Pharmacist Reported Protocols for QTc Monitoring of Psychiatric Medications.

Background Psychiatric medications, such as antipsychotics and antidepressants, are associated with QTc interval prolongation. There is currently no consensus best practice on how to mitigate this risk. This study aimed to collect and analyze information about methods used for QTc monitoring in patients taking psychiatric medications to better understand current practice. Methods An anonymous electronic survey was distributed on September 22, 2022, using a national psychiatric pharmacist organization email list. The survey closed on December 15, 2022. Descriptive statistics were used to analyze the multiple-choice questions. Qualitative analysis applying grounded theory for thematic analysis was performed for free response questions. Results A total of 48 initiated the survey. Of the respondents, 11.4% (5/44) reported that their institution had a formal protocol for monitoring QTc intervals in patients receiving psychiatric medications, while 32.4% (12/37) reported that their institution had an informal process. Out of those with a protocol or process, approximately half reported that it was drug-specific. Among the respondents, 88.6% (31/35) reported that there was a psychiatric clinical pharmacy specialist at their institution and 34.3% (12/35) reported that pharmacists could order an electrocardiogram (ECG). Major themes that emerged from the qualitative analysis included pharmacist-driven QTc monitoring, referring the patient to another provider for monitoring, and encountering significant barriers to monitoring. Conclusion A variety of methods are currently being employed to monitor QTc prolongation risk in patients taking psychiatric medications. Pharmacist authorization to order ECGs may be an opportunity to advance practice and improve care for this population. Further research is needed to more clearly understand best practices for QTc prolongation risk mitigation in patients receiving psychiatric medications.

Direct oral anticoagulants versus warfarin for the treatment of inferior vena cava thrombus.

OBJECTIVE: To evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to warfarin in patients with inferior vena cava (IVC) thrombus. METHODS: This was a single-system, retrospective cohort study of hospitalized adult patients with IVC thrombus treated with a DOAC or warfarin therapy. The primary efficacy endpoint was the thrombus resolution on imaging, and the primary safety endpoint was major bleeding, both assessed within 6 months of hospital discharge. Secondary endpoints included hospitalization for a bleeding-related event, pulmonary embolism, or death within 6 months of hospital discharge. RESULTS: A total of 33 patients were included in the study. Twenty-three (70%) patients received a DOAC, and 10 (30%) received warfarin. Of the 10 patients with repeat imaging available, complete resolution was noted in two (33%) DOAC patients and no warfarin patients (p = .5). Major bleeding occurred in two (8.7%) DOAC patients and one (10%) warfarin patient (p = .9). No significant differences in secondary endpoints were observed between groups. CONCLUSIONS: There were no differences in efficacy and safety between patients receiving DOACs or warfarin for the treatment of IVC thrombus, although results are limited by the small patient population and number of patients with repeat imaging available.

Paired or Pooled Analyses in Continuing Medical Education, Which One is Better?

In data analyses, pairing participant responses is often thought to yield the purest results. However, ensuring all participants answer all questions can be challenging. Concerns exist that pooling all responses together may diminish the robustness of a statistical analysis, but the practical insights may still exist. Data from a live, in-person, continuing education series for health professionals was analysed. For each topic, identical questions were asked prior to the educational content (pre), immediately following the content (post), and on a rolling 4 to 6 week follow-up survey (follow-up). For each educational topic, responses were matched by participant for a paired analysis and aggregated for a pooled analysis. A paired analysis was done for matched responses on pre vs post and pre vs follow-up questions. A pooled analysis was done for the aggregate responses on pre vs post and pre vs follow-up questions. Responses from 55 questions were included in the analysis. In both the paired and pooled pre vs post analyses, all questions yielded a statistically significant improvement in correct responses. In the paired pre vs follow-up analysis, 59% (n = 33) of questions demonstrated a statistically significant improvement in correct responses, compared to 62% (n = 35) in the pooled pre vs follow-up analysis. Paired and pooled data yielded similar results at the immediate post-content and follow-up time periods.