Hospital Pharmacy - May 2017 - 354

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Hospital Pharmacy 52(5)

Methods

Statistical Analysis

Study Design

The Mann-Whitney U test was used to compare nonparametric continuous data. The chi-square test was used for nominal
data. Descriptive statistics were performed for baseline demographics, and a univariate analysis was performed with odds
ratios calculated for possible risk factors for cisplatin-induced
nephrotoxicity (cisplatin dose, mannitol use, hypertension,
diabetes, female gender, feeding tube, radiation therapy, and
concomitant nephrotoxin use). All statistical analyses were
calculated using PASW Statistics 18 (SPSS, Chicago, Illinois).
The primary endpoint was the change in mean mannitol
dose prescribed before and after the newsletter intervention.
Secondary endpoints included rate of AKI before and after
the newsletter intervention and possible risk factors for AKI.

Educational newsletters were developed monthly by
Advanced Pharmacy Practice Experience (APPE) students. Topics were selected by the APPE preceptor (J.B.B.)
who edited the newsletter after the revision process.
Topics focused on supportive care of oncology patients
and techniques to minimize toxicity from chemotherapy.
To encourage readability, the newsletters were short (1-2
pages) and included figures or tables to easily communicate information. In October 2010, an educational newsletter (eAppendix) was delivered electronically to all
institutional oncologists, oncology nurses, and oncology
pharmacists that described the state of evidence at that
time for using mannitol to prevent cisplatin-induced
nephrotoxicity.
To determine whether the newsletter changed prescribing
practices, a retrospective chart review of patients treated for
the first time with cisplatin at Johnson City Medical Center
(JCMC) and the Regional Cancer Center (RCC) was conducted. Patients were identified by pharmacy billing records
for cisplatin followed by a review of electronic medical
records. This study was approved by East Tennessee State
University Institutional Review Board.

Results
A total of 85 patients were identified via the pharmacy database; 18 were excluded, leaving a total of 67 patients for statistical analysis. Reasons for exclusion included being
previously treated with cisplatin (14 patients), incomplete
medical records for assessment (1 patient), and age younger
than 18 years (3 patients). Thirty patients were included in
the prenewsletter cohort, and 37 patients were included in
the postnewsletter cohort.

Study Population and Data Collection

Demographics

JCMC is a 445-bed community hospital and a member of
the Mountain States Health Alliance (MSHA). The MSHA
RCC includes a 21-bed outpatient infusion suite and physician clinics. Patients receiving their first dose of cisplatin at
JCMC or RCC during the study period were included. The
study period included prenewsletter (January 1, 2010, to
June 30, 2010) and postnewsletter (January 1, 2011, to
December 31, 2011) cohorts around the time of newsletter
publication (October 2010) with a 6-month gap to allow for
diffusion of information. Patients younger than 18 years,
those who initiated cisplatin treatment outside the study
periods, and those with incomplete medical records were
excluded.
Information regarding each patient's cancer diagnosis and
stage, nephroprotective strategy for cisplatin (including
mannitol use and dose), demographics, diabetes or hypertension history, treatment regimen (monotherapy or in combination with either chemotherapy or radiation therapy), the use
of concomitant nephrotoxins, prescriber, use of feeding tube,
cisplatin dose and number of doses, baseline SCr and creatinine clearance (CrCl) (including peak SCr and CrCl), and
acute kidney injury (AKI) incidence, grade, and time to AKI
were recorded. In the case of AKI, a grade of 0 to 5 was
assigned based upon the Common Terminology Criteria for
Adverse Events version 4.0.8

The patients' demographic data for both the prenewsletter
and postnewsletter cohorts are summarized in Table 1.
Patients were almost entirely Caucasian, and there was an
approximately equal gender distribution. The median age of
the prenewsletter cohort was 59 years (range, 33-74 years),
and the median age of the postnewsletter cohort was 57 years
(range, 40-76 years). Patient characteristics were similar
between the prenewsletter and postnewsletter cohorts with
the exception of primary tumor sites. In the prenewsletter
cohort, more patients had lung cancer or other as the primary
tumor site, whereas in the postnewsletter cohort, more
patients had head/neck as the primary tumor site. Most
patients in the prenewsletter cohort were receiving radiation
(66.67%) and other chemotherapy (76.67%). The majority of
patients in the postnewsletter cohort were also receiving
radiation (81.08%) and other chemotherapy (83.78%).
Patients in both cohorts were likely to be on concomitant
nephrotoxins: 83.3% in the prenewsletter cohort and 97.3%
in the postnewsletter cohort. Mean baseline renal function
was normal in both cohorts.
The average dose of mannitol (Table 2) in the prenewsletter cohort was 12.75 g, with the average dose of mannitol in
the postnewsletter cohort decreasing to 4.14 g (P = .02). The
average cisplatin dose in the prenewsletter group was 59.4
mg versus 54.9 mg in the postnewsletter group (P = .34).



Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
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Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
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