Incidence of neurobehavioral side effects associated with levetiracetam compared to phenytoin in traumatic brain injury patients.

Background: Phenytoin is recommended for seizure prophylaxis in traumatic brain injury (TBI). Levetiracetam has been proposed as an alternative agent. The purpose of this study was to determine whether there is a difference in the incidence of neurobehavioral side effects in patients with TBI receiving levetiracetam compared to those receiving phenytoin for seizure prophylaxis.Methods: This was a retrospective cohort study conducted at a level 1 trauma center from June 2008 to April 2014. Patients with TBI aged 16 years and older who received levetiracetam or phenytoin for seizure prophylaxis were evaluated and incidence of neurobehavioral side effects were compared for the two groups.Results: Of the 200 patients who met inclusion criteria, 95 (47.5%) received phenytoin and 105 (52.5%) received levetiracetam. Incidence of neurobehavioral side effects was not statistically different between groups (76 [80%] vs. 75 [71.4%], p = .189). The two groups were well matched.Conclusion: In patients with TBI, receipt of levetiracetam for seizure prophylaxis did not appear to be associated with increased neurobehavioral side effects compared to receipt of phenytoin.

Initial study of clinical pharmacy work prioritization tools.

PURPOSE: The development, implementation, and validity of clinical pharmacy work prioritization tools (CPWPTs) were analyzed. METHODS: Informatics pharmacists were contacted and asked to participate in 30-minute teleconference interviews, as they have primary responsibility for the technical configuration of CPWPTs. A total of 19 respondents participated in the survey. The qualitative data collected encompassed the thoughts and ideas of practicing informatics pharmacists who are knowledgeable about the design, configuration, management, and use of CPWPTs. In addition to capturing their thoughts and ideas with open-ended questions, demographic data were collected, as was information about the sites where respondents worked and the CPWPTs they used. RESULTS: Most of the CPWPTs were built into existing electronic health record platforms. There was considerable variation among the prioritization factors used at each site. The most commonly identified categories of prioritization factors were patient-specific factors, therapeutic classes of medications, and potential pharmacist interventions. All respondents reported that the prioritized tasks generated by their CPWPTs were examined for face validity. Of the 19 respondents, only 4 reported that the priorities generated by their CPWPT had been empirically validated in some way. Qualitative data analysis revealed that informatics pharmacists have 5 general perceptions about CPWPT factors, validation, and use in practice: (1) mirroring practice, (2) pharmacist consensus-based design, (3) complexity of logic, (4) tension between task-oriented and patient-centric approaches to practice, and (5) comfort from tracking tasks to completion. CONCLUSION: Early CPWPTs vary significantly in their prioritization factors. These tools partially reflect the scope of clinical pharmacy practice at the sites where they are used.