Impact of a Pharmacist-Initiated Therapeutic Drug Monitoring Consult Service for Children Treated with Gentamicin
Bibliographic record
Abstract
ABSTRACT Background: Starting in April 1988, the Pharmacy Department at The Hospital for Sick Children, Toronto, Ontario, provided a therapeutic drug monitoring (TDM) consult service for patients admitted to nursing units that did not have a clinical pharmacist as a member of the interdisciplinary team. This service was withdrawn on July 1, 2003. Objective: To determine the appropriateness of clinicians’ response to exceptional serum concentrations of gentamicin (peak concentration outside the range 5 to 10 mg/L or trough concentration outside the range 0.6 to 2 mg/L) and subsequent laboratory monitoring before and after termination of the pharmacist-initiated TDM consult service. Methods: A chart review was conducted for the 6 months before and 6 months after removal of the pharmacist-initiated TDM consult service. All children admitted to general surgery units who received gentamicin therapy and who were reported to have exceptional serum concentrations of this drug were included. The ideal gentamicin dose assessment was determined for each concentration pair (peak and trough), and this ideal assessment was then compared with the dose assessment actually performed. Laboratory tests ordered (serum concentrations of gentamicin and creatinine) were compared with the institution’s standard of care. Results: Clinicians’ action in response to exceptional serum gentamicin concentrations was appropriate in 99% (93/94) of cases before removal of the consult service and in 64% (64/100) of cases after removal of the service (p Conclusions: The appropriateness of assessment in cases of exceptional serum gentamicin concentration decreased significantly after withdrawal of a pharmacist-initiated TDM consult service. ABSTRACT Historique : En avril 1988, un service de consultation pour la surveillance pharmacocinetique des medicaments (SPM) a commence a etre offert par le service de pharmacie du Hospital for Sick Children, a Toronto en Ontario, pour les patients admis aux unites de soins qui n’avaient pas de pharmacien clinicien attitre au sein de leur equipe interdisciplinaire. Ce service a ete aboli le 1er juillet 2003. Objectif : Determiner la pertinence de la reaction des cliniciens face a des concentrations plasmatiques de gentamicine exceptionnelles (concentration maximale en dehors de la marge de 5 a 10 mg/L ou concentration minimale en dehors de la marge de 0,6 a 2 mg/L) et de la surveillance subsequente des examens de laboratoire avant et apres l’abolition de ce service de consultation pour la SPM assure par le pharmacien. Methodes : Une analyse des dossiers medicaux a ete menee dans les six mois precedant et suivant l’abolition du service de consultation pour la SPM assure par le pharmacien. Tous les enfants admis a une unite de chirurgie generale, ayant recu de la gentamicine et presentant des concentrations plasmatiques exceptionnelles de gentamicine ont ete admis a l’etude. L’evaluation ideale de la dose de gentamicine a ete determinee pour chaque paire de concentrations (maximale et minimale), puis comparee a l’evaluation reelle de la dose. Les examens de laboratoire demandes (concentrations plasmatiques de gentamicine et de creatinine) ont ete compares aux normes de soins de l’etablissement. Resultats : La reaction des cliniciens face a des concentrations plasmatiques exceptionnelles de gentamicine etait appropriee dans 99 % (93/94) des cas avant l’abolition du service de consultation, et dans 64 % (64/100) des cas apres l’abolition de ce service (p Conclusions : La pertinence de l’evaluation dans les cas de concentrations plasmatiques exceptionnelles de gentamicine a diminue significativement apres l’abolition du service de consultation pour la SPM par le pharmacien.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".