Peter Jewesson - Academia.edu (original) (raw)

Papers by Peter Jewesson

In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the... more In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.

PubMed, Jul 1, 1993

Poor empiric dosing of aminoglycosides continues to be a problem in many hospitals. Consequently,... more Poor empiric dosing of aminoglycosides continues to be a problem in many hospitals. Consequently, a two-phase study was undertaken to evaluate gentamicin and tobramycin (G-T) dosing in our institution and to develop practical guidelines to achieve optimum initial G-T serum concentrations. In the pre-intervention phase (phase 1), approximately one-third of 232 G-T treatment courses were initiated with regimens that resulted in low initial serum concentrations. Empiric dosing guidelines were subsequently developed using Pharmacy Pharmacokinetic Service data and literature recommendations. They were validated with patients in phase 1. Compared with earlier dosing methods, the guidelines resulted in initial serum G-T concentrations within the therapeutic range in an equivalent proportion of patients. To simplify the procedure, recommended dosages were based on age, total weight, and serum creatinine only. The guidelines were tabular in format, and prescriber calculations were not required. Pocket and wall chart guidelines were distributed and promoted. During the post-intervention phase (phase 2), the impact of the guidelines was assessed. A review of 232 phase 1 and 203 phase 2 treatment courses revealed an increase in the initial mean dose per interval prescribed after the intervention (p < 0.01). No change in the mean interval was noted. When guidelines were followed, a higher proportion of treatment courses achieved early therapeutic serum concentrations (Cpmax 5-10 mg/L, 80% vs 54%; p < 0.005). The new empiric guidelines appear to be a practical alternative to existing methods of dosing aminoglycosides.

The Canadian journal of infectious diseases, 1995

PJ JEWESSON. Pharmaceutical, pharmacokinetic and other considerations for intravenous to oral ste... more PJ JEWESSON. Pharmaceutical, pharmacokinetic and other considerations for intravenous to oral stepdown therapy. Can J Infect Dis 1995;6(Suppl A):1 1A-16A. Parenteral to oral Lepdown therapy represents an effective cost containment strategy which can minimize intravenous therapy associated morbidity and may facil itate earlier hospital discharge. Several oral anti-infectives are available to the prescriber and there are as many opportunities to slepdown to the same agent as there are to other drugs of the same class or other classes. Recognition of the pharmacokinetic characteristics of U1ese oral agents is essential lo successful therapy. Good bioavailability may not always be assured. A simple regimen wi ll promote compliance.

Annals of Pharmacotherapy, Nov 1, 1995

To investigate the influence of infusion duration on infusion-related adverse effects (IRAEs) ass... more To investigate the influence of infusion duration on infusion-related adverse effects (IRAEs) associated with prophylactic or treatment regimens of amphotericin B in patients with leukemia/bone marrow transplant (BMT). Randomized, double-blind, 2-arm, complete crossover, prospective clinical trial. A university-affiliated tertiary care teaching hospital. The study population consisted of 25 consecutive patients with leukemia/BMT who received 162 prophylactic regimen infusions and 169 treatment regimen infusions of amphotericin B via a central line. Prior to each infusion all patients received a parenteral IRAE prophylaxis regimen of diphenhydramine 25 mg and hydrocortisone 25 mg. No test doses or incremental amphotericin B doses were administered. Patients were monitored closely for IRAEs, which were documented by using a standardized data collection form. The incidence and nature of IRAEs during a 6-hour monitoring period following the initiation of each infusion was measured. Patients served as their own controls. IRAEs were compared according to infusion duration and therapeutic indication. Three hundred and thirty-one 2- and 4-hour amphotericin B infusions were administered. We found no difference between 2- and 4-hour infusions in the incidence and severity of IRAEs, including overall events (29% of 166 2-hour infusions vs. 25% of 165 4-hour infusions), chill scores (8% of 166 2-hour infusions vs. 7% of 165 4-hour infusions; highest score 7 vs. 6), nausea and vomiting (7% vs. 12%; highest score 4 in both groups), fever (3% vs. 2%), highest temperature increase (2.4 vs. 1.6 degrees C), systolic hypotension (6% vs. 2%), greatest decrease from baseline (40 vs. 62 mm Hg), diastolic hypotension (5% vs. 3%), and greatest decrease (30 vs. 28 mm Hg) (p &amp;gt; 0.05). Overall, IRAEs were less common in prophylactic treatment regimens (35 events [22%] in 162 infusions) than in treatment regimens (55 events [32%] in 169 infusions) (p &amp;lt; 0.05). This study demonstrates that patients with leukemia/BMT without myocardial or renal dysfunction who receive hydrocortisone and diphenhydramine as premedications can tolerate 2-hour central line infusions of prophylactic or treatment regimens of amphotericin B as well as 4-hour infusions.

The Canadian Journal of Hospital Pharmacy, May 8, 2018

Journal of Clinical Microbiology, Oct 1, 1990

We evaluated the Cand-Tec (Ramco Laboratories Inc., Houston, Tex.) and LA-Candida antigen detecti... more We evaluated the Cand-Tec (Ramco Laboratories Inc., Houston, Tex.) and LA-Candida antigen detection system (Immuno-Mycologics Inc., Norman, Okla.) tests as possible rapid alternatives to blood cultures for the identification of patients with candidemia. Tests were performed on sera from (i) 33 patients with candidemia, (ii) 82 patients with fever and risk factors for invasive candidiasis, and (iii) 13 healthy controls. A total of 21 patients had no evidence of invasive candidiasis, as determined by clinical course, blood culture, and/or autopsy; results for 61 patients were indeterminate regarding the presence of invasive candidiasis, or else the patients had invasive candidiasis with organ involvement. By using a threshold positive Cand-Tec titer of '1:4, the sensitivity in candidemic patients was 49%; the specificity was 43% (patients with true-negative results had neither candidemia nor other evidence of invasive candidiasis). Coexistent disseminated candidiasis in some candidemic patients may have accounted for some positive Cand-Tec tests and possible overestimation of the sensitivity of the test for candidemia. Cand-Tec test results were negative for healthy controls. All test results obtained by the LA-Candida antigen detection system assay were negative. Our findings indicate that neither of these assays reliably identifies patients with candidemia.

Journal of Local and Global Health Science, 2015

IPE: Interprofessional Healthcare Education (IPE) competencies provide the criteria against which... more IPE: Interprofessional Healthcare Education (IPE) competencies provide the criteria against which to measure the capacity and capability of fully collaborative healthcare teams to learn and work together. Significant work already exists in the determination of IPE competencies across all disciplines. Although there is still a lack of agreement on a single set of shared core competencies, successive competency iterations enhance its development. IPE competencies need to take into account local and cultural contexts as recommended by WHO, (2010). Here we present a collaborative process that builds on existing competency development, assessing additional academic IPE needs. Core competencies: After the development of a set of shared core IPE competencies a two-day workshop was delivered to healthcare students from four professions. The results and feedback from students showed the value of the competencies. We discuss the evolving process through two major stages: (1) development of a model determining four shared core IPE domains, (2) the development and delivery of a set of IPE workshops explicitly and intentionally based on the model. This process is an example for the future development of IPE and IPP in any local setting. Results: Testing the developed IPE in specific workshops revealed that most clinical scenarios were on a similar standard but also showed a deficit in collaborative patient centered care, an aspect suggestive of deficient interprofessional contact and prioritization.

Canadian Medical Association journal, 1985

The recent release, relatively high cost and potential adverse effects of parenterally administer... more The recent release, relatively high cost and potential adverse effects of parenterally administered metronidazole prompted a quality-of-use audit at a 1000-bed teaching hospital. Ninety-two courses of treatment in 81 inpatients during a 6-week period were studied. Appropriateness of therapy was assessed on the basis of published indications. Parenterally administered metronidazole was prescribed primarily in anaerobic and anaerobic-aerobic infections. It was used as frequently for prophylaxis as for therapy. Surgical services accounted for 95% of the treatment courses. Inappropriate use was noted in 27 (29%) of the courses: agents other than parenterally administered metronidazole were indicated in 12 (13%), while the dose, dosing interval or duration of treatment was suboptimal in 15 (16%). Substantial savings would be achieved if oral or rectal metronidazole therapy were substituted for intravenous therapy for perioperative prophylaxis in elective colorectal surgery. Written justi...

Antimicrobial Agents and Chemotherapy, 1989

New fluoroquinolones have generally been well tolerated. In a double-blind evaluation of oral fle... more New fluoroquinolones have generally been well tolerated. In a double-blind evaluation of oral fleroxacin, using 400, 600, or 800 mg once daily for 7 days in an ambulatory setting for treatment of uncomplicated genital infections, we encountered unexpectedly high rates of adverse reactions. The objective of this analysis was to determine whether any factors in addition to dose could be found to account for our observations. Adverse reactions developed in 66 (84%) of 79 individuals, and severe reactions arose in 38 (48%). Most frequent were central nervous system reactions (70%), with insomnia being especially frequent (49%); gastrointestinal reactions (39%) and photosensitivity reactions (10%) were also common. Development of any reaction (central nervous system reactions, insomnia, and severe intestinal reactions) was dose related. Development of photosensitivity reactions correlated with an outdoor occupation. No other factors, including usual daily caffeine use, correlated with th...

Antimicrobial Agents and Chemotherapy, 1990

Teicoplanin is a glycopeptide antibiotic with a mode of action and spectrum of activity similar t... more Teicoplanin is a glycopeptide antibiotic with a mode of action and spectrum of activity similar to those of vancomycin. Its efficacy and tolerability as empiric therapy and its pharmacokinetic properties in neutropenic patients are being studied in a double-blinded, randomized trial in comparison with those of vancomycin. We report here a modified agar diffusion bioassay which is suitable for monitoring levels of either teicoplanin or vancomycin in serum during combination therapy with beta-lactams, aminoglycosides, and amphotericin B. Serum samples spiked with either teicoplanin or vancomycin gave reproducible results (mean coefficient of variation, 8.8%) regardless of the presence of tobramycin, amikacin, piperacillin, ceftazidime, amphotericin B, or their combinations. Among 25 patients who received teicoplanin at a dosing schedule of 6 mg/kg every 24 h intravenously, steady state was reached after 14.2 +/- 4.0 days, and 1-h peak and trough concentrations of teicoplanin in serum ...

Journal of Healthcare Leadership, 2011

To characterize the professional demographics, opinions about the medication use process, perceiv... more To characterize the professional demographics, opinions about the medication use process, perceived public satisfaction with pharmacy services, and professional satisfaction of pharmacists practicing in the state of Qatar. Materials and methods: The study was designed as a hypothesis-generating, online, anonymous, opinion survey of practicing pharmacists in Qatar. Results: Two hundred and sixty-four survey accesses were recorded during the 6-week study period, and 250 surveys containing responses to one or more questions were included in the analysis. Eighty-four percent of respondents reported graduating at least 5 years prior to the survey, and 86% held a baccalaureate degree in pharmacy as their highest degree. The most common source of the highest degree was one of five countries (Egypt, Jordan, India, Sudan, or Pakistan). Forty-five percent of respondents were working in a hospital setting, and 33% were in a community pharmacy. The lowest incidence of agreement across the 10 drug procurement and distribution process statements was observed for the adequacy of medication supplies statements (33% of all respondents). The highest incidence of agreement across the eight medication use process statements was for the statement pertaining to infrequent dispensing errors (68%), and the lowest incidence of agreement was observed for the statement pertaining to the adequacy of patient monitoring (30%). The pharmacist was chosen as the best candidate to resolve perceived unmet medication needs for four of eight statements, whereas physicians were most frequently chosen for three of the four remaining statements. Respondents' perceptions regarding patient satisfaction with the different elements of the medication use process revealed that the lowest incidence of agreement pertained to patients' satisfaction with the waiting time required to obtain their medications (35%). Forty percent of all respondents rated themselves as professionally dissatisfied. Improvements to their professional role, greater opportunities for professional development, and enhancements in human resource-related conditions were identified as potential remedies to this situation. Conclusion: This study represents the first known attempt to formally solicit the opinions of pharmacists in Qatar. The study results have provided valuable information regarding the demographic characteristics, pharmacist perceptions about the medication use process, and professional satisfaction of practicing pharmacists in the country. This information is being utilized to guide workforce planning, to help identify potential shortcomings in the health care system, and to better understand continuing education and professional satisfaction needs of Qatar's pharmacy practitioners. We encourage other countries to conduct similar surveys in order to better understand the characteristics, perceptions, and needs of their health care workers.

PubMed, Jun 1, 1989

To control aminoglycoside usage and costs, a two-stage intervention was implemented at this 1,000... more To control aminoglycoside usage and costs, a two-stage intervention was implemented at this 1,000-bed, major Canadian teaching hospital. An informational stage, reviewing the therapeutic equivalence of netilmicin, gentamicin, and tobramycin in various internal publications, was followed by an automatic therapeutic interchange program. The intervention involved removing netilmicin from the formulary and substituting gentamicin for tobramycin. Comparing the 8-week pre-implementation period with the 24-week, post-implementation period, new orders for netilmicin declined from 42% to less than 1% of the total new aminoglycoside courses initiated. During the same time frame, new orders for gentamicin increased from 50% to 90%, orders for tobramycin remained stable at approximately 5.5%, and orders for amikacin remained unchanged at 1%. A retrospective health record review revealed a low incidence of microbiologically inappropriate interchanges. Pharmacy manpower requirements were minimal and prescriber acceptance was high. A +27,000 cost savings per year was estimated.

Almost any infection that may be encountered in the nonpregnant individual can also occur during ... more Almost any infection that may be encountered in the nonpregnant individual can also occur during pregnancy. Pregnancy, however, influences both the frequency and nature of such infections. Some, such as bacteriuria and pyelonephritis, pose a particular threat to both mother and fetus. Others, such as syphilis and toxoplasmosis, may be relatively innocuous to the mother while resulting in high perinatal morbidity and mortality or congenital malformations. In contrast, certain infections such as cestodiasis (tapeworms) or giardiasis seldom pose any hazard either to the mother or fetus. In fact, the need for antimicrobial therapy in these latter instances is primarily determined by the safety and efficacy of available drugs.

Antimicrobial Agents and Chemotherapy, Nov 1, 1991

A prospective, randomized, and double-blind study comparing teicoplanin with vancomycin in the in... more A prospective, randomized, and double-blind study comparing teicoplanin with vancomycin in the initial management of febrile neutropenic patients was conducted. Teicoplanin was administered at 6 mg per kg of body weight every 24 h (q24h) intravenously (i.v.) after initial loading at 6 mg/kg ql2h for three doses. Vancomycin was administered at 15 mg/kg ql2h i.v. Patients also received piperacillin (3 g q4h i.v.) and tobramycin (1.5 to 2.0 mg/kg q8h i.v.). Of 53 patients enrolled, 50 were judged to be evaluable. Among these, 25 received teicoplanin and 25 received vancomycin. At enrollment, both groups were comparable in age, sex, renal function, underlying hematologic condition, and concurrent therapy. Both groups had similar sites of infection and microbial pathogens. Empirical antimicrobial therapy resulted in the cure of or improvement in 23 (92%) teicoplanin patients and 21 (84%) vancomycin patients (P = 0.67). Failures occurred with two vancomycin patients but no teicoplanin patients. Clinical response was indeterminate for two patients in each group. Adverse reactions occurred significantly more often in the vancomycin group than in the teicoplanin group (P = 0.01), and these reactions required the termination of the study regimens of 6 vancomycin versus

The Journal of Infectious Diseases, Nov 1, 1988

1. J Infect Dis. 1988 Nov;158(5):1142-3. Kinetics of intraventricular vancomycin in infections of... more 1. J Infect Dis. 1988 Nov;158(5):1142-3. Kinetics of intraventricular vancomycin in infections of cerebrospinal fluid shunts. Reesor C, Chow AW, Kureishi A, Jewesson PJ. PMID: 3183426 [PubMed - indexed for MEDLINE]. Publication Types: Case Reports; Letter. MeSH Terms: ...

Clinical Infectious Diseases, May 1, 1985

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, a... more JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact

Dicp-The annals of pharmacotherapy, Sep 1, 1988

PubMed, Nov 1, 1990

A two-stage intervention was undertaken to extend the dosing interval of metronidazole--from the ... more A two-stage intervention was undertaken to extend the dosing interval of metronidazole--from the typically prescribed q6h or q8h regimen to a q12h dosing interval. Following an 2-week informational period, all prescriptions for parenteral metronidazole specifying a dosage interval of 8 hours or less were modified to 12-hour dosage intervals, unless overridden by the prescriber. Prescriptions for the 6-month periods prior to and following the intervention were reviewed to assess its impact on prescribing patterns and cost containment. The incidence of regimens involving 12-hour intervals increased from 5 to 95% following the intervention. A 2-year general hospital/drug utilization health record screen found no drug substitution effect, nor any change in postoperative infection rate or death among metronidazole recipients. Overall, the two-stage intervention was a well-accepted and effective means of cost containment, resulting in an estimated yearly cost savings of $28,000.