A <scp>PHARMacist</scp> led Initiative for the Management of Hydroxyurea Therapy in Pediatric Sickle Cell Anemia patients attending a Multidisciplinary Tertiary Hemoglobinopathy Clinic: A retrospective cohort study (<scp>PHARMIT‐SCA</scp>)
Bibliographic record
Abstract
Abstract Background The pharmacological treatment of choice for sickle cell anemia (SCA) is hydroxyurea (HU). The therapeutic effect of HU is believed to be dose‐dependent and titration to maximum tolerated dose (MTD) is the standard of care. Clinical pharmacists took an active role in managing HU therapy through patient assessment and prescribing as part of a multidisciplinary team in a pediatric Hemoglobinopathy Clinic. Objectives To identify the proportion of pediatric patients with SCA achieving MTD within 6 months of initiating HU therapy with traditional or pharmacist‐led management. Secondary objectives included quantifying and characterizing pharmacist interventions, and comparing the rate of dose change, dose assessments secondary to laboratory visits and number of acute care visits between cohorts in the 6 months post therapy initiation. Methods For this retrospective single center cohort study, 46 patients with SCA on treatment for six consecutive months between January 3, 2013 and February 28, 2019 were included and analyzed. Both groups were allocated 23 patients. Data were collected using electronic and paper medical records. SPSS version 25 was used for all statistical analyses. A P‐value <.05 was used for statistical significance. Results Mean HU dose at 6 months was significantly higher in the pharmacist cohort (19.1 vs 22.2, P = .038). No patients achieved MTD in either cohort. More acute care visits occurred in the traditional cohort (20 vs 6, P = .01), and dose assessments secondary to laboratory visits occurred more in the pharmacist cohort (1 vs 3 per patient, P = .002). Pharmacists completed 82 follow‐ups and 175 interventions. Most follow‐ups were by phone (53.7%) to assess HU therapy for dose assessments secondary to laboratory visits (58.5%). Thirty‐eight percent of pharmacist interventions were related to HU dose and medication adherence was assessed in 76.8% of follow‐ups. Conclusion Pharmacist‐led HU dose management resulted in a significantly higher mean dose of HU at 6 months, more frequent dose assessments secondary to laboratory work, and a reduced number of acute care visits.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 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, unvalidatedLabeled directly by 2 models reading the full record.
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".