{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:57:38Z","timestamp":1790787458499,"version":"4.1.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative hypocalcemia is a common complication of total thyroidectomy. Due to a lack of standardized perioperative management protocols, there is often a wide variation in clinical practice, resulting in non-guideline conforming calcium and vitamin D analogue (NGC-CaVD) prescribing. This can lead to issues with patient safety and recovery. Objective To determine if a multi-faceted intervention could reduce NGC-CaVD after total thyroidectomy, assess safety outcomes, and identify factors associated with inappropriate prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational cohort study included 629 adults undergoing total thyroidectomy (322 pre-intervention, 307 post-intervention). The intervention bundle included: (1) developing an institutional guideline, (2) conducting staff education, (3) pharmacist-led medication reviews with structured recommendations, (4) medication reconciliation, and (5) collaborative rounds. The primary outcome was the rate of NGC-CaVD. Safety outcomes included the incidence of symptomatic hypocalcemia and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The multifaceted intervention significantly reduced the overall NGC-CaVD rate from 45.96% in the pre-intervention group to 23.45% in the post-intervention group (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). Results Improvements were also seen in specific areas: inappropriate calcium preparation selection (8.07%\n                      <jats:italic>versus<\/jats:italic>\n                      2.93%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), calcium dosage (23.91%\n                      <jats:italic>versus<\/jats:italic>\n                      11.73%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), vitamin D analogue dosage (30.75%\n                      <jats:italic>versus<\/jats:italic>\n                      6.84%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), and delayed IV to oral switch (4.97%\u20131.95%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.04). The per-group NGC-CaVD cost decreased from RMB 17.34 (IQR: 0, 19.56) to RMB 4.42 (IQR: 0, 0) (p &amp;lt; 0.01). The main barrier influencing NGC-CaVD was physician-related factors, including excessive concern for the risk of postoperative hypocalcemia. The rate of symptomatic hypocalcemia remained unchanged (6.83%\u20135.86%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.62) as did mean hospital stay (7.16 \u00b1 2.70 days vs. 7.21 \u00b1 2.65 days,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.75). Multivariable analysis identified that longer surgical times (adjusted OR: 1.012, 95% CI: 1.007\u20131.035,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.023) and longer lengths of stay (adjusted OR: 1.128, 95% CI: 1.008\u20131.262,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.036) were independent predictors of NGC-CaVD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The implementation of a multi-faceted intervention improved guideline adherence for postoperative prescribing of calcium and vitamin D analogues without affecting symptomatic hypocalcemia and length of stay. Additionally, the model provides a framework for the standardization of post-thyroidectomy hypocalcemia management and the improved appropriateness of medication prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1795773","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:51:09Z","timestamp":1773903069000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of a multifaceted intervention on reducing non-guideline-concordant prescribing of calcium and vitamin D analogues after total thyroidectomy"],"prefix":"10.3389","volume":"17","author":[{"given":"Yue","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizhi","family":"He","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1016\/j.amjsurg.2015.07.010","article-title":"A safe and effective protocol for management of post-thyroidectomy hypocalcemia","volume":"210","author":"Albuja-Cruz","year":"2015","journal-title":"Am. 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