Hilary M. Jasmin

Objective: To analyze practicing pharmacists' use of drug information (DI) resources in the United States. Methods: An electronic survey was distributed to practicing US pharmacists through professional organization email lists and social media. The survey questionnaire asked respondents which subscription-based DI resources are provided through their employer, whether they personally pay for additional resources, how often they use subscription-based resources, and other related questions. Results: The survey received 430 responses, 387 of which were able to be fully analyzed. The resources that respondents most frequently had access to through their employer were UpToDate (77.0%), Lexicomp (74.9%), and Micromedex (62.3%). Many respondents (40.8%) paid for subscriptions with personal funds, and 28.9% reported never experiencing access issues due to payment barriers. Respondents in community settings were more likely to have paid for resources with personal funds (57.1%, p<0.05) and have less access to resources (51.4%, p<0.05). In the open-text responses, the most desired resources were point-of-care tools (UpToDate) and DI databases (Lexicomp). Conclusions: US pharmacists experience a varied level of access to DI resources through their employer. Pharmacy educators should focus their instruction on resources that are the most accessible to practicing pharmacists. Many, especially community pharmacists, pay out of pocket for desired resources, presenting an opportunity to advocate for increased resources.

Introduction: Gallbladder agenesis (GA) is often misdiagnosed as a gallbladder pathology. This systematic review aimed to summarize the current evidence on epidemiology, clinical presentation, diagnostic approaches, and management strategies. Methods: PubMed/MEDLINE, Scopus, and Embase databases were comprehensively searched in English, French, and Spanish for GA cases published before November 2022. Two reviewers screened articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed to identify the clinical features, diagnostic approaches, management strategies, and associated factors. Results: A total of 9186 unique articles were screened, 125 of which met the inclusion criteria (151 cases in total). Most patients were female (66%), with a median age of 45 years. Most patients (73%) were diagnosed intraoperatively, and the most common presenting symptoms were right upper quadrant pain (66%), nausea (32%), or emesis (30%). Less than 15% of patients had elevated liver enzyme levels or leukocytosis. Ultrasonography was the primary imaging modality (81%). Most patients (79%) underwent operative management, with laparoscopy in 49.6% and exploratory laparotomy in 50.4%. Diagnosis by hepatobiliary iminodiacetic acid scan was associated with higher complications (odds ratio 8.53, 95% confidence interval 1.21–59.1, P = 0.026). There were more complications in the US cohort than in the non-US cohort (20% vs. 4.5%, P = 0.006). Conclusions: This systematic review showed that many patients with GA underwent unnecessary operative interventions with an associated increase in complications. Surgeons should be familiar with this diagnosis to minimize unnecessary interventions and reduce healthcare costs.