schwartz RB, Charlton NP, Lewis B, Kleinschmidt KC, Sharma K, Lavonas EJ. Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients. Clin Toxicol (Phila) 2018; 57:25-30. [PMID: 30175628 DOI: 10.1080/15563650.2018.1491982] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. METHODS A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. RESULTS Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p = .025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. CONCLUSIONS In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.
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Affiliation(s)
- Victoria E Anderson
- a Rocky Mountain Poison and Drug Center , Denver Health and Hospital Authority , Denver , CO , USA
| | - Charles J Gerardo
- b Division of Emergency Medicine , Duke University School of Medicine , Durham , NC , USA
| | - Malin Rapp-Olsson
- a Rocky Mountain Poison and Drug Center , Denver Health and Hospital Authority , Denver , CO , USA
| | - Sean P Bush
- c Department of Emergency Medicine , Brody School of Medicine , Greenville , NC , USA
| | - Michael E Mullins
- d Division of Emergency Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | - Spencer Greene
- e Department of Emergency Medicine , Baylor College of Medicine , Houston , TX , USA
| | - Eric A Toschlog
- f Department of Surgery , Brody School of Medicine , Greenville , NC , USA
| | - Eugenia Quackenbush
- g Department of Emergency Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - S Rutherfoord Rose
- h Department of Emergency Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Richard B Schwartz
- i Department of Emergency Medicine and Hospital Services , Medical College of Georgia , Augusta , GA , USA
| | - Nathan P Charlton
- j Department of Emergency Medicine , University of Virginia , Charlottesville , VA , USA
| | - Brandon Lewis
- k Texas A&M Health Science Center , College Station , TX , USA
| | - Kurt C Kleinschmidt
- l Department of Emergency Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Kapil Sharma
- l Department of Emergency Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Eric J Lavonas
- m Department of Emergency Medicine and Rocky Mountain Poison and Drug Center , Denver Health and Hospital Authority , Denver , CO , USA
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Fowler AL, Hughes DW, Muir MT, VanWert EM, Gamboa CD, Myers JG. Resource Utilization After Snakebite Severity Score Implementation into Treatment Algorithm of Crotaline Bite. J Emerg Med 2017; 53:854-861. [PMID: 29102095 DOI: 10.1016/j.jemermed.2017.08.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/04/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Crotaline envenomation clinical manifestations vary considerably among patients. Current recommendations for treatment with Crotalidae polyvalent immune Fab require assessment of envenomation control. Determining control of envenomation, particularly when patients are evaluated by different providers in separate clinical settings, can be difficult. OBJECTIVE To determine if a difference in total vials of Crotalidae antivenin therapy exists between pre-protocol and post-Snakebite Severity Score (SSS) protocol. METHODS Retrospective medical record review at an academic medical and regional Level I trauma center. Resource utilization in patients with a diagnosis of "snakebite" was compared between patients treated pre- and post-SSS protocol implementation. RESULTS One hundred forty-six patients were included in the evaluation. One hundred twenty-seven (87.0%) patients received antivenin, n = 80 (90.9%) in the pre-protocol group and n = 47 (81.0%) in the post-protocol group. Median total number of antivenin vials per patient was lower in the post-protocol group than the pre-protocol group, 16 (10-24 interquartile range) vs. 12 (10-16 interquartile range), p = 0.006. This decreased utilization correlates to an approximate $13,200 savings per patient. Hospital and intensive care unit length of stay, opioid use, incidence of blood product transfusion, need for surgical intervention, or need for intubation were not different between groups. CONCLUSIONS A snakebite protocol with SSS utilization to guide antivenin administration results in significantly decreased antivenin therapy in snakebite patients without increase in other health care utilization.
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Affiliation(s)
- Amanda L Fowler
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Darrel W Hughes
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Emergency Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mark T Muir
- Department of Trauma and Emergency Surgery, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Elizabeth M VanWert
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, Michigan
| | - Conrado D Gamboa
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John G Myers
- Department of Trauma and Emergency Surgery, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Gerardo CJ, Quackenbush E, Lewis B, Rose SR, Greene S, Toschlog EA, Charlton NP, Mullins ME, Schwartz R, Denning D, Sharma K, Kleinschmidt K, Bush SP, Ryan S, Gasior M, Anderson VE, Lavonas EJ. The Efficacy of Crotalidae Polyvalent Immune Fab (Ovine) Antivenom Versus Placebo Plus Optional Rescue Therapy on Recovery From Copperhead Snake Envenomation: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial. Ann Emerg Med 2017; 70:233-244.e3. [DOI: 10.1016/j.annemergmed.2017.04.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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Dixit R, Herz J, Dalton R, Booy R. Benefits of using heterologous polyclonal antibodies and potential applications to new and undertreated infectious pathogens. Vaccine 2016; 34:1152-61. [PMID: 26802604 PMCID: PMC7131169 DOI: 10.1016/j.vaccine.2016.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Passive immunotherapy using polyclonal antibodies (immunoglobulins) has been used for over a century in the treatment and post-exposure prophylaxis of various infections and toxins. Heterologous polyclonal antibodies are obtained from animals hyperimmunised with a pathogen or toxin. AIMS The aims of this review are to examine the history of animal polyclonal antibody therapy use, their development into safe and effective products and the potential application to humans for emerging and neglected infectious diseases. METHODS A literature search of OVID Medline and OVID Embase databases was undertaken to identify articles on the safety, efficacy and ongoing development of polyclonal antibodies. The search contained database-specific MeSH and EMTREE terms in combination with pertinent text-words: polyclonal antibodies and rare/neglected diseases, antivenins, immunoglobulins, serum sickness, anaphylaxis, drug safety, post marketing surveillance, rabies, human influenza, Dengue, West Nile, Nipah, Hendra, Marburg, MERS, Hemorrhagic Fever Virus, and Crimean-Congo. No language limits were applied. The final search was completed on 20.06.2015. Of 1960 articles, title searches excluded many irrelevant articles, yielding 303 articles read in full. Of these, 179 are referenced in this study. RESULTS Serum therapy was first used in the 1890s against diphtheria. Early preparation techniques yielded products contaminated with reactogenic animal proteins. The introduction of enzymatic digestion, and purification techniques substantially improved their safety profile. The removal of the Fc fragment of antibodies further reduces hypersensitivity reactions. Clinical studies have demonstrated the efficacy of polyclonal antibodies against various infections, toxins and venoms. Products are being developed against infections for which prophylactic and therapeutic options are currently limited, such as avian influenza, Ebola and other zoonotic viruses. CONCLUSIONS Polyclonal antibodies have been successfully applied to rabies, envenomation and intoxication. Polyclonal production provides an exciting opportunity to revolutionise the prognosis of both longstanding neglected tropical diseases as well as emerging infectious threats to humans.
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Affiliation(s)
- Rashmi Dixit
- The Children's Hospital, Westmead, Sydney, Australia.
| | | | | | - Robert Booy
- The Children's Hospital, Westmead, Sydney, Australia
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Monzavi SM, Salarian AA, Khoshdel AR, Dadpour B, Afshari R. Effectiveness of a clinical protocol implemented to standardize snakebite management in Iran: initial evaluation. Wilderness Environ Med 2015; 26:115-23. [PMID: 25698180 DOI: 10.1016/j.wem.2014.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 08/13/2014] [Accepted: 09/06/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran. METHODS In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P-) in Mashhad Medical Toxicology Centre (MTC). Demographic characteristics and treatment details of all patients were recorded prospectively. Envenomation severity of each victim was assessed according to snakebite severity score (SSS). RESULTS After implementation of the protocol, a smaller percentage of patients received antivenom (AV) therapy (78% vs 95%; P=.079). In spite of no significant difference in baseline severity of envenomation between the 2 groups (SSS [mean±SD], 34.8±18.1 vs 35.5±17.4; P=.801), the P+ group received significantly fewer AV vials (8.4±6.8 vs 12.1±5.6 vials; P=.042) and had a significantly shorter length of hospital stay (2.2±1.5 vs 3.2±1.8 days; P=.027). Moreover, smaller proportion of P+ patients experienced recurrence of venom-induced effects; however, the difference was not significant (18.5% vs 36%; P=.159). The reduction in use of antiallergy treatments to prevent or treat acute hypersensitivity reactions approached statistical significance (41% vs 68%; P=.051). These findings denote a reduction in AV use of approximately 4 vials and a reduction in hospital stay of 1 day for each patient, which translates to approximately $196/patient in healthcare cost savings. CONCLUSIONS Implementation of a snakebite management protocol at MTC reduced overall antivenom usage, use of antiallergy interventions, and length of hospital stay.
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Affiliation(s)
- Seyed Mostafa Monzavi
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel); Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari)
| | - Amir Ahmad Salarian
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel)
| | - Ali Reza Khoshdel
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel)
| | - Bita Dadpour
- Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari)
| | - Reza Afshari
- Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari).
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Gerardo CJ, Lavonas EJ, McKinney RE. Ethical considerations in design of a study to evaluate a US Food and Drug Administration–approved indication: Antivenom versus placebo for copperhead envenomation. Clin Trials 2014; 11:560-4. [DOI: 10.1177/1740774514543538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In 2000, the US Food and Drug Administration approved CroFab® Crotalidae Polyvalent Immune Fab, ovine (FabAV), which had received orphan drug designation, for use in patients with minimal to moderate North American crotaline envenomations including copperhead snakes. As existing evidence on the effectiveness of FabAV for this indication is limited, wide practice variation in its use exists. In order to provide more definitive clinical evidence as to the role of this treatment, a new randomized, placebo-controlled trial of FabAV specifically for copperhead bites was initiated. Purpose: In light of the existing US Food and Drug Administration approval, ethical considerations of participation in this trial have been raised. We discuss the ethical principles pertinent to this randomized, placebo-controlled trial with placebo arm. We apply an accepted framework for ethical research to this trial. Due to the evidence gap in the literature, wide-ranging treatment recommendations by medical experts, and broad practice variation, clinical equipoise exists in the treatment of copperhead envenomation with FabAV. The impact of this clinical equipoise on the value and scientific validity of the trial is discussed. The trial’s risk–benefit ratio is also considered. Potential risks to the patients are minimized as the protocol includes a plan for rescue therapy in the event that patients progress to severe envenomation symptoms. Overall, risks are further minimized by the inclusion of an interim analysis with stopping rules based on demonstrated efficacy should the therapy clearly prove to be beneficial. Conclusion: Although a post-marketing clinical study of this nature is unusual for an approved indication, this trial adheres to all ethical preconditions found in existing guidelines for clinical research involving human subjects.
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Affiliation(s)
- Charles J Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, NC, USA
| | - Eric J Lavonas
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
- Division of Medical Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ross E McKinney
- Trent Center for Bioethics, Humanities, & History of Medicine, Duke University Medical Center, Department of Pediatrics, Duke University, Durham, NC, USA
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Holder M, Smith KM, Fugit A, Macaulay T, Cook AM. National survey of pharmacy residency on-call programs. Am J Health Syst Pharm 2014; 70:1676-80. [PMID: 24048604 DOI: 10.2146/ajhp120639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The results of a national survey to evaluate on-call practices and responsibilities of pharmacy residents nationwide, as well as opinions related to duty-hour changes, are reported. METHODS A 39-question survey was distributed to 1292 residency program directors (RPDs) listed in the American Society of Health-System Pharmacists (ASHP) online residency directory, which includes programs in all stages of the accreditation process. The survey opened on November 7, 2011, and closed on November 28, 2011. The survey collected demographic information and answers to questions about the residency's on-call component (if applicable) and barriers to the creation of an on-call component. Respondents were also asked to indicate their support of or opposition to the adoption of the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules and identify the areas of greatest concern. RESULTS Of the 1292 RPDs listed in the ASHP online residency directory to whom the survey was sent, 521 surveys were completed, yielding a response rate of 40%. Of these, 471 identified their residency program as including or excluding an on-call component. Of the 138 programs with on-call services, 102 programs (74%) indicated the inclusion of an overnight experience. Programs that did not utilize an on-call component indicated barriers such as a perceived lack of demand (39%) and duty-hour limitations (21%). Common on-call activities included drug information consults and therapeutic drug monitoring. There was not a clear consensus from RPDs regarding the adoption of the 2011 ACGME duty-hour standards. CONCLUSION Among usable responses to a survey of pharmacy residency programs, 29% indicated that their program included an on-call component. On-call programs varied greatly in activities, location, hours, and requirements.
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Affiliation(s)
- Martina Holder
- Martina Holder, Pharm.D., BCPS, is Emergency Medicine Clinical Pharmacy Specialist, University of Florida Health Shands, Gainesville, FL; at the time of this study she was Postgraduate Year 1 Pharmacy Practice Resident, UK HealthCare, Lexington, KY. Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP, is Associate Dean, Academic and Student Affairs, and Associate Professor, Pharmacy Practice and Science; Ann Fugit, Pharm.D., BCPS, is Clinical Pharmacist Specialist, Ambulatory Care and Adjunct Assistant Professor; Tracy Macaulay, Pharm.D., BCPS (AQ-Cardiology), is Clinical Pharmacist Specialist, Cardiology, and Adjunct Assistant Professor; and Aaron M. Cook, Pharm.D., BCPS, is Clinical Pharmacist Specialist, Neurosurgery/Critical Care, and Assistant Adjunct Professor, Pharmacy, UK HealthCare
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Mcconeghy KW, Winstead PS, Cook AM, Martin CA, Weant KA, Flynn JD. Benefits of a 24-hour inhouse on-call program for pharmacy residents. Am J Health Syst Pharm 2012; 69:2160-4. [DOI: 10.2146/ajhp120240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kevin W. Mcconeghy
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago; at the time of writing, he was Postgraduate Year 2 Critical Care Resident, University of Kentucky (UK) Chandler Medical Center, Lexington
| | - P. Shane Winstead
- Pharmacy Services, UK Chandler Medical Center, and Adjunct Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, UK, Lexington
| | - Aaron M. Cook
- Pharmacy Services, UK Chandler Medical Center, and Adjunct Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, UK
| | - Craig A. Martin
- Pharmacy Services. UK Chandler Medical Center, and Adjunct Assistant Professor, Department of Pharmacy Practice and Science. College of Pharmacy, UK
| | - Kyle A. Weant
- Public Health and Preparedness and Response Branch, North Carolina Department of Public Health, Raleigh
| | - Jeremy D. Flynn
- Pharmacy Services. UK Chandler Medical Center, and Adjunct Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, UK
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