Houston Methodist Department of Pharmacy Annual Research Report 2020-2021 by Houston Methodist Professional Publications

HOUSTON METHODIST DEPARTMENT OF PHARMACY Annual Research Report | 2020-2021

2020-2021 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

TABLE OF CONTENTS

2 Letter from Daniel L. Metzen, PharmD, MBA

3 Letter from Alex C. Varkey, PharmD, MS

System Director of Pharmacy Services, Houston Methodist Director of Pharmacy Services, Houston Methodist Hospital

4 Letter from Jill C. Krisl, PharmD, BCPS, BCTXP

Chair of Pharmacy Research Committee

5 Pharmacy Research Committee Members

6–7 Pharmacy Research Funding 8–30 2020-2021 Houston Methodist Hospital Pharmacy Postgraduate Trainees 8 PGY1 Pharmacy Residency Corey Dinunno, PharmD Breanna Hinman, PharmD Olivia Kreidler, PharmD Caitlin Labay, PharmD Melissa O’Neal, PharmD Nina Srour, PharmD

14 PGY1 International Graduates Pharmacy Residency

Abdullah Alshehry, PharmD Jingshi “Iris” Chen, PharmD Hala Halawi, PharmD

17 PGY1/PGY2 Health-System

22 PGY2 Critical Care Pharmacy Residency Diane Dreucean, PharmD Hangil Seo, PharmD

24 PGY2 Infectious Diseases Pharmacy Residency Taryn Eubank, PharmD

25 PGY2 Internal Medicine Pharmacy Residency Will Towers, PharmD

26 PGY2 Oncology

Pharmacy Residency

Pharmacy Administration Residency Stephanie Crowley, PharmD Nathan Jones, PharmD Gabrielle Wu, PharmD Niha Zafar, PharmD

21 PGY1/PGY2 Pharmacy Informatics Residency

Blake Buzard, PharmD Ashka Patel, PharmD

28 PGY2 Solid Organ Transplant Pharmacy Residency

Anna Curtis, PharmD Johnny Hoang, PharmD

30 Clinical Pharmacy Fellowship

Wenfei Wei, PharmD

33 System Pharmacy Research Bibliography

in Outcomes Research Tomona Iso, PharmD Anh Thu Tran, PharmD Farrah Yuan, PharmD

LETTER FROM THE SYSTEM DIRECTOR OF PHARMACY SERVICES Thank you to all who contributed to the endeavors in this annual report. The past 20 months have been memorable yet a blur, if that makes sense. I’m certain this annual report required extra energy and effort knowing much of our time was dedicated to caring for the hundreds of COVID patients in our hospitals along with supporting the soon-to-be a million vaccinations of our patients and community. This is truly a testament of unparalleled and dedication to excellence. Congratulations to a successful year!

Daniel L. Metzen, PharmD, MBA System Director of Pharmacy Services, Houston Methodist

LETTER FROM THE DIRECTOR OF PHARMACY SERVICES ON BEHALF OF THE HOUSTON METHODIST HOSPITAL PHARMACY MANAGEMENT TEAM, I want to extend my sincere appreciation to all of our graduating residents and fellows. Our residents and fellows fully invest in their respective opportunities to grow both personally and professionally, and in the process, make a lasting impact on HMH Pharmacy’s effort to optimize patient outcomes. The last two academic years have been especially challenging given our need to respond to the global COVID-19 pandemic, and as usual, HMH Pharmacy responded with unparalleled efforts in patient care and in facilitating cutting-edge research. We are on the cusp of administering 1 million doses of COVID-19 vaccinations and have emerged as a national leader in the provision of monoclonal antibody treatments. Our system efforts have been lauded by state and national leaders and have been highlighted in a number of highly reputable publications, including the New England Journal of Medicine (NEJM). Our organization and patients are indebted to the pharmacy team members involved in all facets of COVID-19 treatment research, preparation, and administration. Without their expertise and commitment, Houston Methodist would not have been able to provide these cutting-edge therapies to so many patients. Our clinical specialists were involved in several multi-center, COVID-19 research studies, not only allowing our patients and clinicians to be on the forefront of science but also adding approximately $20,000 in research funding revenue to the pharmacy division. As has been the case for over 30 years, a catalyst for our department-initiated research success has resided in our pharmacy training programs, and we continue to be grateful for the hard work and dedication of our pharmacy learners, preceptors/practitioners, and staff. Each of our achievements took considerable commitment and an immense amount of work. Our successes in research and scholarship are a true testament to HMH pharmacy’s commitment to working alongside other health care disciplines in advancing patient care. At Houston Methodist, we take “Leading Medicine” seriously. I continue to be impressed with the quality of pharmacy’s efforts in growth and innovation, and I have our residents, fellows and their preceptors to thank for much of that. We remain in position to develop and share innovative practices in part because of our Pharmacy Research Committee, a group dedicated to ensuring excellence in the quality and feasibility of research conducted by HM pharmacy. As we move ahead to the 2021-2022 residency year, we will continue with laser focus on what we do each and every day. That includes enhancing our medication distribution, clinical services, and regulatory/quality compliance efforts to provide an environment of unparalleled safety, quality, service, and innovation for our patients. Our patients always deserve our best – and it is the reason we all work so hard to develop safe and effective processes and practices from which our patients will benefit. Thanks for all that you have done and continue to do for patients.

Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services, Houston Methodist Hospital

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LETTER FROM THE PHARMACY RESEARCH COMMITTEE CHAIR

Welcome to our Department of Pharmacy’s sixth edition of the Annual Research Report. This report serves to showcase the dedication to research and patient care our department has remained committed to during this last year, even as the coronavirus pandemic continued to impact our lives. Over the course of 2020-2021, members of our pharmacy department have lead research collaborations within the surgical, internal medicine, infectious diseases, solid organ transplant, critical care, and oncology patient populations. The pharmacy department continues to strive toward the advancement of pharmacy practice and patient care across Houston Methodist. The mission of the Pharmacy Research Committee is to ensure quality and feasibility of research conducted, in addition to excellence of research training provided by the Department of Pharmacy at Houston Methodist. The PRC has continued to optimize established programs including project proposal development, project approval, resident alignment, support, education, visibility, and building a robust research infrastructure through partnership with the Research Institute. Clinician and preceptor education remained a focal point for 2020-2021, helping to facilitate the research process from inception to project completion. During this year, the PRC sought to leverage the potential of the entire Houston Methodist system by placing additional emphasis on research endeavors outside of the TMC. The PRC continues to evolve to meet the needs of the department. We now are 16 members, including three pharmacy research fellows assisting with our support lead. With our new members, we now have representation across the system hospitals and the 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 would like to sincerely thank all members of the Pharmacy Research Committee for the continued dedication and hard work; the work of this group is truly vital to our success.

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

PHARMACY RESEARCH COMMITTEE MEMBERS

Joshua Swan, PharmD, MPH, FCCM, BCPS Founding Chair; Infrastructure

Mobolaji Adeola, PharmD, BCPS Project Approval Lead

David R. Putney, PharmD, MPH, BCPS - AQ Cardiology Project Alignment Lead

Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM Education Lead

Brett J. Pierce, PharmD, BCPS Visibility Lead

Christine Pham, PharmD Member

Elsie Rizk, PharmD Member

Phuong Duong, PharmD Member - Fellow

Bader Alghamdi, PharmD Member - Fellow

Navjot Kaur, PharmD Member - Fellow

Punit Shah, PharmD, BCPS, BCIDP Member

Hayley Brazeale, PharmD, BCPS Member

Godsfavor Umoru, PharmD Member

Chelsea Lopez, PharmD, BCCCP Member

Engie Attia, PharmD, BCPS Project Development Lead

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PHARMACY RESEARCH FUNDING Joshua T. Swan, PharmD, MPH, BCPS, FCCM, scientist and Associate Professor of Surgery in Outcomes Research, received $394,758 in external funding to support four investigator-initiated studies and participation in an industry-sponsored clinical trial. This success was only possible due to tremendous support from Elsie Rizk, PharmD, and fellows in the Clinical Pharmacy Fellowship in Outcomes Research. • “Optimization of opioid discharge prescriptions following thyroid and parathyroid surgeries.” Subaward to the parent award under direction of Douglas Thornton, PhD, PharmD, at the University of Houston; HHS000437900001 Texas Health and Human Services; $80,500 • “Taking the pain out of treating osteoarthritis: assessing for appropriate management of osteoarthritis associated pain,” Pfizer; $90,090 • “Evaluation of wound morphology among patients who receive rabies postexposure prophylaxis in the emergency department,” Kedrion Biopharma; $36,000 • “Second human factors formative study of the Sedaconda anesthetic conserving device,” Sedana Medical; $72,086 • “A phase 3b, randomized, open-label study of HTX-011 as the foundation of a nonopioid, multimodal analgesic regimen to decrease opioid use following unilateral open inguinal herniorrhaphy,” Heron Therapeutics; $116,082

Niaz Deyhim, PharmD, MS, BCPS and a HM systemwide team of collaborating pharmacists (Kayleigh Emerson, PharmD; Joke Fasoranti, PharmD; Anne Nguyen, PharmD; and Ian Dunne, PharmD) were awarded a $5,000 grant from the ASHP Foundation to describe the implementation and study the impact of a hospital-system Doctor of Pharmacy Longitudinal Advanced Pharmacy Practice Experience (LAPPE) program.

PHARMACY RESEARCH FUNDING Lilly Fu, PharmD, BCOP and a pharmacy team led by some of our oncology clinical specialists across the system (Rodrigo De La Torre, PharmD; Erika Brown, Cynthia El Rahi, PharmD; Hanna Zaghloul, PharmD) and Isha Rana, PharmD, an administrative specialist in our formulary management hub, were awarded a $19,500 grant allowing them to more completely assess the “cost” of divergent insurance plan coverages for biosimilars on patient care.

Hongmei Wang, PharmD, BCPS TSU faculty member with a practice site at HMH, along with our IM teams and William L. Musick, PharmD, BCIDP from our ID team, was awarded $50,000 to conduct longitudinal antiretroviral medication therapy management services to improve medication adherence and develop a new objective medication adherence monitoring tool.

Christine Pham, PharmD, with the lung transplant team (Brett J. Pierce, PharmD and Howard J. Huang, MD), was awarded a $305,388.98 grant from CareDX to explore donor-derived cell-free DNA monitoring in our lung transplant recipients with antibody mediated rejection. This prospective laboratory monitoring study will allow us to better characterize patients with donor specific antibodies who subsequently develop clinical antibody mediated rejection. Results of this study will ultimately allow us to practice precision medicine, mitigate costs (through balancing over-/under-treatment), and improve patient outcomes.

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Time to therapeutic tacrolimus levels and association with acute cellular rejection and de novo donor-specific antibody development in lung transplant recipients Corey Dinunno, PharmD; Christine Pham, PharmD; Brett Pierce, PharmD; Ahmad Goodarzi, MD; Simon W. Yau, MD; Jihad G. Youssef, MD; Duc T. Nguyen, MD, PhD; Edward A. Graviss, PhD, MPH; Howard J. Huang, MD PURPOSE

RESULTS

Tacrolimus (FK506) is standard of care for preventing rejection in lung transplant for maintenance immunosuppression. Both acute cellular rejection (ACR) and de novo donor-specific antibodies (dnDSAs) are strongly associated with development of chronic lung allograft dysfunction. The optimal time to therapeutic (TTT) FK506 level post-transplant has not been established, and a standardized dosing strategy for all patients in the immediate post-transplant period may be inappropriate. We evaluated whether TTT FK506 impacted ACR and dnDSA rates within 6 months of lung transplantation.

Median TTT was 7 days (IQR 5.0-10.0) in 222 patients. There was no difference in ACR [7.6% vs 9.7% (p=0.63)] or dnDSA [35% vs 44% (p=0.20)] between patients achieving therapeutic FK506 <7 days vs >7 days. Recipients therapeutic <7 days had a longer median time to dnDSA development (44 days vs 27 days, p=0.043). TTR at 1 month was longer in patients therapeutic <7 days (40% vs 28%, p<0.001). Neither median nor percentage of TTR had an impact on the composite outcome (HR 0.99; 95% CI 0.95-1.03). AKI incidence (>stage 2) was similar (40.3% vs 38.8%, p=0.82) between groups. Multivariate analysis identified receipt of a double lung transplant as the only covariate associated with a higher risk of AKI [OR 3.56, 95% CI 1.40-9.05 (p=0.01)].

METHODS

We retrospectively reviewed lung transplant recipients between 5/2016 – 12/2019. We excluded patients who did not receive FK506, received their first dose >48 hours post-transplant, were transitioned off FK506 during the study period, or expired within 30 days. Our primary outcome was a composite of ACR and dnDSA development within 6 months for patients achieving therapeutic FK506 (8-15 ng/mL) within 7 days, versus >7 days. Secondary endpoints included: time within therapeutic range (TTR) at 1 month and incidence of acute kidney injury (AKI) within 14 days.

CONCLUSION

There was no significant difference in development of ACR or dnDSA within 6 months between lung transplant recipients achieving therapeutic FK506 <7 days vs >7 days. Increased time to dnDSA development in the <7-day cohort suggests a potential benefit to minimizing time to therapeutic FK506 level post-transplantation.

PGY1 PHARMACY RESIDENCY

Corey Dinunno, PharmD Corey completed his undergraduate coursework and earned his PharmD from the University of Connecticut in 2020. After completion of his PGY1, Corey will be completing a PGY2 in Internal Medicine at Houston Methodist Hospital. Primary project preceptor: Christine Pham, PharmD Presented at 2020 Virtual Vizient Pharmacy Network Conference; 2021 Virtual Midwest Pharmacy Residents Conference; 2021 Virtual ISHLT Annual Meeting

Evaluation of fluorouracil, leucovorin and oxaliplatin (FOLFOX) chemotherapy dosing in obese colorectal cancer patients Breanna Hinman, PharmD; Erika Brown, PharmD; Hanna Zaghloul, PharmD; Zhili Fu, PharmD; David Putney, PharmD; Kirk Heyne, MD PURPOSE

RESULTS

The purpose of this study is to evaluate the safety and tolerability fluorouracil, oxaliplatin, and leucovorin (FOLFOX) chemotherapy regimen dosing in colorectal cancer patients.

A total of 58 colorectal cancer patients were included with 29 patients having BSA < 2 m2, 24 with BSA of ≥2 m2 non-capped, and 5 with BSA ≥2 m2 capped. There were similar rates of any grade toxicity amongst the groups (86% vs. 88% vs. 100%, p = 0.051), but a higher risk of grade ≥ 3 toxicity was observed with BSA < 2 m2 and BSA of ≥2 m2 non-capped (p=0.026).

METHODS

This retrospective chart review of colorectal cancer patients receiving FOLFOX chemotherapy. The primary endpoint of this study was to evaluate the safety and tolerability of FOLFOX chemotherapy regimen dosing in colorectal cancer patients with a calculated body surface area (BSA) < 2 m2 compared to patients with a BSA ≥ 2 m2 given capped chemotherapy dosing at 2 m2, and a BSA ≥ 2 m2 given non-capped, weightbased chemotherapy. Tolerability will be defined as the degree to which overt adverse effects of a drug can be tolerated by a patient.

CONCLUSION

In our study, dosing practices varied amongst clinicians, and therefore this study could not confirm the benefits of dose capping. Further large studies are needed to assess body weight and its effect on both adverse events as well as clinical outcomes.

PGY1 PHARMACY RESIDENCY

Breanna Hinman, PharmD Breanna Hinman earned her BS in Biology from University of Georgia in 2016 and PharmD from University of Houston in 2020. Following completion of her PGY1, Breanna will continue her residency training as a PGY2 Oncology Resident at Houston Methodist. Primary project preceptor: Erika Brown, PharmD, BCOP Presented at 2020 Virtual Vizient Pharmacy Network; 2020; 2021 Virtual Midwest Pharmacy Residents Conference 2021 Virtual HOPA Annual Conference

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Description and impact of anti-Xa levels in patients presenting with acute ischemic stroke taking apixaban or rivaroxaban Olivia Kreidler, PharmD; Kevin R Donahue, PharmD; Tanu Garg, MD; Eric Salazar, MD, PhD; Annette Lista, PharmD PURPOSE

RESULTS

Factor Xa inhibitors (FXaIs) use continues to increase, however there remains residual risk of acute ischemic stroke (AIS). Guidelines recommend against tissue plasminogen activator (tPA) administration in patients whose last FXaI dose was <48 hours. Anti-Xa assays correlating apixaban and rivaroxaban serum concentrations with anti-Xa activity are available and have potential to help guide tPA use in patients with AIS. The purpose of this study is to determine time to stroke intervention, defined as the time to tPA administration or mechanical thrombectomy, in patients taking apixaban or rivaroxaban at the time of AIS. Secondary outcomes of this study included anti-Xa level turnaround time, anti-Xa levels, and rate of major bleeding events.

The final analysis included 225 patients presenting with AIS on apixaban or rivaroxaban therapy. Median time to stroke intervention was 99.5 minutes in patients with FXaI anti-Xa levels and 60 minutes in patients without levels (95% CI -45.1, 76.9; p=0.586). In those with FXaI anti-Xa levels, a total of 6 (15%) patients received intervention, in which 1 (2.5%) patient was administered tPA and 5 (12.5%) underwent mechanical thrombectomy. In patients without FXaI anti-Xa levels, 17 (9.2%) received intervention, in which 1 (0.5%) patient was administered tPA and 16 (9%) underwent mechanical thrombectomy.

METHODS

This was a retrospective chart review and included patients presenting with AIS taking apixaban or rivaroxaban.

CONCLUSION

The results of this study may serve as proof of concept for utilizing FXaI anti-Xa levels in patients with AIS as a means of guiding revascularization therapy.

PGY1 PHARMACY RESIDENCY

Olivia Kreidler, PharmD Olivia earned her BS in Biochemistry from Texas State University in 2016 and PharmD from the University of Houston in 2020. Following completion of her PGY1, Olivia will be completing a PGY2 in Critical Care at the Medical University of South Carolina. Primary project preceptor: Annette Lista, PharmD, BCCCP Presented at 2020 Virtual Vizient Pharmacy Network Conference; 2021 Virtual Midwest Pharmacy Residents Conference

Desmopressin versus dextrose in water for therapeutic re-lowering of sodium Caitlin Labay, PharmD; Kathryn Pidcock, PharmD; Neil Sutaria, MD; Nisarg Gandhi, MD; Hayley Brazeale, PharmD PURPOSE

RESULTS

Hyponatremia is a common and difficult to correct electrolyte disorder. Safe correction of sodium is essential to prevent devastating neurologic complications. In the event of anticipated or observed overcorrection of sodium, desmopressin (1-desamino-8-d-arginine vasopressin, or DDAVP) and/or dextrose 5% in water (D5W) may be used to slow the rate of sodium increase. The purpose of this study is to compare the efficacy and safety of these agents in the setting of hyponatremia management.

The use of both DDAVP and D5W was found to reduce Na24 significantly more than either agent alone (1.5 vs 1 vs -1 mEq/L for DDAVP, D5W, and both, respectively; p < 0.001). This finding was primarily driven by the differences between groups in patients treated with DDAVP in a reactive strategy (those who were given a reversal agent after an observed sodium correction of > 0.5 mEq/L/ hr). The use of both agents was also associated with an increased incidence of rebound overcorrection (1% vs 4% vs 16% for DDAVP, D5W, and both, respectively; p <0.001). The incidence of osmotic demyelination syndrome was assessed via the frequency of head imaging; no differences were found between groups.

METHODS

This retrospective, observational study included 369 patients who were treated for hyponatremia (defined by a serum sodium < 130 mEq/L) and subsequently received DDAVP and/or D5W. The primary endpoint of the study was the change in serum sodium within 24 hours of reversal agent initiation (Na24).

CONCLUSION

The use of both DDAVP and D5W is more effective at reducing the rate of correction of serum sodium in the setting of hyponatremia management than either treatment alone. The combination of these therapies may be associated with higher rates of rebound overcorrection following their discontinuation.

PGY1 PHARMACY RESIDENCY

Caitlin Labay, PharmD Caitlin completed her undergraduate coursework and earned her PharmD from the University of Texas at Austin in 2020. Following completion of her PGY1, Caitlin will begin her PGY2 in Critical Care at Houston Methodist Hospital. Primary project preceptor: Kathryn Pidcock, PharmD, BCPS Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residency Conference

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Characterization of carbaenem-resistent enterobacterales at a large urban health system Melissa P. O’Neal, PharmD; Katherine Pérez, PharmD; Joshua Knight, PharmD; William Musick, PharmD PURPOSE

RESULTS

The purpose of this study is to assess the antibiotic susceptibilities of carbapenem-resistant E. coli and K. pneumoniae isolates and develop clinical decision support tools for empiric treatment of CRE. A secondary purpose is to gauge clinical outcomes of patients with CRE, including treatment choice and survival to hospital discharge.

This review included 883 carbapenem-resistant (CR) E. coli and K. pneumoniae, of which 10.8% and 45.4% displayed carbapenemase production, respectively. Amikacin, tigecycline, and novel beta-lactam/beta-lactamase inhibitors (BL-BLIs) displayed varying in vitro susceptibility. Prior hospitalization in the preceding 90 days, index visit length of stay, and extended spectrum beta-lactamase (ESBL) production were all significantly higher in the carbapenemase producing cohort.

METHODS

We performed a retrospective review of the electronic health record to include all ertapenem resistant E. coli and K. pneumoniae. Repeat cultures and related patient encounters were excluded.

CONCLUSION

Characterization of these organisms helps streamline empiric treatments prior to finalized AST results. Given variability in resistance mechanisms, phenotypic and genotypic data must be evaluated to adequately represent a population. We identified a large number of highly resistant isolates, primarily in urine cultures, and collected the results of phenotypic testing.

PGY1 PHARMACY RESIDENCY

Melissa P. O’Neal, PharmD Melissa earned both her BS in Pharmaceutical Science and PharmD from the University of South Carolina in 2020. Following completion of her PGY1, Melissa will continue her post-graduate training as a PGY2 Pharmacy Resident in infectious diseases at Houston Methodist. Primary project preceptor: William Musick, PharmD Presented at 2020 Virtual Vizient Pharmacy Network, New Orleans; 2021 Virtual Midwest Pharmacy Residents Conference, Omaha, NE

Evaluation of viscoelastic test-guided blood and factor transfusions in cirrhotic patients Nina Srour, PharmD; Jesse E. Harris, PharmD; Luma Succar, PharmD; Eric Salazar, MD; Scott Lindberg, MD; Constance M. Mobley, MD PURPOSE

RESULTS

The purpose of this study is to assess our institutional TEG-guided transfusion practices to understand variables impacting TEG evaluation and correction thresholds.

A total of 116 patients with 559 TEG results met inclusion criteria. Majority of tests were ordered for correction of coagulopathy in non-bleeding encounters (46.5%). Platelets (PLT) were the most commonly transfused products

METHODS

(41.3%), followed by fresh frozen plasma (FFP) (34.9%) and cryoprecipitate (31.1%). Median (interquartile range (IQR)) transfusions per TEG encounter were 1 unit (1–2) for PLT and FFP, and 10 units (10–20) for cryoprecipitate. Rate of compliance with the transfusion algorithm was 31.7%. Non-compliance was mostly driven by maximum amplitude (MA). In a subgroup-analysis of non-bleeding TEGs, under-correction for abnormal K time, -angle, and MA was associated with a significant reduction in packed red blood cell (PRBC) transfusions. Over-correction with FFP and cryoprecipitate was higher when INR was ≥ 2 and fibrinogen < 100 mg/dL, respectively (p<0.01). New thrombotic events occurred in 6 patients and 2 patients had transfusion-related reactions.

This was a single-center, retrospective study of critically ill, adult cirrhotic patients between May 2016-August 2020. TEGs obtained during the intra- and post-operative periods were excluded. Endpoints evaluated included a description of blood products administered, compliance with the TEG algorithm, and bleeding events. Outcomes were presented per TEG encounter using descriptive statistics.

CONCLUSION

Despite the availability of TEG results, CCTs continue to influence correction of coagulopathy without reducing bleeding rates. Our review showed that transfusions based on standard TEG cutoffs was not associated with a reduction in PRBC transfusions compared to undercorrections. However, TEG thresholds that can accurately reflect underlying coagulopathy and bleeding risks of cirrhotic patients are yet to be determined.

PGY1 PHARMACY RESIDENCY

Nina Srour, PharmD Nina earned her PharmD from The University of Colorado in 2020. Following completion of her PGY1, Nina will continue her residency training as a PGY2 Critical Care Resident at Houston Methodist. Primary project preceptor: Luma Succar, PharmD, BCCCP Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference.

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Assessment of patients readmitted with venous thromboembolism within 30 days from index admission for high risk factor Abdullah O. Alshehry, PharmD, MBA; Allison Wilson, PharmD, BCPS; Michelle Murillo, PharmD; Wilda Chung On, PharmD, MBA; Kim Ngo, PharmD; Erica Martin, PharmD; BCPS, Nghi (Andy) Bui, PharmD, BCPS PURPOSE

RESULTS

To compare patients readmitted with VTE and without VTE within 30 days from index admission to identify risk factors that predisposed them to readmissions with VTE, modelling off the CRAM criteria.

Data for 100 patients in each group were evaluated. Some VTE risk factors were numerically higher in the VTE group compared to the control group, such as obesity (72 vs 66), sepsis (26 vs 3), pneumonia (25 vs. 6), malignancy (24 vs. 10), stroke (7 vs. 0) or a history of hip, pelvis, or leg fracture (17 vs. 3). The median Caprini score was 8 points (IQR = 5 -11) in the VTE groups and 6 points (IQR = 5 -7) in the control group. A total of 34 patients in the VTE group received appropriate VTE prophylaxis compared to 57 patients in the control group.

METHODS

In this retrospective chart review, patients readmitted within 30 days to the Houston Methodist Hospital System, Houston, Texas from 2016 to 2020 with VTE as a principal diagnosis were compared to patients readmitted within 30 days without VTE. The objective of this study was to describe the differences in baseline characteristics, comorbidities, and contributing risk factors for VTE, based on risk factors assessed in the Caprini Risk Assessment Model (CRAM).

CONCLUSION

Malignancy and diseases with inflammatory burden were associated with increased risk of readmission with VTE within 30 days. Caprini score may provide a better objective predictor of VTE risk within 30 days from hospitalization.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Abdullah Alshehry, PharmD Abdullah earned his BS in Pharmacy from King Saud University in Riyadh, Saudi Arabia in 2010 and PharmD and MBA from Long Island University, New York, NY in 2010. Following completion of his PGY1, Abdullah will practice as clinical pharmacist at King Fahad Medical City,Riyadh, KSA. Primary project preceptor: Nghi (Andy) Bui, PharmD, BCPS Presented at 2021 Virtual Midwest Pharmacy Residents Conference

Evaluation of outcomes with apixaban use for venous thromboembolism in hospitalized patients with end-stage renal disease receiving renal replacement therapy Jingshi Chen, PharmD; Steffany Nguyen, PharmD, BCPS; Melanie Ruegger, PharmD, BCPS; Leena Samuel, MD; Eric Salazar, MD, PhD; Ian Dunne, PharmD, BCPS PURPOSE

RESULTS

Direct oral anticoagulants (DOACs) have revolutionized anticoagulation therapy. While apixaban and rivaroxaban received expanded labeling for use in atrial fibrillation for end-stage renal disease (ESRD) patients based on pharmacokinetic trials, little data exists regarding the use of DOACs in ESRD patients requiring renal replacement therapy (RRT) for venous thromboembolism (VTE).

A total of 68 patients met criteria for inclusion in the final analysis. Major bleeding events occurred in 9 (13.2%) of patients receiving apixaban within the last 72 hours. Among these patients, 2 were taking apixaban 10 mg twice daily, 2 were taking apixaban 5 mg twice daily, and 5 were on apixaban 2.5 mg twice daily dosing. CONCLUSION

METHODS

This retrospective, descriptive cohort study was conducted from May 2016 to September 2020 at Houston Methodist Hospital System. Adult patients with a diagnosis of ESRD on RRT and with a VTE diagnosis receiving apixaban therapy prior to or during admission were included. The primary objective was to identify major bleeding events within 72 hours of last apixaban dose administration. Secondary objectives included new VTE while on apixaban, appropriateness of anticoagulation regimen with regards to FDA labeled dosing and frequency, anticoagulation regimen adjustments, and factor Xa inhibitor-specific anti-Xa levels if available.

The use of apixaban for VTE in patients with ESRD on RRT may lead to an increased risk of bleeding. Therefore, apixaban use should occur following shared decision making especially if there is no contraindication to warfarin.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Jingshi “Iris” Chen, PharmD Iris earned her BS in chemistry from Rhodes College in 2016 and PharmD from the University of Iowa in 2020. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY1, Iris will seek for a clinical pharmacist position in the future. Primary project preceptor: Ian Dunne, PharmD, BCPS Presented at 2021 Virtual Midwest Pharmacy Residents Conference

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Impact of statins on the incidence of gastrointestinal bleeding events among patients with continuous flow left ventricular assist devices Hala Halawi, PharmD; Jesse E. Harris, PharmD, BCCCP; David Putney, PharmD, BCPS, MPH; Duc T. Nguyen, MD, PhD; Edward A. Graviss, PhD, MPH, FIDSA; Mahwash Kassi, MD PURPOSE

RESULTS

Patients with continuous flow left ventricular assist devices (CF-LVADs) are at increased risk of gastrointestinal bleeding (GIB) events due to non-pulsatile flows of the device. LVAD patients also commonly receive statins for the primary or secondary prevention of cardiovascular disease. However, the impact of such therapy on the incidence of GIB is controversial. Importantly, literature regarding the impact of statins on GIB in LVAD patients is lacking.

Of the 123 patients who met inclusion criteria, 66 (54%) received statin therapy during the study period. No difference was observed in the primary outcome of major GIB between the statin and non-statin groups (21.2% vs. 12.3%, p=0.19). Similarly, AVM confirmed GIB (12.1% vs. 5.3%, p=0.22), other major GIB (9.1% vs. 7.0%, p=0.75), and non-clinically relevant GIB (3.0% vs. 1.8%, p=0.65) were similar between the two groups. Using a competing risk modeling, we observed no difference in the development of a major GIB (32.4% vs. 18.7%, p=0.14) or in the frequency of major GIB [1.5 (interquartile range, 1-2) vs. 1 (1-1), p=0.12] within 12 months of device implantation. Multivariable Cox regression revealed that older age and higher baseline creatinine were associated with an increased risk of GIB within 1-year of LVAD implantation (p<0.05 for both).

METHODS

This was a single-center, retrospective review of adult patients that underwent CF-LVAD implantation between May 2016 and January 2020. Patients were categorized based on statin use throughout the study period. The primary outcome was the composite of arteriovenous malformation (AVM) confirmed GIB and other major GIB events for up to 1-year post-LVAD implantation. Secondary outcomes included each of the components of the primary outcome, non-clinically relevant GIB, time to GIB, and frequency of GIB. Multivariable Cox regression was utilized to assess association between confounding variables and GIB.

CONCLUSION

Among patients with CF-LVADs, there was a non-significant increase in the incidence of major GIB events with the use of statin therapy. Further long-term studies are needed to determine if statin use has a significant impact on the incidence of GIB events among this patient population.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Hala Halawi, PharmD Hala earned her PharmD degree from the Lebanese American University in 2020. She is completing her PGY1 pharmacy residency at Houston Methodist Hospital. Following completion of her PGY1, Hala will be staying at Houston Methodist Hospital to complete a PGY2 in critical care. Primary project preceptor: Jesse E. Harris, PharmD, BCCCP Presented at 2020 Virtual Midwest Pharmacy Residents Conference; 2021 Society of Critical Care Medicine Texas Chapter 10th Annual Symposium

Evaluation of the impact of revisiting just culture within a pharmacy department in an academic medical center Stephanie Crowley, PharmD, MS; Engie Attia, PharmD; Mobolaji Adeola, PharmD; Alex Varkey, PharmD, MS; Catherine Hatfield, PharmD; David Wallace, PharmD PURPOSE

RESULTS

The primary objective was to assess change in perceived just culture after distribution of the medication safety newsletter, which was measured by change in percentage of negative responses (PNR) to the just culture assessment tool (JCAT) pre- and post- intervention.

A total of 118 (40.5%) and 79 (27.5%) of pharmacy department employees completed the pre-and post-Just Culture Assessment Tool (JCAT) surveys, respectively. For the primary endpoint there was an unexpected statistically significant increase in overall JCAT PNR between the pre- and post-surveys (p=0.035). These results were likely due to confounders related to response rate rather than the intervention itself. There were statistically significant increases in PNR for the ‘Openness of Communication’ (p=0.009) and ‘Continuous Improvement’ (p=0.032) domains.

METHODS

CONCLUSION

Cultivating a just culture is developed over time and is a dynamic process that is influenced by many factors. Just culture process improvements are likely to impact more than one just culture domain thus utilizing a validated tool to measure changes at the domain level may be beneficial.

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

Stephanie Crowley, PharmD, MS Stephanie earned her PharmD and her MS in Pharmacy Leadership and Administration from University of Houston College of Pharmacy in 2019 and 2021, respectively. Following her completion of her PGY2 residency, Stephanie will assume the role of pharmacy operations manager at HCA Kingwood. Primary project preceptor: Engie Attia, PharmD, BCPS Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Alcalde Southwest Leadership Conference.

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Evaluation of anti-Xa level-based enoxaparin bridge therapy in patients with left ventricular assist devices. Nathan Jones, PharmD; May Achi, PharmD PURPOSE

RESULTS

Patients with a left ventricular assist device (LVAD) on warfarin with sub-therapeutic INR values require additional pharmacologic anticoagulation to prevent blood clots. This study aims to assess the bleeding risk of enoxaparin in association with anti-Xa results for LVAD patients.

A total of 81 encounters were included, with 25 encounters having at least 1 anti-Xa result. Patients were administered a mean enoxaparin dose of 1.24 mg/kg/day for an average of 1.44 days. Major bleeding occurred in 1 encounter with a corresponding anti-Xa of <0.5 IU/mL. Thrombosis occurred in 1 encounter with a corresponding anti-Xa of 0.5-0.9 IU/mL.

METHODS

This is a single-center, observational, retrospective study of up to 50 patients admitted to Houston Methodist Hospital from January 2016 through September 2020. Patients included had implanted LVAD (HVAD, HEARTMATE II or III), received ≥ 2 doses of enoxaparin, had one or more anti-Xa levels for enoxaparin, and INR <2. Patients will be excluded if they had LVAD implantation during the same hospital visit, GI bleeding within the last 30 days, or who only received one dose of enoxaparin during their hospital stay. The incidence of major bleeding and transfusion requirements will be assessed as primary safety outcomes in addition to incidence of minor bleeding events, transfusion requirements and the incidence of thromboembolic events while receiving enoxaparin. Descriptive statistics will be performed to determine if the specific anti-Xa goal is associated with improved safety.

CONCLUSION

In patients with LVAD admitted to Houston Methodist Hospital on enoxaparin, a similar rate of bleeding and thrombosis occurred between anti-Xa groups. Additional studies would be necessary to determine anti-Xa goals for enoxaparin bridging in these patients.

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

Nathan Jones, PharmD Nathan completed his undergraduate coursework and earned his PharmD from the University of Kansas School of Pharmacy in 2020. Following this year, he will continue into the second year of his combined PGY1/PGY2/MS HSPAL residency program. Primary project preceptor: May Achi, PharmD, BCPS Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference

Cost effectiveness analysis of remdesivir in COVID-19 patients at a large academic medical center Gabrielle Wu, PharmD, MS; Stephen Ma, MBA; Michael Fahey II, PharmD, MBA; Divya Varkey, PharmD, MS; Kevin Garey, PharmD, MS, FASHP PURPOSE

RESULTS

Cost-effectiveness analysis (CEA) is one form of health economic evaluation. In general, a CEA model can establish the comparative impact of a new intervention on “individuals’ length of life and health-related quality of life”, commonly measured as quality-adjusted life-year (QALY). A decision model for remdesivir was adapted and built in TreeAge software, then validated with real-world data collected at an academic medical center. The purpose of the model was to determine the changes in hospitalization costs associated with the differences in treatment using remdesivir plus standard of care versus treatment with standard of care alone.

The incremental cost-effectiveness ratio was $346,622 as determined by the adapted CEA model based on parameters from the ACTT-1 trial. This incremental cost-effectiveness ratio value was not considered to be cost-effective. The modified CEA model populated with real-world patient data resulted in an incremental cost-effectiveness ratio value of $3,280,952, which was considered not cost-effective.

METHODS

The design was a long-term longitudinal cohort decision tree model study. The target population comprised of adult patients admitted between March 6, 2020 and May 31, 2020 with a novel severe acute respiratory syndrome coronavirus 2 infection. Hospitalized patients with moderate or severe category of disease based on the institution’s COVID-19 treatment algorithm at the time of patients’ admissions were included. The decision tree structure was an adaptation of the CEA model published by the Institute for Clinical and Economic Review (ICER). This model aimed to estimate the incremental cost required to gain one unit of health benefit, or per QALY, for remdesivir at the $50,000 QALY threshold.

CONCLUSION

Remdesivir was concluded to not be cost-effective in reducing disease-severity bundled hospitalization costs when used to treat hospitalized patients with COVID-19 disease in combination with standard of care, as compared to standard of care alone. However, the results of this study are not extractable to other countries where hospital payments are based on per diem estimates and are not bundled into one single cost regardless of the duration of hospital stay.

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

Gabrielle Wu, PharmD, MS Gabrielle earned her BS in Cellular and Molecular Biology from UOM in 2014 and PharmD from UNC in 2019. She also received her MS in Pharmacy Leadership and Administration from the UH Pharmacy in 2021. Following completion of her PGY2 residency, Gabrielle will assume the role of pharmacy program coordinator in financial management at Cedars-Sinai Medical Center. Primary project preceptor: Kevin Garey, PharmD, MS, FASHP Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Alcalde Southwest Leadership Conference

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Implementation of centralized pharmacy order verification services in a large multi-hospital health-system Niha Zafar, PharmD; Niaz Deyhim, PharmD, MS; Sunny Bhakta, PharmD, MS; Magdi Ayyad, RPh; Alex Varkey, PharmD, MS PURPOSE

RESULTS

The purpose of this study was to explore the processes to successfully implement centralized pharmacy order verification services in a multi-hospital health system and evaluate its impact on operational efficiency, productivity, and quality.

The average hourly order verification rate after implementation of the pilot was 105 orders per hour, compared to an average of 46 orders per hour for all hospitals in the health-system prior to the pilot. The aggregate verification turnaround time decreased overall from 7.25 minutes in the pre-implementation period to 5.25 minutes in the post-implementation period. The number of medication orders adjusted per 100 orders verified remained similar between the pre- and postimplementation periods.

METHODS

A quasi-experimental study was performed to evaluate the implementation of centralized pharmacy order verification in a multi-hospital health system. The study timeframe included a pre-intervention period from June 2020 to August 2020 and a post-intervention period from April 2021 to June 2021. A pilot with three of eight institutions in the healthsystem was initially established in September 2020, with a phased approach to inclusion of additional institutions to allow time for pharmacists to develop comfort with unfamiliar orders and adjustments to workflow. A shared work queue was created with orders from specific units from each institution for centralized verification. The primary endpoint was the productivity measured through average hourly order verification rates. The secondary endpoints included aggregate verification turnaround time and medication orders adjusted per 100 orders verified as an objective surrogate for safe practices.

CONCLUSION

Implementation of a centralized pharmacy order verification pilot demonstrated an increase in pharmacist productivity while maintaining quality of medication order review. Continuous evaluation of process improvements and quality assurance is essential for successful implementation of these services. Further assessment is needed to determine the long-term opportunities for advancement and expansion of onsite pharmacist roles to provide value-added services to individual institutions.

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

Niha Zafar, PharmD Niha completed her undergraduate coursework and earned her PharmD from the University of Houston College of Pharmacy in 2020. Following completion of her PGY1 residency, Niha will continue her residency training in the combined program as a PGY2 Pharmacy Administration Resident. Primary project preceptor: Alex Varkey, PharmD, MS, FAPhA Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference; 2021 ASHP Virtual Conference for Pharmacy Leaders

Patient Safety And Financial Outcomes Of Smart Pump – Electronic Health Record Interoperability Wenfei Wei, PharmD; William Coffey, BSPharm, DDS; Mobolaji Adeola, PharmD, BCPS; Ghalib Abbasi, PharmD, MS, MBA PURPOSE

RESULTS

Integrating a hospital’s smart pump with its electronic health record (EHR) is predicted to improve patient safety and finances by reducing pump programming errors and enhancing nursing workflow efficiency. The purpose of this study is to describe the impact of pump – EHR interoperability on safety and financial parameters at a community hospital.

Drug library compliance increased from 73.8% to 82.9% (P<0.001), overridden alerts increased from 64.8% to 68.9% (P<0.001), overridden alerts within 2 seconds decreased from 17.3% to 13.8% (P<0.001), high risk overridden alerts did not change significantly from 1.5% to 1.6% (P=0.654), and reprogrammed alerts decreased from 20.7% to 18.3% (P=0.002). Estimated value of nursing time savings was $376,329.

METHODS

Houston Methodist Sugar Land Hospital (HMSL) went live with pump – EHR interoperability in October 2019. Data was collected from the smart pump’s reporting tool during the pre-implementation period, April 1, 2019 to June 30, 2019 and post-implementation period, April 1, 2020 to June 30, 2020. Primary endpoint was drug library compliance, defined as infusions programmed with dose-error reduction software (DERS) out of all infusions. Secondary safety endpoints were overridden alerts, overridden alerts within 2 seconds, high risk overridden alerts, and reprogrammed alerts. Secondary financial endpoint was nursing labor cost savings, calculated as estimated time saved per infusion (10 minutes) multiplied by number of post-implementation infusions and nursing pay rate.

CONCLUSION

Increase in overridden alerts suggests inappropriate override or inappropriate drug library settings. Decrease in reprogrammed alerts suggests fewer pump programming errors. Improved nursing workflow efficiency through automation results in financial benefit.

PGY1 – PGY1/PGY2 PHARMACY INFORMATICS RESIDENCY

Wenfei Wei, PharmD Wenfei Wei earned her BA in Biochemistry and Cell Biology from Rice University in 2013 and PharmD from Texas A&M University in 2020. Following completion of her PGY1, Wenfei will continue advance in her current Pharmacy Informatics Residency program as a PGY2, after which she will pursue a career as an informatics pharmacist. Primary project preceptor: William Coffey Presented at 2020 Virtual Vizient Conference, 2021 Virtual Midwest Pharmacy Residents Conference.

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Outcomes associated with bacteremia in patients with axillary mechanical circulatory support devices Diane Dreucean, PharmD; Celia Morton, PharmD; Luma Succar, PharmD; Jill Krisl, PharmD; Katherine Perez, PharmD; Kevin Donahue, PharmD PURPOSE

RESULTS

Development of bloodstream infections (BSI) while on durable mechanical circulatory support (MCS) devices has been shown to negatively impact orthotopic heart transplantation (OHT) outcomes. However, this association has not been explored in patients on temporary MCS. The aim of this study was to assess the incidence of BSI in patients with axillary MCS devices and characterize patient outcomes following device removal.

We retrospectively reviewed 194 patients that underwent axillary MCS device placement with an intra-aortic balloon pump (IABP), Impella® 5.0, or Impella® 5.5 from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary device support, reported as the proportion of patients who developed a BSI and BSI per 1000-device days. CONCLUSION

METHODS

Incidence of BSI across axillary-placed MCS devices is not well defined. Our results demonstrate that unique factors, such as longer duration of MCS or prior femoral device use, can play a role in development of BSI and warrant further investigation. Strategies to prevent BSI, including use of peri-procedural antimicrobials, may have clinical utility in improving post-device outcomes. Larger studies are needed to fully elucidate risk factors associated with BSI development in this patient population, evaluate the BSI risk profile of femoral versus axillary MCS devices, and assess the impact of BSI on patient outcomes.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Diane Dreucean, PharmD Diane completed her undergraduate coursework and earned her PharmD from the University of Houston in 2019. She completed her PGY1 at Houston Methodist Hospital. Following completion of her PGY2, Diane will be staying on at Houston Methodist Hospital as an overnight critical care clinical pharmacy specialist. Primary Project Preceptor: Kevin Donahue, PharmD, BCPS Presented at 2020 Virtual ASHP Midyear Clinical Meeting; 2021 TMC Critical Care Virtual Research Forum

Evaluation of inhaled alprostadil in hospitalized adult patients Hangil Seo, PharmD; Chelsea N. Lopez, PharmD; Luma Succar, PharmD; Kevin R. Donahue, PharmD PURPOSE

RESULTS

Intermittent inhaled alprostadil (iPGE1) represents a potential alternative to traditional inhaled pulmonary vasodilators, however there is limited evidence for its use in adult patients. The goal of this study was to describe the clinical characteristics of inpatients receiving iPGE1 and identify the populations most likely to benefit from its use.

Fifty-four patients received iPGE1 and were included in the study. Indication for iPGE1 use was pulmonary (pHTN or ARDS) in 40 (75%) patients or cardiac in 14 (25%) patients. Overall, there was no difference between indications in the number of patients de-escalated from baseline level of respiratory (53% vs 57%, p = 0.76), inotropic (70% vs 57%, p=0.39), or vasopressor support (78% vs 57%, p=0.17). Furthermore, there was no significant improvement in partial pressure to fraction of inspired oxygen ratios, cardiac index, or pulmonary artery pressures in either of the groups at multiple time intervals after iPGE1 initiation.

METHODS

This was a single center, retrospective, descriptive analysis of all inpatient adult patients who received at least one dose of iPGE1 at a large academic medical center from May 2016 to July 2020. The primary objective of this study was to describe the patient characteristics and dosing strategies employed. Secondary outcomes included changes in respiratory support requirements, hemodynamics, and inotropic or vasoactive drug dosing. Outcomes were stratified and compared based on the primary indication for alprostadil initiation as either cardiac or pulmonary.

CONCLUSION

This study represents the largest to date investigation on the use of intermittent iPGE1 in hospitalized patients. Alprostadil was utilized in novel populations; however, efficacy as evaluated by clinical or surrogate endpoints could not be demonstrated. Further investigation is needed in select subpopulations to evaluate for its optimal place in therapy.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Hangil Seo, PharmD, BCPS Hangil earned his BS in Pharmaceutical Sciences in 2016 and PharmD from the University of Pittsburgh in 2018. He completed his PGY1 residency at NYU Langone Health in New York, New York. Following completion of his PGY2, Hangil will work as an overnight critical care clinical pharmacy specialist at Tufts Medical Center. Primary project preceptor: Chelsea Lopez, PharmD, BCCCP Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Texas Medical Center PGY2 Critical Care Resident Research Virtual Forum.

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Multicenter evaluation of superinfection occurrence and impact on clinical outcomes in patients with COVID-19 Taryn A. Eubank, PharmD; William L. Musick, PharmD, BCIDP; Katherine K. Perez, PharmD, BCIDP; Charles E. Janak, PharmD, BCPS; Keving W. Garey, PharmD, MS PURPOSE

RESULTS

The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread globally in late 2019. We sought to evaluate the overall bacterial and fungal superinfection rate within our COVID-19 population, effect on 28-day mortality, and patient characteristics that correlate with a higher risk of a superinfection.

A total of 404 patients were included in the study analyses of which 56 (13.9%) had a clinically significant superinfection within 28-days from admission. Mortality at 28 days was significantly higher in patients with superinfections (12.1% vs 5.8%, p ≤ 0.001). Risk of superinfection was significantly higher among patients of Black ethnicity, those with chronic kidney disease, ICU status at admission, receipt of tocilizumab, and/or lymphocytopenia.

METHODS

Hospitalized, adult patients with laboratory confirmed and symptomatic COVID-19 disease admitted between March 12, 2020 and May 31, 2020 within the Houston Methodist Hospital System including a large, 900-bed, quaternarycare hospital and five community hospitals in the greater Houston, Texas, metro area were eligible for inclusion in this study. Follow-up continued through June 28, 2020. Outcomes of this analysis include overall bacterial and fungal superinfection occurrence rate within 28 days of admission, patient characteristics that correlate with a higher risk of a superinfection, and the effect on 28-day mortality.

CONCLUSION

In conclusion, our retrospective cohort study reports a superinfection rate of 13.9%. Presence of a superinfection significantly increases the likelihood of mortality within 28days from admission. These results can aid in de-escalation of empirical antimicrobial therapies in patients that are low risk of a superinfection as the overall occurrence of superinfection is relatively low.

PGY2 INFECTIOUS DISEASES PHARMACY RESIDENCY

Taryn A. Eubank, PharmD Taryn earned her BS in Biochemistry and Molecular Biology in 2015 and PharmD in 2019 from Harding University in Searcy, AR. She completed her PGY1 at Houston Methodist Hospital. Following completion of PGY2, Taryn will complete an Infectious Diseases Research Fellowship and Training Program in Antimicrobial Resistance through the Gulf Coast Consortium for Antimicrobial Resistance in Houston, Texas. Primary project preceptor: William L. Musick, PharmD, BCIDP Presented at 2020 Virtual Vizient Pharmacy Network, 4th Annual Texas Medical Center Antimicrobial Resistance and Stewardship Conference, and Midwest Pharmacy Residency Conference

Apixaban and rivaroxaban anti-Xa level monitoring versus standard monitoring in hospitalized patients with acute kidney injury William Towers, PharmD; Steffany N. Nguyen, PharmD; Melanie C. Ruegger, PharmD; Eric Salazar, MD, MPH; Kevin R. Donahue, PharmD PURPOSE

RESULTS

Oral direct factor Xa inhibitors (FxaI) are commonly used anticoagulants for stroke prevention in atrial fibrillation and the treatment of venous thromboembolism. As FxaIs are renally eliminated, acute kidney injury (AKI) may increase risk for drug accumulation and bleeding. There is minimal data describing the effects of AKI on anti-Xa levels or clinical outcomes in patients receiving a FxaI. The purpose of this study was to compare anti-Xa level monitoring to standard monitoring in patients who experience AKI on apixaban or rivaroxaban.

A total of 196 patients were included in the final analysis. Major bleeding occurred in two patients who received anti-Xa level monitoring compared to 14 patients who received standard monitoring (2.1% versus 14%; p<0.01). Variables identified as predictors of major bleeding included a documented history of liver (odds ratio 3.17; 95% confidence interval, 1.04-9.67; p=0.04) and antiplatelet use (odds ratio 4.18; 95% confidence interval, 1.28-13.7; p=0.02). CONCLUSION

METHODS

This retrospective cohort study included adult patients admitted within the Houston Methodist (HM) System from May 2016 to October 2020 and was approved by the HM Research Institute Institutional Review Board. Patients were included if they received apixaban or rivaroxaban within 72 hours prior to AKI. Patients with a history of end-stage kidney disease requiring kidney replacement therapy prior to admission were excluded. Patients were stratified into one of two groups, those with anti-Xa level monitoring or those who received standard monitoring. The primary outcome was major bleeding as defined by the International Society of Thrombosis and Haemostasis.

Anti-Xa level monitoring was associated with a significant reduction in major bleeding compared to standard monitoring. A history of liver disease and antiplatelet use may increase the risk of bleeding in patients who develop AKI while receiving apixaban or rivaroxaban. The optimal management of antithrombotic medications in patients with AKI and recent exposure to a FxaI requires further investigation.

PGY2 INTERNAL MEDICINE PHARMACY RESIDENCY

William Towers, PharmD, BCPS Will earned his BS in Biomedical Sciences from Auburn University in 2015 and PharmD from the Auburn University Harrison School of Pharmacy in 2019. He completed his PGY1 residency at Methodist University Hospital in Memphis, TN. Following completion of his PGY2, he will assume the role of internal medicine pharmacy specialist at MD Anderson Cancer Center in Houston, Texas. Primary project preceptor: Kevin Donahue, PharmD, BCPS Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference.

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Immunotherapy vs Chemoimmunotherapy in Advanced Non-Small Cell Lung Cancer Blake Buzzard, PharmD; Hanna Zaghloul, PharmD; Monica Chintapenta, PharmD; Godsfavour Umoru, PharmD, Eric Bernicker, MD PURPOSE

RESULTS

The purpose of this study is to compare front-line treatment of advanced NSCLC utilizing immunotherapy alone versus chemoimmunotherapy, particularly according to PD-L1 expression.

A total of 164 patients were evaluated and 59 patients met inclusion criteria, 31 in the immunotherapy group and 28 in the chemoimmunotherapy group. The mean number of cycles completed were 11 vs 7 in the immunotherapy compared to chemoimmunotherapy groups respectively. For patients with PD-L1 expression at 1-49%, the mean cycles in the two groups were 7 vs 7. In patients with PD-L1 expression greater than or equal to 50%, the mean cycles completed were 12 vs 9. The number of patients discontinuing therapy due to progression was 18 (58%) vs 9 (32%) respectively. The number of patients discontinuing therapy due to adverse events was 7 (23%) vs 15 (54%).

METHODS

This is a retrospective cohort study of oncology patients newly diagnosed with advanced NSCLC and received treatment at Houston Methodist Hospital between November 2016 and December 2019. Patients received either pembrolizumab or atezolizumab monotherapy or pembrolizumab combined with platinum-based chemotherapy. The study is approved by the hospital’s institutional review board. The primary objective is to determine the number of completed treatment cycles of immunotherapy monotherapy compared to immunotherapy with platinum-based chemotherapy. Secondary endpoints will include PD-L1 expression, adverse effects, dose reduction and rationale, type of second-line therapy, and number of completed cycles of second-line therapy.

CONCLUSION

Immunotherapy provided a similar time-to-treatment discontinuation compared to immunochemotherapy, even within the patients with PD-L1 expression 1-49% and demonstrated less incidence of treatment discontinuation due to side effects.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Blake A Buzard, PharmD Blake Buzard earned his BS in Pharmaceutical Sciences and PharmD from University of Kansas in 2019. He completed his PGY1 residency at Ascension Via Christi in Wichita, Kansas Following completion of his PGY2, Blake will move into an oncology clinical specialist role at St. Luke’s Hospital in Kansas City. Primary project preceptor: Hanna Zaghloul, PharmD, BCOP Presented at: 2020 Virtual Vizient Pharmacy Network, HOPA 2021, 2021 Virtual Midwest Pharmacy Residents Conference 2021.

Cytomegalovirus (CMV) reactivation rate in allogeneic hematopoietic stem cell transplant (HSCT) patients Ashka Patel, PharmD; Godsfavour Umoru, PharmD; William Musick, PharmD; Hanna Zaghloul, PharmD; James Cox, PharmD PURPOSE

RESULTS

Cytomegalovirus (CMV) infection is a clinically significant infection in patients post allogeneic hematopoietic stem cell transplant (HSCT). Prophylactic letermovir use after allogeneic HCST reduces risk of CMV reactivation. The objective of this study is to quantify CMV reactivation rates pre- and post- the initiation of letermovir prophylaxis at our institution.

A total of 129 patients were identified, 78 in the preletermovir arm and 51 in the post letermovir arm. 51.3% of patients in the pre-letermovir arm experienced CMV reactivation; 41.3% of patients in the post letermovir arm experienced CMV reactivation. 50% of the patients receiving letermovir 28 days or more post-transplant experienced CMV reactivation; whereas, 39.5% of the patients receiving letermovir within 28 days of transplant experienced CMV reactivation.

METHODS

A single-center, retrospective chart review was performed to identify eligible patients that received allogeneic HSCT between May 1, 2016 and June 30, 2020. Eligible patients were evaluated from admission through day +100 post-transplant. The primary outcome of this study is to evaluate the rate of CMV reactivation between the pre-letermovir arm and post-letermovir arm. Secondary outcomes included evaluating timing of letermovir initiation, CMV reactivation rates in relation to donor serologic status, provider prescribing practices, and concurrent immunosuppression. Patient demographic information were also be collected.

CONCLUSION

Although not statistically significant the patients in the post letermovir arm had less incidence of CMV reactivation compared to patients in the pre-letermovir arm.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Ashka Patel, PharmD Ashka earned her PharmD from MCPHS University in 2019. She completed his/her PGY1 residency at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Following completion of his/her PGY2, Ashka will be an Oncology Pharmacy Clinical Specialist at Boston Medical Center. Primary project preceptor: James Cox PharmD BCOP Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference; 2021 HOPA

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Impact of Positive Donor Cultures on Postoperative Lung Transplantation Infectious Outcomes Anna Curtis, PharmD; Christine Pham, PharmD; Brett J. Pierce, PharmD, BCPS; Duc Nguyen, MD, PhD; Edward Graviss, PhD, MPH PURPOSE

RESULTS

Transmission risk of microbes present in donor lungs at time of donation to lung transplant recipients (LTR) is unclear. Infection is the second highest cause of 30-day (d) mortality. Guidelines for donor-derived infections recommend 7-14d of antibiotics in recipients of bacteremic donors. There is limited data assessing transmission of non-blood donor infections and outcomes post-lung transplantation. We sought to describe infectious outcomes within 90 days after lung transplant in patients with positive donor cultures.

Of 83 included patients, C. diff occurred in 11% (n=9) and MDRO occurred in 25% (n=21) of LTR within 90d. Donor cultures were 96% bacterial and 94% from lungs/sputum. Immediate organism clearance (organism identified in donor but not in LTR cultures) occurred in 83% of LTR (n=69). All donor-derived organisms were respiratory infections (RI) in the 14 LTRs that grew through post-op antibiotics. Median duration of post-op antibiotics was 14d (IQR 11-18) in these positive RI LTR vs 11d (IQR 9-15) in those who demonstrated immediate clearance. Positive RI LTR demonstrated organism clearance after a median of 4d (IQR 3-6).

METHODS

This was a single-center, retrospective, descriptive study. We reviewed LTR from 2016-2020 with positive donor cultures from any site. Patients were excluded if they had cystic fibrosis, a multiorgan or redo transplant, or active infection at time of transplant. Protocol post-op antibiotics included vancomycin and cefepime x7d with extension to 14d if positive donor cultures were reported. Our primary outcome was the incidence of infectious outcomes, defined as Clostridioides difficile (C. diff) and multi-drug resistant organisms (MDRO), within 90d post-lung transplantation. Secondary outcomes included transmission characterization, antibiotic regimens, and 90-day mortality.

CONCLUSION

While incidence of C. diff and MDRO was low and did not appear to correlate with antibiotic duration, LTR may benefit from decreased antibiotics duration given immediate clearance occurred in 83% of LTR. Our study suggests antibiotics past 7d may not be necessary in lung transplant patients with gram-positive respiratory cultures or with non-respiratory and/or non-bacteremic donor cultures.

PGY2 SOLID ORGAN TRANSPLANT PHARMACY RESIDENCY

Anna E Curtis, PharmD Anna earned her PharmD from the University of Houston College of Pharmacy in 2019. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Anna has accepted a position as an Abdominal Transplant Pharmacist at Medical City Fort Worth. Primary project preceptor: Christine Pham, PharmD Presented at 2020 Virtual Vizient Pharmacy Network Conference, 2021 Virtual Midwest Pharmacy Residents Conference, and 2021 Virtual American Transplant Congress

Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection Johnny Hoang, PharmD; Mozhgon Moaddab, PharmD, BCPS; Duc T Nguyen, MD, PhD; Edward A Graviss, PhD, MPH; Ashrith Guha, MD, MPH; Jill Krisl, PharmD, BCPS PURPOSE

RESULTS

Hypogammaglobulinemia (HGG) is a complication of solid organ transplantation associated with an increased infection risk. Intravenous immunoglobulin G (IVIG) replacement in patients with HGG may be able to reduce rates of infection; however, few studies have assessed the use of IVIG in mild to moderate HGG (IgG 400-700 mg/dL) and heart transplant recipients with simultaneous infection.

Forty-two patients were included in this study. Patients in the IVIG group received on average one dose of IVIG at 0.5 g/kg. No differences in incidence of new infection at 3 months (26.3% vs 17.4%; p=0.71) and 6 months (42.1% vs 34.8%; p=0.63) were observed between the IVIG and non-IVIG groups. Infections based on mild or moderate HGG also had no differences. Severity of HGG was not associated with new infections at 3 and 6 months.

METHODS

CONCLUSION

A single center, retrospective study was performed assessing heart transplant recipients admitted between October 2017 to May 2020 with a documented infection and mild (IgG 500-700 mg/dL) to moderate (IgG 400-499 mg/dL) HGG.

Our findings suggest that IVIG in mild to moderate HGG may have little to no benefit in reducing incidence of new infections. Larger prospective studies are needed to confirm these findings.

PGY2 SOLID ORGAN TRANSPLANT PHARMACY RESIDENCY

Johnny Hoang, PharmD Johnny earned his PharmD from the University of Houston College of Pharmacy in 2019. He completed his PGY1 residency at Houston Methodist Hospital. Following completion of his PGY2, Johnny will work as an advanced clinical pharmacist in solid organ transplant at Medical City Dallas. Primary project preceptor: Jill Krisl, PharmD, BCPS Presented at 2020 Virtual Vizient Pharmacy Network, 2021 Virtual Midwest Pharmacy Residency Conference, and 2021 Virtual American Transplant Congress

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Unnecessary Emergency Department Visits for Rabies Vaccination Tomona Iso, PharmD; Fangzheng Yuan, PharmD; Elsie Rizk, PharmD; Anh Thu Tran, PharmD; R. Benjamin Saldana, DO; Prasanth Boyareddigari, MD; Ngoc-anh A. Nguyen, MD; Daniela Espino, PharmD; Julia S. Benoit, PhD; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

This study reviewed emergency department (ED) visits for rabies postexposure prophylaxis (PEP) to identify unnecessary ED visits for rabies vaccination.

This study included 145 patients with 203 ED visits (113 initial and 90 non-initial healthcare visits). Unnecessary ED visits were identified for 19% (28 of 145) of patients and 66% (59 of 90) of ED visits for non-initial healthcare. Contributing factors for unnecessary ED visits were suboptimal ED discharge instructions to return to the ED for vaccination (n=20 visits) and patients’ inability to coordinate outpatient follow-up (n=17 visits). Patients with previous unnecessary ED visits had a 73% probability for unnecessarily returning to the ED for vaccination..

METHODS

This retrospective study included patients who received human rabies immune globulin (HRIG) or rabies vaccine at 15 Houston Methodist EDs from 2016-2018. All ED visits were classified as initial or non-initial healthcare visits after animal exposure. Emergency department visits for non-initial healthcare were classified as necessary (HRIG administration, worsening symptoms, other emergent conditions, or vaccination during a natural disaster) or unnecessary (rabies vaccination only).

CONCLUSION

One of 5 patients who received rabies PEP in the ED had unnecessary ED visits for subsequent rabies vaccination, diverting valuable ED resources from patients with more urgent conditions and increasing health care costs. Most (66%) ED visits for non-initial healthcare were unnecessary. Future programs are needed to educate providers and implement appropriate discharge planning and follow up for patients who receive rabies PEP in the ED to prevent unnecessary ED visits for rabies vaccination.

FELLOW – CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Tomona Iso, PharmD Tomona earned her BS in Pharmacy from Tohoku Pharmaceutical University in 2006 and her PharmD from Nova Southeastern University in 2018. Following completion of her fellowship training, Tomona will assume the role of an assistant professor in the Department of Pharmacy Practice at Loma Linda University. Primary project preceptor: Joshua T. Swan, PharmD, MPH, FCCM, BCPS Presented at 2020 Virtual International Society for Pharmacoeconomics and Outcomes Research Meeting

Real-world data on liposomal bupivacaine and inpatient hospital costs after colorectal surgery Anh Thu Tran, PharmD; Elsie Rizk, PharmD; Eric M. Haas, MD; George Naufal, PhD; Lixian Zhong, PhD; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

To compare total cost of care among colorectal surgery patients who received liposomal bupivacaine versus those who did not (control) from a health institution perspective.

Of 486 included patients, 286 (59%) received liposomal bupivacaine. Total cost of care using public costs included perioperative local anesthetics (mean±SD; $392±74 liposomal bupivacaine vs. $8±13 control), analgesics within 48 hours after surgery ($132±99 liposomal bupivacaine vs. $117±127 control), postoperative ileus management ($5±51 liposomal bupivacaine vs. $65±284 control), and hospital length of stay ($4,459±3,576 liposomal bupivacaine vs. $7,769±7,082 control). Liposomal bupivacaine was associated with an adjusted absolute difference in total cost of care of –$1,435 (95%CI –$2,401 to –$470; p-value=0.004) using public costs and –$1,345 (95%CI –$2,215 to –$476; p-value=0.002) using internal costs.

METHODS

This pharmacoeconomic evaluation was conducted among adults undergoing open or minimally invasive colorectal resection at an academic medical center from May 2016 to February 2018. Healthcare resource utilization was derived from the electronic health record. Total cost of care (2018 USD) was analyzed using a generalized linear model adjusted for American Society of Anesthesiologists score, enhanced recovery after surgery management, open surgery, opioid use before surgery, height, cancer, and age. The primary analysis used public costs. A sensitivity analysis used internal costs from the hospital to maximize internal validity.

CONCLUSION

Liposomal bupivacaine in colorectal surgery was associated with a significant reduction in total cost of care that was predominately driven by reduced costs for hospital stay and postoperative ileus management despite higher medication costs.

FELLOW – CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Anh Thu Tran, PharmD Anh Thu earned her BS in Mathematical Biology from the University of Houston in 2012 and PharmD from Texas A&M University in 2019. Following completion of her fellowship training, Anh Thu will assume the role of a research analyst at IBM Watson Health. Primary project preceptor: Joshua T. Swan, PharmD, MPH, BCPS, FCCM Presented at 2021 Virtual International Society for Pharmacoeconomics and Outcomes Research Meeting

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Clinical Decision Support Improves Delivery of Human Rabies Immune Globulin in the Emergency Department Fangzheng Yuan, PharmD; Tomona Iso, PharmD; Elsie Rizk, PharmD; Anh Thu Tran, PharmD; Robert B. Saldana, DO; Ngoc-anh A. Nguyen, MD; Prasanth R. Boyareddigari, MD; Daniela Espino, PharmD; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

To evaluate implementation of a rabies postexposure prophylaxis (PEP) bundle on human rabies immune globulin (HRIG) patient selection and administration in the emergency department (ED).

Implementation of the bundle was associated with an increase in full adherence from 37% (95 of 254) in the historical control group to 61% (43 of 70) in the post-implementation group (absolute difference 24%; 95% confidence interval 11% to 37%; P<0.01). Adherence improved for QI-4, QI-5, and QI-6 (all P<0.05). Non-significant increases were observed for proportions of patients with clear HRIG administration site documentation (88% to 95%; P=0.16) and patients who received any amount of HRIG infiltration (56% to 63%; P=0.48). The proportion of patients who received infiltration of the full HRIG dose increased from 24% to 43% (P=0.03).

METHODS

This before-and-after study included patients who received HRIG or rabies vaccine in 15 EDs at a multihospital health system. The bundle was implemented in December 2019 and consisted of electronic health record enhancements, ED staff education, and patient education. Patients treated from January 2015 to June 2018 were included in the historical control group. Patients treated from December 2019 to November 2020 were included in the post-implementation group. The primary outcome was full adherence to 6 quality indicators (QI) for HRIG: (QI-1) patient selection, (QI-2) dose, (QI-3) timing, (QI-4) infiltration into wounds, (QI-5) administration distant from rabies vaccine site, and (QI-6) administration that avoids the buttock.

CONCLUSION

Implementation of a rabies PEP bundle improved patient selection and delivery of HRIG in the ED.

FELLOW – CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Farrah Yuan, PharmD Farrah earned her PharmD degree from St. Louis College of Pharmacy in 2018. She completed her PGY1 residency at Ascension-St. Joseph Hospital in Milwaukee, Wisconsin. Following completion of her fellowship training, Farrah will assume the role of an Investigational Drug Services Pharmacist at Baptist Hospitals of Southeast Texas. Primary project preceptor: Joshua T. Swan, PharmD, MPH, FCCM, BCPS Presented at 2020 Virtual American College of Clinical Pharmacy Annual Meeting

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SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2016 TO 2021 Patel SJ, Kuten SA, Knight RJ, et al. Incidence and factors associated with de novo DSA after BK viremia in renal transplant recipients. Clinical Transplants 2016, Chapter 11, Terasaki Research Institute, CA. Patel SJ, Kuten SA, Musick WL, et al. Combination Drug Products for HIV-A Word of Caution for the Transplant Clinician. Am J Transplant 2016;16(8):2479-82. Patel SJ, Suki WN, Loucks-DeVos J, et al. Disparate rates of acute rejection and donor-specific antibodies among high-immunologic risk renal transplant subgroups receiving antithymocyte globulin induction. Transpl Int. 2016;29(8):897-908. Peled Y, Varnado S, Lowes BD, et al. Sinus tachycardia is associated with impaired exercise tolerance following heart transplantation. Clin Transplant 2017; 31 (5): e12946 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 Philip A, Desai A, Nguyen P, et al. Evaluating Pharmacy Leader Development Through The Seven Action Logics. Am J Health-Syst Pharm. 2016;73:82-5. Pritchard ER, Murillo JR Jr, Putney D, Hobaugh EC. Singlecenter, 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. Richards R, Azad R, Adeola M, Clary B. Delirium: The 21st century health care challenge for bedside clinicians. Journal of Nursing Education and Practice 2016; 6(6). 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, 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, 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. Rossitter CW, Vigo RB, Gaber AO, et al. Evaluation of carotid ultrasonography screening among kidney transplant candidates: a single-center, retrospective study. Transplant Direct. 2017;3(3):e135. Ruder TL, Donahue KR, Colavecchia AC, et al. Hemodynamic Effects of Dexmedetomidine in Adults with Reduced Ejection Fraction. Journal of Intensive Care Medicine. Online First 2020. 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 [epub online ahead of print] 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. September 2021. 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. Shank B, Nguyen P, Pherson E. Transitions of Care in Patients With Cancer. Am J Manag Care. 2017;23(7 Spec No.):SP280-SP284. 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. 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.J Oncol Pharm Pract. 2018. Epub ahead of print. 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. 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, 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.

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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. Whiddon AR, Dawson KL, Fuentes A, et al. Postoperative antimicrobials after lung transplantation and the development of multidrug-resistant bacterial and Clostridium difficile infections: an analysis of 500 noncystic fibrosis lung transplant patients. Clin Transplant. 2016;30(7): 767-73 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. Article in Press 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 202;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. Epub ahead of print. 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; Epub ahead of print. 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. Publish ahead of print. 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.

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 dose-dense chemotherapy regimens. J Oncol Pharm Pract. 2020 Aug 12:1078155220948937. Epub ahead of print. Varkey A and Deyhim N. Lessons on preparing and adapting your health-system pharmacy in the COVID-19 crisis. Washington, DC: American Pharmacists Association; 2020 Varnado S, Peled-Potashnik Y, Huntsberry A, et al. Effect of diltiazem on exercise capacity after heart transplantation. Clin Transplant 2017; 31 (8): e12997. 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.

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2020 QUICK FACTS HOUSTON METHODIST

8 2,541 1.2M

Hospitals Operating beds Outpatient visits

120,356

Admissions

26,098

Employees

5,256

Affiliated physicians

HOUSTON METHODIST RESEARCH INSTITUTE

2,047

Credentialed researchers

775

Faculty

570

Active clinical trials

1,470

Ongoing clinical protocols

1,554

Peer-reviewed publications

$64.1M

Extramural research funding

HOUSTON METHODIST houstonmethodist.org/pharmacy

122021

Houston Methodist Department of Pharmacy Annual Research Report 2020-2021

Articles inside

PGY2 Solid Organ Transplant Pharmacy Residency

PGY1/PGY2 Pharmacy Informatics Residency

PGY1 Pharmacy Residency

PGY1 International Graduates Pharmacy Residency

PGY1/PGY2 Health-System Pharmacy Administration Residency

PGY2 Infectious Diseases Pharmacy Residency

PGY2 Internal Medicine Pharmacy Residency

PGY2 Oncology Pharmacy Residency

PGY2 Critical Care Pharmacy Residency