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  1. Article: Treatment of Clostridium difficile infection in community teaching hospital: a retrospective study.

    Elbeddini, Ali / Gerochi, Rachel

    Journal of pharmaceutical policy and practice

    2021  Volume 14, Issue 1, Page(s) 19

    Abstract: Objectives: Clostridium difficile infection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. ...

    Abstract Objectives: Clostridium difficile infection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital.
    Methods: This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy.
    Results: Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%.
    Conclusion: An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.
    Language English
    Publishing date 2021-02-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2734772-2
    ISSN 2052-3211
    ISSN 2052-3211
    DOI 10.1186/s40545-020-00289-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Evaluation of the prophylaxis and treatment of COVID-associated coagulopathy.

    Elbeddini, Ali / Gerochi, Rachel / Elshahawi, Ahmed

    Journal of pharmaceutical policy and practice

    2020  Volume 13, Page(s) 73

    Abstract: Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst. But in these times of rapidly changing information ... ...

    Abstract Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst. But in these times of rapidly changing information and perspective, an assessment of all available data (including expert opinion) is the goal of this review. Bleeding risk factors for COVID-19-associated bleeding may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. Bleeding risk factors may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. My manuscript presents the risk and evidence around the COVID-19-associated coagulopathies.
    Keywords covid19
    Language English
    Publishing date 2020-10-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2734772-2
    ISSN 2052-3211
    ISSN 2052-3211
    DOI 10.1186/s40545-020-00274-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Evaluation of the prophylaxis and treatment of COVID-associated coagulopathy

    Elbeddini, Ali Gerochi Rachel Elshahawi Ahmed

    Journal of Pharmaceutical Policy & Practice

    Abstract: Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst But in these times of rapidly changing information and ...

    Abstract Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst But in these times of rapidly changing information and perspective, an assessment of all available data (including expert opinion) is the goal of this review Bleeding risk factors for COVID-19-associated bleeding may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression Individuals with hypertension should not discontinue their medication Current evidence does not support changes in the management of hypertension As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients D-dimers are an indicator of a clot (thrombus) formation and breakdown More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection Bleeding risk factors may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression Individuals with hypertension should not discontinue their medication Current evidence does not support changes in the management of hypertension As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients D-dimers are an indicator of a clot (thrombus) formation and breakdown More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection My manuscript presents the risk and evidence around the COVID-19-associated coagulopathies [ABSTRACT FROM AUTHOR] Copyright of Journal of Pharmaceutical Policy & Practice is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #892375
    Database COVID19

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  4. Article: Pharmacy response to COVID-19: lessons learnt from Canada.

    Elbeddini, Ali / Botross, Amy / Gerochi, Rachel / Gazarin, Mohamed / Elshahawi, Ahmed

    Journal of pharmaceutical policy and practice

    2020  Volume 13, Issue 1, Page(s) 76

    Abstract: When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few ... ...

    Abstract When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few front-line health care workers who remained accessible in person for patients, had to rapidly adopt critical changes in their pharmacies to respond in the best interest of their patients and their pharmacy staff. As challenging and demanding as such changes were, they provided pharmacists with invaluable lessons that would be imperative as the country enters a potentially more dangerous second wave. This article seeks to identify and summarize opportunities for improvement in pharmacy as learnt from the pandemic's first wave. Such areas include but are not limited to handling of drug shortage and addressing drug hoarding and stockpiling, providing physical and mental support for staff, timing of flu vaccine and COVID-19 screening/testing, collaboration between different health care sites as well as collaboration with patients and with other health care professionals, telemedicine and willingness to adopt innovative ideas, need for more staff training and more precise research to provide accurate information and finally the need for more organizational and workplace support. Learning from what went well and what did not work in the early stages of the pandemic is integral to ensure pharmacy professionals are better prepared to protect themselves and their patients amidst a second and possibly subsequent waves.
    Language English
    Publishing date 2020-12-09
    Publishing country England
    Document type Letter
    ZDB-ID 2734772-2
    ISSN 2052-3211
    ISSN 2052-3211
    DOI 10.1186/s40545-020-00280-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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