bluuebunny/crossref_metadata_2025 huggingface dataset:
Restoring in‐stream habitat in urban catchments: Modify flow or the channel?
Authors: Anim Desmond O. , Fletcher Tim D. , Vietz Geoff J. , Pasternack Gregory B. , Burns Matthew J.
Published: October 2018

Urban streams have almost universally altered physical habitat conditions due to excess stormwater run‐off. This includes changes to in‐channel hydraulics and channel morphology. Restoration of in‐channel habitat has two main levers: address the hydrology or channel morphology. Both variables impact in‐stream habitat, but understanding the relative role of hydrologic and morphologic change remains a challenge. This study uses two‐dimensional hydraulic modelling to examine the relative roles of flow and channel morphology in setting hydraulic conditions. We investigated four test scenarios involving the combinations of urban versus natural hydrology and urban versus natural channel morphology. The analysis investigated three ecologically relevant hydraulics characteristics: bed mobilization, retentive habitat, and floodplain inundation, using Shields stress, shallow slow‐water habitat (SSWH) area, and floodplain inundation area hydraulic metrics, respectively. The results indicate substantial differences in hydraulic conditions between the two reaches. The urban reach showed increased bed mobility potential and SSWH availability plummeted as flow increased, whereas the natural channel showed a relatively stable bed with substantially more SSWH at most flows. Floodplain inundation frequency was low in the urban channel with decreased duration. Scenarios examined suggest that hydraulic conditions are highly sensitive to channel morphology relative to flow regime. This suggests that once channel form has been degraded, mitigating urbanization impacts on flow regime cannot maintain “natural” channel hydraulics. Management approaches therefore must protect channel morphology from change. Where the channel has already been fundamentally altered, opportunities for channel morphology rehabilitation need to be considered.
Early urine electrolyte patterns in patients with acute heart failure
Authors: Collins Sean P. , Jenkins Cathy A. , Baughman Adrienne , Miller Karen F. , Storrow Alan B. , Han Jin H. , Brown Nancy J. , Liu Dandan , Luther James M. , McNaughton Candace D. , Self Wesley H. , Peng Dungeng , Testani Jeffrey M. , Lindenfeld JoAnn
Published: October 2018

Aims

We conducted a prospective study of emergency department (ED) patients with acute heart failure (AHF) to determine if worsening HF (WHF) could be predicted based on urinary electrolytes during the first 1–2 h of ED care. Loop diuretics are standard therapy for AHF patients. A subset of patients hospitalized for AHF will develop a blunted natriuretic response to loop diuretics, termed diuretic resistance, which often leads to WHF. Early detection of diuretic resistance could facilitate escalation of therapy and prevention of WHF.

Methods and results

Patients were eligible if they had an ED AHF diagnosis, had not yet received intravenous diuretics, had a systolic blood pressure > 90 mmHg, and were not on dialysis. Urine electrolytes and urine output were collected at 1, 2, 4, and 6 h after diuretic administration. Worsening HF was defined as clinically persistent or WHF requiring escalation of diuretics or administration of intravenous vasoactives after the ED stay. Of the 61 patients who qualified in this pilot study, there were 10 (16.3%) patients who fulfilled our definition of WHF. At 1 h after diuretic administration, patients who developed WHF were more likely to have low urinary sodium (9.5 vs. 43.0 mmol; P < 0.001) and decreased urine sodium concentration (48 vs. 80 mmol/L; P = 0.004) than patients without WHF. All patients with WHF had a total urine sodium of <35.4 mmol at 1 h (100% sensitivity and 60% specificity).

Conclusions

One hour after diuretic administration, a urine sodium excretion of <35.4 mmol was highly suggestive of the development of WHF. These relationships require further testing to determine if early intervention with alternative agents can prevent WHF.
Mesoporogen‐Free Synthesis of High‐Silica Hierarchically Structured ZSM‐5 Zeolites and their Superior Performance for the Methanol‐to‐Propylene Reaction
Authors: Guo Hangle , Ge Tongguang , Lv Jian , Du Changlin , Zhou Jian , Liu Zhicheng , Hua Zile
Published: October 2018

A series of hierarchically structured ZSM‐5 zeolites (ZSM‐5 HSZs) with a Si/Al ratio of about 200 have been successfully synthesized in the absence of additional mesoporous agents. XRD, N2 sorption isotherms, SEM, TEM and NH3‐TPD results showed that the obtained HSZs materials possess high crystallinity, interconnected micro/mesoporous structures and similar total acid amounts. Meanwhile, in the methanol‐to‐propylene (MTP) reaction, compared to the microporous counterpart, all synthesized ZSM‐5 HSZs demonstrated superior performance benefitting from their hierarchical porous structures. Interestingly, 27Al MAS NMR and Py‐FTIR results confirmed the inter‐transformation of framework and extra‐framework Al species with the extension of materials crystallization duration and consequently the variation of materials surface acidity. As a result, the optimized catalyst achieved the highest initial propylene selectivity of 54.4 % and the longest catalyst lifetime (t90) of 175 h under the weight hourly space velocity (WHSV) of 1.0 g g–1 h–1. Moreover, a new “in situ alkali etching‐hydrothermal restoring“ mechanism has been proposed to elucidate the structural evolution of here reported high‐silica ZSM‐5 HSZs during the synthesis.
Solvent‐Free Encapsulation at High Pressure with Carboxylate‐Based MOFs
Authors: Monteagudo‐Olivan Rebeca , Paseta Lorena , Potier Grégory , López‐Ram‐de‐Viu Pilar , Coronas Joaquín
Published: October 2018

The solvent‐free encapsulation of caffeine and kojic acid was carried out in different carboxylate‐based MOFs [MIL‐53(Al), UiO‐66 and Mg‐MOF‐74] by high pressure (0.32 GPa) contact. This methodology enables fast and ecofriendly encapsulation and gives rise to additive@MOFs with physical and features equivalent to those of materials obtained by common liquid phase encapsulation processes. It could be applied to other host–guest systems, simplifying the procedures, reducing the use and waste of harmful chemicals, and approaching the conditions of interest in the industry. The characterization carried out by thermogravimetry, X‐ray diffraction, N2adsorption, and13C NMR provided information about the presence and conformation of the additives in the MOFs. The highest encapsulation values for caffeine (37 %) and kojic acid (32 %) were obtained with MIL‐53(Al).
Complete Hydrogen Production from Hydrazine Borane over Raney Ni Catalyst at Room Temperature
Authors: Zhang Shiliang , Yao Qilu , Li Qingyang , Feng Gang , Lu Zhang-Hui
Published: October 2018

The synthesis of noble‐metal‐free recyclable catalysts with prominent catalytic performance for the complete hydrogen production from hydrazine borane (N2H4BH3, HB) is of great significance in achieving a hydrogen economy‐based society. Herein, Raney Ni is synthesized using a rapidly quenched aluminum–nickel alloy under a typical alkali leaching condition and is used to catalytically convert hydrogen of N2H4BH3 to H2 via hydrolyzing BH3 groups and decomposing the N2H4 moiety in alkaline conditions. It is the first report of a noble‐metal‐free catalyst achieving a complete production of hydrogen from N2H4BH3 at room temperature. This noble‐metal‐free catalyst might tremendously broaden the actual utilization of HB as a promising chemical hydrogen storage material. In addition, such a simple strategy can also be expanded to design and synthesize other porous metals for more applications.
Sinuosity evolution along an incising channel: New insights from the Jordan River response to the Dead Sea level fall
Authors: Dente Elad , Lensky Nadav G. , Morin Efrat , Dunne Thomas , Enzel Yehouda
Published: October 2018

The geomorphic evolution of the Jordan River in recent decades indicates that interaction between incision and high‐magnitude floods controls sinuosity changes under increasing mouth gradients during base‐level fall. The evolution of the river was analyzed based on digital elevation models, remotely sensed imagery, hydrometric data, and a hydraulic model. The response varies along the river. Near the river mouth, where incision rate is high and a deep channel forms, overbank flooding is less likely. There, large floods exert high shear stress within the confined channel, increasing sinuosity. Upstream, near the migrating knickzone channel gradients also increase, incision is more moderate and floods continue to overtop the banks, favoring meander chute cutoffs. The resulting channel has a downstream well‐confined meandering segment and an upstream low‐sinuosity segment. These new insights regarding spatial differences along an incising channel can improve interpretations of the evolution of ancient planforms and floodplains that responded to base‐level decline. © 2018 John Wiley & Sons, Ltd.
Early (90‐day) mortality after radical radiotherapy for head and neck squamous cell carcinoma: A population‐based analysis
Authors: Hamilton Sarah Nicole , Tran Eric , Berthelet Eric , Wu Jonn , Olson Robert
Published: October 2018

Background

A retrospective, population‐based analysis of 90‐day mortality in patients with squamous cell carcinoma of the head and neck treated with radiotherapy was performed to determine the early mortality rate and associated risk factors.

Methods

Data were abstracted for all consecutive patients with cancer of the head and neck treated from 1998 to 2014 at the BC Cancer Agency with curative intent radiotherapy (n = 5658). Logistic regression analysis was used to determine factors associated with early mortality.

Results

The median age at diagnosis was 63 years. The mortality rate at 90 days after starting radiotherapy (RT) was 3.6% (n = 203/5658). The cause of death was attributed to head and neck cancer for 81% of patients. Multivariate analysis demonstrated that increasing age, oral cavity subsite, and advanced T and N classification were associated with an increased risk of early mortality (p < .05).

Conclusions

The risk of early mortality was 3.6%. Elderly patients with advanced T and N classification had the highest risk of early mortality.
The dynamics of national ICT ecosystems
Authors: Nguyen Simon Pettersen , Mahundi Masoud Hussein
Published: October 2018

The ICT ecosystem is a new and emerging concept which suggests that ICTs should not be viewed as technical systems in insolation, but rather as a part of a wider network that takes into account non‐technical dynamics, being socio‐economic, political, spatial, and such. Nguyen, Nielsen, and Sæbø (2017) have conceptualized thenational ICT ecosystemwhich adequately describes the socio‐technical components surrounding an ICT embedded within a country. However, their conceptualization is merely a static description of the ecosystems' components without sufficient description of their dynamics. Based on a case study of a health management information system and its surrounding ecosystem in Tanzania, we contribute by identifying three dynamics of national ICT ecosystems: (1) evolution occurring in small and incremental steps; (2) co‐adaption in the ecosystem following integrations between ICTs; and (3) ICTs being integrated due to perceived network effects.
Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial
Authors: Dehmer Steven P. , Maciosek Michael V. , Trower Nicole K. , Asche Stephen E. , Bergdall Anna R. , Nyboer Rachel A. , O'Connor Patrick J. , Pawloski Pamala A. , Sperl‐Hillen JoAnn M. , Green Beverly B. , Margolis Karen L.
Published: October 2018

Background

Pharmacist‐managed (team‐based) care for hypertension with home blood pressure monitoring support interventions has been widely studied and shown to be effective in improving rates of hypertension control and lowering blood pressure; however, few studies have evaluated the economic considerations related to bringing these programs into usual practice.

Objective

To analyze the economic outcomes of the Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (Hyperlink) study, a cluster randomized controlled trial which used home blood pressure telemonitoring and pharmacist case management to achieve better blood pressure control in patients with uncontrolled hypertension was conducted.

Methods

A prospective analysis compared differences in medical costs and encounters in the Hyperlink telemonitoring intervention and usual care groups in the 12 months pre‐ and postenrollment using medical and pharmacy insurance claims from a health care sector perspective. Generalized estimating equation models were used to estimate differences between the groups over time. These results, combined with previously published prospective study results on intervention costs and blood pressure outcomes, were used to estimate cost‐effectiveness measures for blood pressure control and reduction.

Findings

Total medical costs in the intervention group were lower compared with the usual care group by an average of $281 per person, but this difference was not statistically significant. Clinic‐based office visit, radiology, pharmacy and hospital costs were also nonsignificantly lower in the intervention group. Statistically significant differences were found in lipid‐related laboratory costs (higher) and in hypertension‐related (higher) and lipid‐related (lower) pharmacy costs. Patterns in medical costs were similar for medical encounters. On average, the intervention cost $7337 per person achieving hypertension control and $139 or $265 per mm Hg reduction in systolic or diastolic blood pressure, respectively.

Conclusions

Home blood pressure monitoring and pharmacist case management to improve hypertension care can be implemented without increasing, and potentially reducing, overall medical care costs.
Longitudinal trends in base antiretroviral therapy utilization for human immunodeficiency virus from 2000 to 2016
Authors: Magagnoli Joseph , Sutton S. Scott , Hardin James W. , Edun Babatunde
Published: October 2018

Objective

The aim of this retrospective, observational study was to describe utilization trends in the base antiretroviral therapy (ART) for management of human immunodeficiency virus in United States Veterans for the time period of 1998 to 2016.

Methods

The Veterans Affairs Informatics and Computing Infrastructure was accessed to obtain ART utilization trends among US Veterans using a national cohort of unique persons within the Department of Veterans Affairs between January 1998 and September 2016. Spaghetti plots of summary statistics were created to visualize the trends in ART across time. For each month, the percentage that each regimen or individual drug constitutes for each ART during that particular month was calculated.

Results

A total of 38 347 patients and 3 714 472 patient‐months were eligible for the study. ART base drug utilization patterns have undergone numerous changes over the past 18 years and the utilization patterns consistently coincided with treatment guideline updates. Among the specific ART regimens, the boosted protease inhibitor (PI) regimen had a total of 17 372 patients and 1 126 708 patient‐months; the integrease strand transfer inhibitors (ISTIs) regimen had 6666 patients and 197 265 patient‐months; the non‐nucleoside reverse transcriptase inhibitors regimen had 17 449 patients and 1 001 606 patient‐months; the PI regimen had 11 367 patients and 571 589 patient‐months; and the single tablet regimen had a total of 18 034 patients and 817 304 patient‐months.

Conclusion

Patients were initially managed in 1998 with multiple tablet regimens consisting of a base PI. Many changes to base ART utilization subsequently occurred over the next 18 years. Examples of changes include the advent of boosted therapy, once‐daily dosing, single tablet regimens, and ISTIs.
Precision drug dosing: A major opportunity for patients and pharmacists
Authors: Pearce Natalie F. , Giblin Erika M. , Buckthal Catherine , Ferrari Alana , Powell J. Robert , Cao Yanguang , Patterson J. Herbert
Published: October 2018

Precision medicine customizes drug treatment to an individual's disease and genetics in order to optimize therapeutic benefit and minimize risk. Surprisingly, drug dosing is generally not discussed as a component of precision medicine. Because dosing regimens are an independent factor modulating efficacy and toxicity, consideration should be given to the clinical significance of precision drug dosing (PDD) in patient care. Pharmacists routinely face dilemmas when they are asked for dosing recommendations for patients with characteristics that fall outside of those represented in the drug label (eg, morbid obesity, pregnancy, frailty, neonatal patients, or elderly patients). The necessary data and technology now exist to create and implement PDD software for high priority drug‐disease targets in order to assist pharmacists and prescribers in choosing the safest and most effective dose for every patient. Within 5 to 10 years, we believe this software will be available. This study discusses how pharmacists can participate in leading the implementation of these PDD tools to achieve effective and routine clinical use.
Creation of Experiential Education Honors to replace Dean's List in recognizing students for exemplary experiential achievement
Authors: Briceland Laurie L. , Rosa Sandra W. , Jablanski Cindy , Lubowski Teresa J.
Published: October 2018

Objective

To develop and implement an Experiential Education (EE) Honors policy designed to recognize excellence throughout introductory/advanced pharmacy practice experience (IPPE/APPE) sequences, as a replacement of Dean's List recognition of academic achievement during the Final Professional (P4) year. The created policy recognizes excellence in ≤10% of students during the APPE sequence predicated on preceptor APPE evaluation of communications, professionalism, and therapeutics knowledge inherent within the APPEs. The awardee selection criterion incorporates preceptor feedback/grades, faculty rubric‐graded work‐products, national poster presentation during P4, and previous IPPE distinctions. Disqualifications include academic integrity infractions, ≤B+ grades, and “Needs Improvement” student learning outcome/competency ratings.

Methods

Grade point averages (GPAs) of EE Honors awardees were compared with an equal number of graduating students in the same cohort who earned the highest GPAs to test the hypothesis that EE Honors awardees would be a different subset of graduates than those solely with high GPAs.

Results

EE Honors have been implemented for 5 years. Over the 5‐year collective, students who received EE Honors earned an average GPA of 3.41, which was lower than top GPA earners (an average GPA of 3.82 for a similar size cohort), demonstrating that the EE Honors awardees were a different subset of students than solely the top GPA earners.

Conclusions

The EE Honors Policy has replaced Dean's List to recognize exemplary performance in 10% of students during the EE sequences. Not surprisingly, due to the comprehensive nature of APPE evaluation which includes professionalism and communications skills, EE award winners were not necessarily the students with the highest GPAs, revealing a different subset of the student population who rises to the top when recognizing exemplary experiential performance.
Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients
Authors: Taber David J. , Gebregziabher Mulugeta , Posadas Aurora , Schaffner Caitlin , Egede Leonard E. , Baliga Prabhakar K.
Published: October 2018

Background

Health disparities in African‐American (AA) kidney transplant recipients compared with non‐AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity.

Objective

To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients.

Methods

Prospective, pharmacist‐led, technology‐aided, 6‐month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one‐year posttransplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent‐to‐treat analyses, with differences assessed between AA and non‐AA recipients.

Results

The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs end of study 68%, P = 0.054) and hemoglobin A1c (HgbA1c) <7% (baseline 33% vs end of study 47%, P = 0.061). African‐Americans demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, P = 0.026), which was not evident in non‐AAs (−0.13 mmHg per month, P = 0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, P = 0.003), which was similar within AAs (−0.11% per month, P = 0.004) and non‐AAs (−0.14% per month, P = 0.029). There were no changes in low‐density lipoproteins, triglycerides, or high‐density lipoproteins over the course of the study. Medication errors were significantly reduced and self‐reported medication adherence significantly improved over the course of the study.

Conclusion

These results demonstrate the potential efficacy of a pharmacist‐led, technology‐aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients (ClinicalTrials.gov NCT02763943).
Interprofessional education: Principles and application. An update from the American College of Clinical Pharmacy
Authors: Murphy John E. , Liles Anne Marie , Bingham Angela L. , Chamberlin Kevin W. , Dang Devra K. , Hill Lucas G. , Lee Mary , Leonard Alyson , Lodise Nicole M. , Rogers Elizabeth
Published: October 2018

Implementation of interprofessional education (IPE) across health care disciplines continues to anchor the coordination and integration of a multidisciplinary approach to clinical care. Since publication of the ACCP white paper on IPE in 2009, IPE has received increased attention among health care professional organizations and accrediting bodies and has been the focus of hundreds of new publications. Notable advances include the updated core competencies from the Interprofessional Education Collaborative (IPEC), the addition of 14 health care professional organizations representing many different health care professional disciplines to the original six that formed IPEC, and the increased attention given to IPE in the accrediting standards of many health care professions. The present white paper serves as an update to the 2009 ACCP white paper addressing IPE implementation, assessment, barriers, sample practices, and resources. It also proposes several efforts that ACCP could pursue to further promote and implement IPE.
Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patients
Authors: Heavner Mojdeh S. , Nguyen Nam K. , Knauert Melissa P. , Verceles Avelino , Pisani Margaret A. , Seung Hyunuk , Gonzales Jeffrey P.
Published: October 2018

Objectives

Sleep deprivation is associated with significant patient morbidity in the intensive care unit (ICU) and must be addressed through a systematic, interdisciplinary approach. The objectives of this study were to describe pharmacists' perceptions and practices regarding sleep in the ICU. We also assessed the prevalence and characteristics of systematic processes to promote sleep in ICU patients.

Methods

We administered an international, cross‐sectional survey to 1723 pharmacists via a member distribution list through the American College of Clinical Pharmacy Critical Care Practice and Research Network. The survey included questions about pharmacists' demographics, practice sites, and individual and site‐specific perceptions of sleep promotion practices.

Results

Two hundred fifty‐five (15%) pharmacists initiated the survey and 195 were completed and included for analysis. Respondents most commonly had less than 5 years of experience in ICU practice, completed a Critical Care Pharmacy Residency, and worked in a Medical or Surgical ICU. All participants responded that the assessment of sleep quality is important in the ICU. Most respondents reported that they recommend both non‐pharmacological (81%) and pharmacological (93%) interventions to optimize sleep in their ICU patients. Pharmacists reported most commonly recommending to adjust non‐sleep‐related medications to avoid nighttime administration (41.4%) and initiating melatonin receptor agonists (33.7%). A low number of respondents (9%) reported the presence of a sleep protocol in their ICU. Within this subset, 59% reported that less than half of their ICU patients actually receive the protocol and 41% indicated low protocol compliance.

Conclusions

Critical care pharmacists value sleep, and most recommend interventions to optimize sleep in their patients. However, sleep protocols in ICUs are uncommon, and overall protocol use and compliance are perceived to be low. Pharmacists can improve protocol use and compliance and potentially impact sleep, delirium incidence, or other ICU patient outcomes. This impact should be evaluated in future studies.
Psychosocial determinants of physician acceptance toward an antimicrobial stewardship program and its computerized decision support system in an acute care tertiary hospital
Authors: Chua Alvin Q. , Tang Sarah S. L. , Lee L. W. , Yii Daphne Y. C. , Kong S. T. , Lee Winnie , Chlebicki Maciej P. , Kwa Andrea L. H. , Lie Desiree A.
Published: October 2018

Objectives

Antimicrobial stewardship programs (ASPs) often employ multipronged strategies, including Computerized Decision Support Systems (CDSSs), to promote appropriate prescribing. Physicians are key determinants of program effectiveness, yet little is known about their attitudes towards these interventions. We aimed to explore hospital physicians' perceptions of and attitudes toward ASPs and CDSSs using a focus group discussion (FGD) approach.

Methods

We recruited physicians from one large tertiary teaching hospital where an ASP and CDSS were available, by purposive sampling and snowballing. Study participants were junior physicians (house officers and medical officers), and senior physicians (consultants who supervise the junior physicians and lead the clinical teams). FGDs for junior and senior physicians were conducted separately using the same question guide. FGDs were audio‐recorded and transcripts independently and systematically coded with subsequent adjudication. Major themes on facilitators and barriers to acceptance of ASPs were extracted. FGDs and coding occurred concurrently. Data analysis and interpretation were consistent with a grounded theory approach.

Results

Twenty‐nine junior and eight senior physicians participated in six and two FGDs, respectively. Theme saturation was achieved. Two themes reflected facilitators for ASP acceptance: (1) helpfulness of ASP strategies; and (2) ASP team members' proactive contact, both of which guided physician antibiotic prescribing. Four themes identified barriers: (1) the primary team's clinical judgment is of utmost importance; (2) the consultant makes the final decision; (3) lack of awareness of ASP strategies/CDSS; and (4) perceived complexity of the CDSS.

Conclusion

Communication, education, and medical hierarchy influence ASP acceptance by physicians. Future research is needed to identify best approaches to enhance collaboration between physicians and their ASP teams to enhance ASP/CDSS acceptance.
Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care
Authors: Borchert Jill S. , Phillips Jennifer , Thompson Bastin Melissa L. , Livingood Angela , Andersen Rebecca , Brasher Cynthia , Bright David , Fahmi‐Armanious Bassem , Leary Mary‐Haston , Lee James C.
Published: October 2018

Changes to the U.S. health care landscape have increased the focus on the quality and use of alternative payment models, with a growing focus on value. As health care costs continue to rise, clinical pharmacists will increasingly engage in roles to expand the breadth and depth of clinical services in providing comprehensive medication management (CMM) to improve patient outcomes. The roles of pharmacy technicians and other support personnel must evolve to meet the needs created by this practice change and allow pharmacists to focus their services on activities that use their expertise to improve medication outcomes. Support personnel, including pharmacy technicians, should be identified to assist with clinical pharmacy tasks on the basis of their skills. To ensure competence, support personnel should be adequately trained and (if applicable) certified. Moreover, support personnel should be optimally incorporated into appropriate components of the clinical pharmacist's process of care to expand the reach and depth of clinical pharmacy services. When supervised by the pharmacist or others as defined in state practice acts, support personnel may be able to assist in the clinical pharmacist's provision of CMM. Finally, research should be conducted and disseminated on the utility and outcomes achieved using support personnel in the clinical pharmacist's process of care.
Evaluation of a comprehensive, integrated, medical service‐based pharmacy practice model
Authors: Vest Tyler A. , Carrasquillo Michelle A. , Morbitzer Kathryn A. , Cruz Jennifer L. , Eckel Stephen F.
Published: October 2018

Purpose

Prior to 2008, the pharmacy practice model utilized by the University of North Carolina (UNC) Medical Center was a traditional central pharmacist and clinical specialist model. The department of pharmacy implemented a unique and innovative pharmacy practice model in 2008 organized around medical services. Through this medical service‐based model, all patients are now covered by a pharmacist. The objectives of this study were to evaluate the sustainability of the improvements associated with the medical service‐based pharmacy practice model at UNC Medical Center, which included pharmacist turnover, employee satisfaction and workforce engagement, resident and student involvement in patient care, and inpatient drug costs.

Methods

This retrospective analysis focused on data spanning fiscal year (FY) 2004 to 2016. Internal data reporting sources were analyzed to evaluate the outcomes of this practice model.

Results

In FY 2016, 67% of work groups were tier 1 (highest satisfaction tier) and 4% were tier 3 (lowest satisfaction tier) and inpatient pharmacist turnover rate was only 7% compared with a 17% hospital turnover rate. Prior to 2008, the average difference between actual and expected drug expenditures was $2.8 million per year, and post‐implementation, the average difference improved to $3.3 million per year. In FY 2017, the department had 35 residents, representing a 169% increase in number of residency positions available compared with FY 2008. In FY 2016, 134 months of early immersion experiences were offered, 29 months of Introductory Pharmacy Practice Experiences (IPPEs), and 417 months of Advanced Pharmacy Practice Experiences (APPEs), which represents a 263% increase in IPPE months and a 369% increase in APPE months from FY 2008.

Conclusion

This practice model, along with other factors, has had a continued sustained positive impact on employee engagement, inpatient drug costs, and patient care in our health system. In addition, this practice model is organized around pharmacist responsibilities that support continued growth of pharmacy learners.
Assessment of clinical productivity tracking via reporting of quality patient indicators
Authors: Stover Kayla R. , Ballou Jordan M. , Liles Anne M. , Fleming Laurie W. , Fleming Joshua W. , Riche Daniel M. , Pitcock James J. , King S. Travis , Capino Amanda C.
Published: October 2018

Introduction

As the role of pharmacists in providing direct patient care continues to expand, the need for and interest in a method for assessing and measuring clinical productivity is becoming more paramount. Unfortunately, there is no consensus on how, when, and which quality indicators or clinical productivity measures should be collected. The primary objective of this study was to assess the landscape of clinical productivity tracking across practice sites.

Methods

A 13‐item Qualtrics questionnaire was administered through email lists from several national pharmacy organizations in the Spring of 2018. There were eight items related to quality indicators or clinical productivity measures. The information gathered included the type of indicator/measure collected, how it was collected, and perceived benefits and barriers. The remaining five items were basic demographic questions.

Results

A total of 349 participants responded, with 231 reporting that they currently track some type of patient quality indicator. Of these, 166 reported collecting a total of 903 indicators or measures using a variety of tracking systems. The most frequently reported measures collected were the number of patients seen and the type of recommendation or intervention made. The most cited reason for collecting these data was to demonstrate the impact to a practice site. The time required to collect data and the limitations of data collection systems were the two most frequently cited perceived barriers to collecting information.

Conclusions

A majority of respondents are collecting some form of quality indicator or clinical productivity measure. However, there is extensive variety in the exact indicators or measures being collected and the tracking systems being utilized for their collection. Although implementation would be difficult, a more standardized approach to tracking clinical productivity may be beneficial.
Interventions associated with implementation of a pharmacist‐led neurology pharmacotherapy clinic in an ambulatory care setting
Authors: Martin Alison W. , Heberle Anna P. , Knight Joshua M.
Published: October 2018

Objectives

Medication management of neurologic disorders can present challenges in an ambulatory care setting. Clinical pharmacy specialists (CPSs) may be uniquely positioned to assist with the medication adjustments and monitoring that is often necessary for these conditions. While pharmacist‐led clinics are well established in some areas of ambulatory care, few examples have been described within neurology. This project aims to describe the interventions associated with a pharmacist‐led neurology clinic within a Veterans Affairs (VA) Medical Center.

Methods

A pharmacist‐led neurology clinic was implemented to assist with medication management of various neurologic conditions and increase access to the neurology service. This retrospective chart review included patients referred to the CPS clinic during a 6‐month period, with a minimum follow‐up of 3 months. The number of medication changes, nonpharmacologic interventions, and adverse drug events (ADEs) managed by the CPS was determined. The number of interim pharmacist‐led visits was used as an estimate of neurology provider time saved.

Results

One hundred sixty‐four patients were included in the analyses. During the 9‐month period assessed, patients had a total of 307 visits in the pharmacist‐led neurology clinic. Patients were referred for multiple neurologic conditions, with headache, neuropathy, Parkinson's disease, non‐Parkinson's tremor, and seizure disorders being the most common. The CPS made 175 dose adjustments, 139 medication additions or discontinuations, and 135 nonpharmacologic interventions. In addition, 41 ADEs were identified and/or managed during CPS encounters. Patients had an average of two visits with the CPS in between scheduled neurology clinic appointments; this allowed for an estimated 34 appointment slots/month to remain open in the neurology provider clinics.

Conclusions

The implementation of a pharmacist‐led neurology clinic allowed for CPS management of medications for multiple neurologic conditions, including the management of ADEs, and increased access to the neurology ambulatory care service at this VA facility.
Cost‐consequence analysis evaluating multifaceted clinical pharmacist intervention targeting patient transitions of care from hospital to primary care
Authors: Rasmussen Maja Kjær , Ravn‐Nielsen Lene Vestergaard , Duckert Marie‐Louise , Lund Mia Lolk , Henriksen Jolene Pilegaard , Nielsen Michelle Lyndgaard , Eriksen Christina Skovsende , Buck Thomas Croft , Hansen Morten Rix , Pottegård Anton , Hallas Jesper , Kidholm Kristian
Published: October 2018

Aims

Drug‐related problems are a common complication in the transition from hospital to primary care and are associated with morbidity and increased health care costs. In this study, we evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, comprised of a medication review and patient interview before discharge and follow‐up for polypharmacy patients.

Methods

This economic evaluation was embedded within a randomized clinical trial. Patients were randomized to either the basic intervention group (n = 493) which received a medication review, the extended intervention group (n = 476) which received a medication review, discharge interview, and follow‐up, or the control group (n = 498) which received standard care. Total health care costs were estimated over a period of 180 days at individual patient level from a health sector perspective.

Results

The mean cost per patient was lower in the intervention groups (basic, €16 748; extended, €15 631) compared with the control group (€17 288), although these differences did not reach statistical significance. The costs of additional time used on medication reviews, patient interviews, and follow‐ups (€88) were outweighed by a decrease in costs of readmissions. The results of the clinical study favored the extended intervention group on clinical outcomes, with statistical significance on a composite of readmissions or emergency department visits within 180 days after inclusion (hazard ratio 0.77, 95% confidence interval 0.64‐0.93).

Conclusions

This comprehensive pharmaceutical intervention was not costly and positive effects were seen in the clinical outcomes, thereby reaching a decrease in total cost per patient on average. The results thus indicate that the intervention is cost‐effective and that the positive net effects can justify costs of the intervention.
Describing education management and perceptions in health‐system pharmacy: A survey of medical institutions
Authors: Tester Carson S. , Wolcott Michael D.
Published: October 2018

Purpose

To describe current pharmacy education organizational structures and perceptions in medical institutions in order to inform education management practices and prompt greater discussion about strategies to optimize workforce development and patient care.

Methods

Two surveys were created and distributed to collect information from key personnel involved in educational management at medical institutions across the nation. The education management survey was distributed to residency program directors and requested participants to define their current organizational structure around and resources for education. The education perceptions survey was distributed to health‐system pharmacy personnel and requested participants to describe their perceptions and needs about current education programs and management strategies used in their respective institution.

Results

Sixty participants from primarily large academic medical institutions (88%) completed the education management survey (37% response rate). Only 27 (45%) institutions were reported to have an individual responsible for education program oversight and 20 (33%) institutions have an education committee. Participants identified that a significant gap remains in resources available for preceptor development, technician continuing education, and conducting research in health‐system pharmacy. The education perceptions survey was completed by 107 participants from 31 institutions; most participants felt their institutional education structure was “above average” (33%) or “average” (45%).

Conclusion

The findings from this study suggest education management in a sample of institutions is variable and in need of greater attention. Institutions are encouraged to commit to refining pharmacy education management models to support lifelong learning practices that are integral for organizational success and advancing the profession.
An asymmetrical dual coating on the stent prepared by ultrasonic atomization
Authors: Wang Jingjing , Ren Yuzhen , Huang Yuhua , Du Ruolin , Xi Yadong , Yin Tieying , Wang Yazhou , Zhang Dechuan , Chen Jinju , Wang Guixue
Published: October 2018

This study aims to design an asymmetric dual coating (ADC) on the stent by ultrasonic atomization to solve the problem of delayed endothelialization and late or very late stent thrombosis which caused by drug eluting stent (DES) with symmetric coating. Chitosan‐loaded monoclonal platelet glycoprotein IIIa receptor antibody SZ‐21 coating (CSC) was sprayed on inner surface of stents, and outer surface was sprayed CSC and poly(lactic‐co‐glycolic acid) (PLGA) loaded with docetaxel (DTX) coating (PDC). The coated surface was uniform without aggregation and no shedding phenomenon either before or after stent expanded. Fluorescence labeling has confirmed that the coating has an asymmetric structure. The cumulative release for SZ‐21 and DTX was 40.11% and 27.22% within first 24 h, then DTX became the major released drug from 24 h to 7 d, after released for 28 d about 40% of the SZ‐21 and 50% DTX still remained on the coated stent. It achieved that ADC can inhibit thrombosis at earlier period and inhibit vascular smooth muscle cells (VSMCs) proliferation at later period. And that ADC has good hemocompatibility and can significantly inhibit VSMCs proliferation. Finally, 4 and 12 weeks after the stent with ADC implanted into rabbit carotid arteries, it showed that the stent with ADC was safe and could effectively prevent thrombosis and in‐stent restenosis. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 825–837, 2019.
Study on bone quality in the human mandible—Alignment of biological apatite crystallites
Authors: Furukawa Takehiro , Matsunaga Satoru , Morioka Toshiyuki , Nakano Takayoshi , Abe Shinichi , Yoshinari Masao , Yajima Yasutomo
Published: October 2018

The importance of considering bone quality during oral implant treatment is increasingly being recognized. Assessment of bone quality in response to changes in the jaw bone is extremely important when planning treatment. The present study analyzed biological apatite (BAp) crystallites, a bone quality factor, in order to investigate crystallographic anisotropy in dentate and edentulous human mandibles. Using mandibular samples from Japanese adult cadavers, a region of interest was established comprising cortical bone in the central incisors. Samples were classified into five morphological categories based on the extent of bone resorption. Bone mineral density (BMD) was measured and diffraction intensity ratios were calculated using a microbeam X‐ray diffraction system. While no differences were observed in BMD, differences were observed in BAp crystallite alignment between the measurement points. In the alveolar region, samples with residual alveolar bone showed strong alignment in the occlusal direction, while samples with marked alveolar bone resorption had preferential alignment in the mesiodistal direction. The present findings suggest that tooth loss and the extent of alveolar bone resorption affects bone quality in the mandible. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B: 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 838–846, 2019.
Large scale segmental bone defect healing through the combined delivery of VEGF and BMP‐2 from biofunctionalized cortical allografts
Authors: Sharmin Farzana , O'Sullivan Michael , Malinowski Seth , Lieberman Jay R. , Khan Yusuf
Published: October 2018

Large scale cortical allografts suffer from poor incorporation and healing and often end in graft failure 5–10 years after implantation. To reduce these failures we have developed a growth‐factor loaded cortical allograft capable of delivering one or two factors with a degree of temporal control and precision that permits the early release of one growth factor followed by the later and more sustained release of the other. We have loaded vascular endothelial growth factor (VEGF) and bone morphogenetic protein‐2 (BMP‐2), both critical components of bone formation and repair, onto cortical long bone allografts such that the VEGF is released first and followed shortly by BMP‐2. Coated and factor‐loaded allografts were placed into a critical sized rat femoral segmental defect and allowed to heal for either 4 or 8 weeks. Healing at each time point was compared to allografts loaded with only BMP‐2 and allografts containing no growth factors. Results indicate statistically significant increases in new bone formation from 4 to 8 weeks around allografts loaded with both VEGF and BMP‐2 over allografts with no growth factor, suggesting that factor‐loaded polymer‐coated allografts delivering multiple factors with temporal precision may provide a new off‐the‐shelf tool to the orthopedic surgeon for management of large‐scale orthopedic bone defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1002–1010, 2019.
In vitro remineralization of artificial enamel caries with resin composites containing calcium phosphate particles
Authors: Alania Yvette , Natale Livia C. , Nesadal Douglas , Vilela Handially , Magalhães Ana C. , Braga Roberto R.
Published: October 2018

The aim of the study was to evaluate the effect of experimental composites containing dicalcium phosphate dihydrate (DCPD) on remineralization of enamel lesions. Five resin‐based composites containing equal parts (in mols) of bisphenol‐A glycidyl dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA), and 60 vol % of fillers were manipulated. Filler phase was constituted by silanized barium glass and 0, 10, or 20 vol % of DPCD particles, either functionalized (F) or nonfunctionalized (NF) with TEGDMA. Artificial subsurface lesions were produced in human enamel fragments and divided according to the resin composite applied on the lesion (no DCPD, 20% NF, 20% F, 10% NF, 10% F) plus a group without composite build‐up (nontreated, NT). Fragments were exposed to 16 days of pH cycling. Specimens were evaluated using transverse microradiography (TMR). Calcium and phosphate concentrations in pH‐cycling solutions were determined by spectrophotometry. TMR and ionic concentrations were analyzed using one‐way ANOVA/Tukey and Kruskal–Wallis/Dunn test, respectively (alpha: 0.05). All composite groups showed enamel remineralization (3%–23%). Higher mineral recovery in the middle (7%–11%) and bottom (2%–7%) thirds of the lesion was observed in groups with DCPD‐containing composites compared to the “no DCPD” group (middle: 1%, bottom: −3%). Lesion depth was significantly reduced in groups using DCPD‐containing composites compared to NT group. No noticeable increase in calcium and phosphate ions was observed in the pH‐cycling solutions due to the presence of DCPD in the composites. In conclusion, composites with DCPD fractions as low as 10%, regardless of functionalization, were able to promote mineral recovery and reduce lesion depth of enamel lesions. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1542–1550, 2019.