bluuebunny/crossref_metadata_2025 huggingface dataset:
Hebb-Based Rules of Neural Plasticity
Authors: Favero Morgana , Cangiano Alberto , Busetto Giuseppe
Published: June 2013

Neuronal death and suppression of functional synaptic inputs are well-known regressive events characterizing PNS and CNS development. In the CNS, participation of activity in synapse elimination has been known ever since the pioneering studies of Hubel and Wiesel, but only recently has a Hebb-based mechanism of spike synchrony versus asynchrony received unequivocal experimental support in the visual system. At the neuromuscular junction (NMJ), where synapse elimination was discovered, the specific function of the “timing of activity” was addressed by only one group of studies and did not receive widespread attention. Here we critically review the latest NMJ investigation advocating an “activity-independent” mechanism for synapse elimination and contrast it with an equally recent study demonstrating a key role for spike timing. Finally, we highlight how the striking similarities between the two mentioned studies on spike timing (visual system and NMJ) establish conclusively its role in the development of the nervous system in general.
Oral Anticoagulation Therapy for Elderly Patients With Atrial Fibrillation
Authors: Forman Daniel E. , Goyette Richert E.
Published: June 2013

Elderly individuals are prone to nonvalvular atrial fibrillation (AF) with associated risks of arterial thromboembolic disease. Despite definitive guidelines, oral anticoagulant therapy (OAC) is notoriously underutilized in patients with AF. Physicians cite excessive bleeding risk as one reason they omit OAC for their older patients with AF. Improved understanding of the pathophysiology of age-related bleeding may improve risk–benefit assessments for warfarin and newer antithrombotic agents. We reviewed the literature to identify age-related pathophysiological elements that can exacerbate the likelihood of bleeding. In the context of the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly (HAS-BLED) bleeding risk framework, we highlight age-related physiological dynamics that predispose to hemorrhage. The combination of increased age (>65 years) with the other elements of the risk factor stratification model identifies patients with AF who are especially susceptible to OAC-related bleeding, irrespective of the agent used. Empirically adjusting OAC dose relative to these common bleeding risks may help to achieve an improved risk–benefit therapeutic ratio.
Prognostic Value of the Neutrophil–Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction
Authors: Gazi Emine , Bayram Basak , Gazi Sabri , Temiz Ahmet , Kirilmaz Bahadir , Altun Burak , Barutcu Ahmet
Published: June 2013

The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil–lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P < .001). An N/L ratio >5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation.
Walk and Be Moved
Authors: Knudsen Brian B. , Clark Terry N.
Published: June 2013

Recent scholarship recognizes the city’s role as “civitas”—a “space of active democratic citizenship” and “full human realization” based on open and free encounter and exchange with difference. The current research emerges from and fills a need within this perspective by examining how local urban contexts undergird and bolster social movement organizations (SMOs). Our theory elaborates and linear regressions assess the relationships between four urban form variables and SMOs. In addition, our theory also examines how urban walking mediates the relationships between these local contextual traits and SMOs. Drawing primarily from the ZIP Code Business Patterns and U.S. Census, we generate a data set of approximately 30,000 cases, permitting regression analyses that distinguish strong direct effects of density, connectivity, housing age diversity, and walking on the incidence of SMOs. Sobel tests indicate that for density and connectivity, walking mediates the relationships with SMOs in a way consistent with the mechanisms of the hypotheses.
Effects of cold storage and 1-methylcyclopropene treatments on ripening and cell wall degrading in rabbiteye blueberry (Vaccinium ashei) fruit
Authors: Deng Jia , Shi Zhengjun , Li Xianzhong , Liu Huimin
Published: June 2013

The effect of postharvest 1-methylcyclopropene and/or cold storage application on texture quality parameters during storage was determined. The changes in fruit quality (including weight loss, firmness, total soluble solids content, and ethylene production), cell wall material (including water-soluble fraction, ethylenediaminetetraacetic acid-soluble fraction, Na2CO3-soluble fraction, 4% KOH-soluble fraction, and 14% KOH-soluble fraction), and cell wall hydrolase activities (including polygalacturonase, endo-1,4 -β-d-glucanase, pectinesterase, α-l-arabinofuranosidase, and β-galactosidase) were periodically measured up to 25 days after postharvest treatments. The application of cold storage reduced weight loss, ethylene production, and delayed ripening of blueberry fruit. The inhibition of senescence was associated with suppressed increase in cell wall hydrolase activities and retarded solubilization of pectins and hemicelluloses. Furthermore, no obvious differences in firmness, weight loss, ethylene production, and cell wall hydrolase activities between fruits with or without 1-methylcyclopropene application were observed, while significant lower levels of the detected parameters were found in cold storage fruit compared with fruit stored in room temperature. Thus, cold storage can be viewed as an effective means to extend the shelf life of blueberry fruit.
Rheological properties of rice–blackgram batter while replacing white rice with brown rice
Authors: Manickavasagan Annamalai , Al-Marhubi Insaaf Mohd , Dev Satyanarayan
Published: June 2013

Rice–blackgram batter is a raw material for many traditional convenience foods in Asia. Reformulation of traditional convenience food by replacing white rice with whole rice (brown rice) is a novel method to reduce the consumption of refined grain and increase the intake of whole grain in our diet. In this study, rheological properties of rice–blackgram batter was investigated while replacing white rice with brown rice at five levels (T1 – 0% replacement (control), T2 – 25% replacement, T3 – 50% replacement, T4 – 75% replacement, and T5 – 100% replacement). The shear stress versus shear rate plot indicates that the rice–blackgram batter exhibited non-Newtonian fluid behavior (shear thinning property) even after 100% replacement of white rice with brown rice. The rheological characteristics of rice–blackgram batters fitted reasonably well in Cassan ( r2 = 0.8521–0.9856) and power law ( r2 = 0.8042–0.9823) models. Brown rice replacement at all levels did not affect the flow behavior index, yield stress, consistency coefficient, and apparent viscosity of batter at 25 ℃. However, at higher temperature, the viscosity was greater for T4 and T5 (no difference between them) than T1, T2, and T3 (no difference between them) batters. Further research is required to determine the sensory attributes and acceptability of the cooked products with brown rice-blended batter.
Effects of different fermentation methods on bacterial cellulose and acid production by Gluconacetobacter xylinus in Cantonese-style rice vinegar
Authors: Fu Liang , Chen Siqian , Yi Jiulong , Hou Zongxia
Published: June 2013

A strain of acidogenic bacterium was isolated from the fermentation liquid of Cantonese-style rice vinegar produced by traditional surface fermentation. 16S rDNA identification confirmed the bacterium as Gluconacetobacter xylinus, which synthesizes bacterial cellulose, and the acid productivity of the strain was investigated. In the study, the effects of the membrane integrity and the comparison of the air–liquid interface membrane with immerged membrane on total acidity, cellulose production, alcohol dehydrogenase (ADH) activity and number of bacteria were investigated. The cellulose membrane and the bacteria were observed under SEM for discussing their relationship. The correlations between oxygen consumption and total acid production rate were compared in surface and shake flask fermentation. The results showed the average acid productivity of the strain was 0.02 g/(100 mL/h), and the integrity of cellulose membrane in surface fermentation had an important effect on total acidity and cellulose production. With a higher membrane integrity, the total acidity after 144 h of fermentation was 3.75 g/100 mL, and the cellulose production was 1.71 g/100 mL after 360 h of fermentation. However, when the membrane was crushed by mechanical force, the total acidity and the cellulose production were as low as 0.36 g/100 mL and 0.14 g/100 mL, respectively. When the cellulose membrane was forced under the surface of fermentation liquid, the total acid production rate was extremely low, but the activity of ADH in the cellulose membrane was basically the same with the one above the liquid surface. The bacteria were mainly distributed in the cellulose membrane during the fermentation. The bacterial counts in surface fermentation were more than in the shake flask fermentation and G. xylinus consumed the substrate faster in surface fermentation than in shake flask fermentation. The oxygen consumption rate and total acid production rate of surface fermentation were respectively 26.13 times and 2.92 times that of shake flask fermentation.
Characterization of wami tilapia (Oreochromis urolepis hornorum) skin gelatin: microbiological, rheological and structural properties
Authors: da Trindade Alfaro Alexandre , Fonseca Gustavo Graciano , Balbinot Evellin , Prentice Carlos
Published: June 2013

Gelatin was extracted from the skin of tilapia ( Oreochromis urolepis hornorum) and its microbiological, rheological and structural properties were characterized. The tilapia skin gelatin presented typical molecular weight distribution of type I collagen with contents of imino acids (proline + hydroxyproline) of 21.67%. Gel strength and viscosity values were 221 ± 5.68 g and 5.98 ± 0.34 cP, respectively, with the maturation time of 18 ± 1 h, and both parameters increased with the maturation time. Melting and gelling points of 25 ℃ and 21 ℃, respectively, were obtained for tilapia skin gelatin. The gelatin presented microbiological standards in accordance with the Brazilian Legislation.
The effect of high pressure at subzero temperature on proteins solubility, drip loss and texture of fish (cod and salmon) and mammal’s (pork and beef) meat
Authors: Malinowska-Pańczyk Edyta , Walecka Marta , Pawłowicz Roman , Tylingo Robert , Kołodziejska Ilona
Published: June 2013

One of the possibilities of using high-pressure technique in inactivation of microorganism is conducting this process at subzero temperature. However, for its practical application in meat preservation the appropriate properties of meat should be maintained. Therefore, the aim of this work was to examine the effect of pressure at subzero temperature (without freezing of water) on proteins and texture of mammal’s and cold-adapted fish meat. The data showed that cod and salmon meat proteins were more susceptible to pressure-induced denaturation/aggregation than beef and pork proteins. Glucose and saccharose exerted protective effect on fish meat proteins treated with pressure of 111 MPatc and −10 ℃ but not at 193 MPatc and −20 ℃. The pressure treatment under the latter conditions increased cook loss of fish meat but not of mammal’s meat. However, after cooking the hardness of all kinds of pressurized meat was at the same level as that for unpressurized cooked samples.
Influence of malting conditions on sorghum (Sorghum bicolor (L.) Moench) as a raw material for fermented beverages
Authors: Hassani Ahmed , Zarnkow Martin , Becker Thomas
Published: June 2013

There has been recently increased interest in sorghum to substitute the gluten containing cereals in the diet of people suffering from celiac disease. The response surface methodology was used to determine the influence of malting parameters (degree of steeping, germination temperature and time) on sorghum ( Sorghum bicolor (L.) Moench). Each parameter was varied at three levels. Malting attributes, considered important to produce high quality malt for the production of lactic acid fermented beverages, were analyzed. The optimized conditions were: degree of steeping 41%, germination temperature 27℃ after 7 days of germination. Under these conditions, the following values of the studied attributes can be obtained: α-amylase 139 U/g, β-amylase 60 U/g, extract 83.8%, free amino nitrogen 117.8 mg/100 g, Kolbach index 26.6%, water-extractable arabinoxylan 0.3 g/L and vitamin B2 114.9 µg/L. Among the tested parameters, the germination time had the highest effect on malting attributes. Although the activity of amylolytic enzymes α- and β-amylase were low, the value of extract was high and comparable to that of barley malt. The obtained results showed that sorghum malt is a promising raw material for the production of lactic acid fermented beverages.
Feature-based analysis of large-scale spatio-temporal sensor data on hybrid architectures
Authors: Saltz Joel H. , Teodoro George , Pan Tony , Cooper Lee A.D. , Kong Jun , Klasky Scott , Kurc Tahsin M.
Published: June 2013

The analysis of large sensor datasets for structural and functional features has applications in many domains, including weather and climate modeling, characterization of subsurface reservoirs, and biomedicine. The vast amount of data obtained from state-of-the-art sensors and the computational cost of analysis operations create a barrier to such analyses. In this paper, we describe middleware system support to take advantage of large clusters of hybrid CPU–GPU nodes to address the data and compute-intensive requirements of feature-based analyses of large spatio-temporal datasets.
What place references can do in social research interviews
Authors: Myers Greg , Lampropoulou Sofia
Published: June 2013

Place is central to many research projects in the social sciences, but it is often taken by researchers as a given. Recently, discourse analysts have devoted more attention to the construction of place in interaction. We focus on one aspect of this construction, the process of drawing inferences from place categories and place names, in transcripts of oral history interviews. We apply membership categorization analysis (MCA) to descriptions of house types and houses, showing how some categories are presented as being shared and recognizable, and how inferences are projected. Then we apply a similar approach to the ways inferences are drawn from place names, focusing especially on proximity. Participants’ categories can be investigated by examining the ways they are used in question–answer pairs, and in the construction of turns using elaborations, contrasting pairs, negatives and qualifications. This analysis shows the work these place references do for the participants, for instance, in categorizing themselves and others and giving accounts for behaviour.
Soul Work
Authors: Ashby Sjon F.
Published: June 2013

English teachers encourage writing that opens college students to transformative learning through soul work as John Dirkx describes and develops the concept of soul work in his theory of transformative learning. This soul work involves the conscious attempt to bring to the surface myths, images, and metaphors from the unconscious through imaginative writing and thinking processes. Participants in this study engage in personal interviews through which they answer questions about the activities most useful for soul work inside their classrooms and the results of their soul work experiences. Through phenomenological methodology, the lived experiences of six community college English teachers yield valuable results that connect holistic learning, soul work, and transformative learning theory. Soul work occurs in English classes when, according to the participants of this study, teachers and students enter a call, movement, and response relationship.
Pharmacists and Home Care: The Agency Perspective
Authors: Woodend A. Kirsten , Mifflin-Bloom Sarah , Young Sandra
Published: June 2013

Early in its development, home care pharmacy focused on the provision and monitoring of intravenous medications. 1 – 3 Its role has expanded to include patient and health professional teaching, drug utilization reviews, and contributions to program and policy development. 3 , 4 There are few rigorous studies of the impact of home care pharmacy services, but existing studies do show that these services result in improved patient care and patient outcomes. 5 – 7 Consequently, the potential for pharmacists to play a needed role in home care provision, and communicate that value, is of interest to many health organizations.
Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT)
Authors: Dolovich L. , Pottie K. , Farrell B. , Kaczorowski J. , Sellors C. , Gaebel K. , Austin Z.
Published: June 2013

Doing research has allowed me the freedom to think about innovation, to identify how I can do better, and to generate results that are applicable to everyday practice. What is engaging about doing research? In the same way as when my dad taught me to tie my shoes by giving me a piece of cardboard with cut-out holes and a shoelace, the research process involves receiving guidance from others, bringing my own creativity to the process, figuring out what objectives are important, coming up with a set approach, defining and measuring success, and creating a sustainable intervention that is applicable to and easy to replicate in similar situations. In other words, the research process is personally and professionally stimulating and an implicit part of everyday life.

I was motivated to participate in the development of IMPACT because I felt it offered an exceptional opportunity to determine the best ways that pharmacists and family physicians can work together within the family practice health team environment. — Lisa Dolovich
Computer Networking to Enhance Pharmacist-Physician Communication
Authors: Sellors Connie , Sellors John , Levine Mitchell , Chan David , Dolovich Lisa , Howard Michelle
Published: June 2013

Background:

The use of technology to enhance communication about patients' drug therapy has been advocated by physician and pharmacist associations in Canada. The objective of this pilot study was to demonstrate the proof of concept for an electronic network linking pharmacists and community family physicians in order to exchange information about patients 65 years of age or older who were taking five or more medications regularly.

Methods:

Three community family physicians, 40 of their patients, and three community-based pharmacists with whom the patients most frequently filled their prescriptions participated in the study. Pharmacist-physician pairs were connected through a secure dial-up electronic network. Patients met with the pharmacist to review their medications, including over-the-counter (OTC) products, and the pharmacist generated an electronic profile for the physician. The physician could respond electronically to the pharmacist with edits in order to arrive at a consensus profile for each patient and to discuss discrepancies or drug-related problems. Electronic communication was followed for four months, after which interviews were conducted with the pharmacists and physicians.

Results:

Patients were mostly female (65%) and were 74.9 years of age on average. Physicians and pharmacists accessed the network a total of 144 times and 96 times, for an average duration of 7 minutes and 41 minutes, respectively. Physicians noted the benefit of learning about their patients' OTC medication use and about issues such as lack of compliance. The most common barrier to using the electronic communication system was lack of time.

Conclusion:

The electronic linkage was found to be useful. Further evaluation of the effectiveness of this communication system is needed. Patients' access to their electronic medication profile should also be considered for future projects of this type.
Patient Tool in Combination Antiplatelet Rx
Authors: Ackman Margaret , Gordon Wendy , Kertland Heather , Kuntz Don , Pickering Jennifer , Thompson Ann
Published: June 2013

Cardiovascular patients receiving dual antiplatelet therapy may benefit from a resource kit that explains the role of medication in acute coronary syndrome. This initiative from The Canadian Cardiovascular Pharmacists Network/Réseau Canadian des Pharmaciens Impliqués en Soins Cardiovasculaires (CCPN/RCPC) is a tool for hospital and community pharmacists striving to support patients who are being discharged after having an acute coronary syndrome.

The kit includes:

Information sheets for patients and their community pharmacists and family physicians Suggested strategies on reimbursement issues.
Drug Shortages — Risk or Reality?
Authors: Woodend A. Kirsten , Poston Jeff , Weir Karen
Published: June 2013

Background:

There has been growing concern about possible drug shortages in Canada, yet we know little about the frequency and impact of shortages in community pharmacies.

Objective:

The objective of this survey was to determine the extent of any drug shortages in Canadian community pharmacies and the implications of these shortages for community pharmacists.

Methods:

Surveys and log sheets were faxed to a random sample of 1000 Canadian community pharmacists.

Results:

More than half of the pharmacists experienced a shortage during one shift, and 80% experienced drug shortages over a one-week period. The three main reasons given for shortages were manufacturing problems, cross-border drug trade, and raw material shortages. The drug products that were most frequently in short supply were Chronovera, Loestrin, Sodium Sulamyd eye drops, and Minestrin. Pharmacists estimated that they spent an average of 17.5 minutes each shift dealing with drug shortages.

Conclusion:

Most pharmacists are experiencing shortages and feel that these shortages have become more frequent over the past year. There are a variety of factors that contribute to drug shortages and, while the amount of time spent dealing with them is manageable at the present time, increases in shortages will further stress the system.
Qualitative Perspectives on a Facilitated Change in Provincial Pharmacare Coverage
Authors: Twohig Peter L. , Putnam Wayne , Frail Dawn
Published: June 2013

Background:

During 2000, Nova Scotia's Department of Health implemented policy changes and educational interventions to encourage a switch from wet nebulization therapy to dry-dose delivery systems. The policy changes applied to beneficiaries of the Nova Scotia Pharmacare Programs, while the educational interventions had a broader provincial perspective.

Methods:

Researchers from Dalhousie University's Department of Family Medicine subsequently interviewed family physicians, pharmacists, and other health professionals to gather their views on the initiative. A single researcher (PLT) conducted interviews in the summer of 2001 in two settings. Interviews were audiotaped and transcribed. Analysis was guided by a grounded theory approach and facilitated by the use of QSR N5, a software program designed for computer-assisted qualitative data analysis.

Results:

The results are discussed in several categories, including the role of evidence, change strategies, user devotion to older delivery systems, and health care provider perspectives on policy change.

Conclusion:

Health care professionals interviewed agreed that this was a well-designed initiative in many respects. Participants identified several key elements that offer insights for future policy-implementation design, execution, and evaluation.
On the Front Line of Smoking Cessation: Education Needs of Community Pharmacists
Authors: Brewster Joan M. , Victor J. Charles , Ashley Mary Jane , Laurier Claudine , Dioso Rachel , Ferrence Roberta , Cohen Joanna
Published: June 2013

Background:

Nicotine replacement therapy (NRT) is now available without prescription, and pharmacists have an opportunity to be the primary health care professionals advising patients who want to try this smoking cessation aid. Undergraduate pharmacy education in Canada incorporates some tobacco-related training, and continuing education opportunities are available. However, there are no published reports of the self-reported educational needs of a broad sample of practising Canadian community pharmacists with regard to smoking cessation.

Methods:

Practising community pharmacists in four Canadian provinces were surveyed about their tobacco-related education and knowledge, practice environment, practices related to helping people quit smoking, needs for further information and training, and methods by which this information might be delivered.

Results:

A corrected response rate of 72% was obtained, giving a weighted n of 960 responses. Most Canadian community pharmacists reported that they would find it helpful to receive additional information or training on a wide range of smoking cessation topics, such as behavioural counselling techniques and motivating patients to quit. Pharmacists who reported that they were familiar with aids such as Helping Your Patients Quit Smoking: A Cessation Guide for Pharmacists (Canadian Pharmacists Association) and who reported that the guide had led them to make changes in their practice were more likely to report that additional information or training would be helpful. Pharmacists who perceived their tobacco-related clinical and non-clinical roles to be important were more likely to report that additional training would be helpful than were those who perceived these roles as less important.

Conclusions:

Although most Canadian community pharmacists would find it helpful to receive additional smoking-related information and training, those who perceive this to be an important activity and who are already using available materials showed the most interest. The challenge to Canadian pharmacy educators is to encourage the enthusiasm of those already interested in helping their patients to quit smoking, while raising the level of interest and motivation among all community pharmacists.
Patient Acceptance and Economic Outcomes of Rabeprazole Therapy — A Pharmacist-Initiated Interchange Protocol
Authors: Evans Charity , Stueck Gordon , Koobair Sandhya , Maharaj Jaimala , Maraj Vikesh
Published: June 2013

Objective:

The purpose of this study was to measure the patient acceptance, as well as the individual and provincial cost savings, of switching from other proton pump inhibitor (PPI) therapies to the less costly rabeprazole.

Design and setting:

This was an uncontrolled, prospective study conducted at a community pharmacy in conjunction with the physicians at the local medical clinic.

Patients:

Male and female patients over 18 years of age who were currently taking a PPI (omeprazole, lansoprazole, pantoprazole) regularly and who were under the care of a participating physician were eligible. Patients who were pregnant or breast-feeding were excluded. All patients were switched from their current PPI therapy to rabeprazole 20 mg daily, except for two patients, whose previous dose of omeprazole 20 mg twice daily was changed to rabeprazole 20 mg twice daily.

Results:

Twenty-six patients were enrolled. All patients were Caucasian; 15/26 (58%) were female, and 11/26 (42%) were male; ages ranged from 43 to 89 years. The PPI therapy being used by patients was omeprazole 20 mg, 77% (20/26); pantoprazole 40 mg, 11.5% (3/26); and lansoprazole 30 mg, 11.5% (3/26). At a six-month follow-up (minimum four months of rabeprazole therapy), seven (26.9%) patients had switched back to their original PPI therapy, while 19 (73.1%) had continued on rabeprazole. Five of the seven (71.4%) patients returned to omeprazole therapy, two (28.6%) returned to lansoprazole, and none (0%) returned to pantoprazole. Annual combined cost savings to individual patients was calculated at $4617.48; cost savings to the provincial government were $5083.56.

Conclusion:

Based on the literature, on the fact that 73.1% of patients found rabeprazole to be equivalent in efficacy and tolerability to the other more costly PPIs, and on the potential cost savings demonstrated, we believe that rabeprazole should be considered as a first choice for PPI therapy.
A Pilot Program of Community Pharmacy—Based Influenza Immunization Clinics
Authors: Bowles SK , Strang RA , Wissmann E
Published: June 2013

Clinics staffed by nurses were established in community pharmacies to increase access to flu shots. Almost 3000 flu shots were given across 42 clinics in Halifax and the surrounding area. Most recipients (80%) preferred getting their flu shot at the pharmacy-based clinics. The clinics were such a success that expanding the program province-wide is being considered for next year.
Prescription Drug Sampling — is the Status quo about to Change?
Authors: Groves Kent E.M. , Pendlebury Jason W.
Published: June 2013

Drug sampling plays a key role in the pharmaceutical marketing industry's attempts to reach the “prescribing audience” of health professionals. The traditional mechanism of pharmaceutical sales representatives giving drug samples to the physician as part of a “detailing” appointment is being supplemented by new mechanisms.

In light of growing public and private concerns regarding the administration, management, and application of drug samples, the efforts to develop alternative approaches and the willingness of health professionals and pharmaceutical companies to consider these approaches are increasing. Success will depend on the acceptance and adoption of the approach by pharmaceutical manufacturers, physicians, pharmacists, policy-makers, insurers (public and private), regulators, as well as consumers. Given the number of stakeholders involved, it is not surprising that many of the attempts to introduce alternative methods have failed to achieve the critical level of participation necessary to advance these initiatives into an economically sustainable, broadly accepted model.
Patients' Preferences for Methods of Counselling about Glaucoma
Authors: Taylor Jeff G. , Deschamps Michelle A. , Bobyn P. Joan , Leson Darlene
Published: June 2013

Objective:

To investigate patients' preference for two counselling methods related to glaucoma therapies.

Design:

Nineteen volunteers with glaucoma received counselling about an eye drop medication in two sessions, one involving verbal presentation of information accompanied by a computer-generated information leaflet and the other involving verbal presentation of information supported by images. To the extent possible, the drug-related content of each session was the same. The setting was the EduLab facility of the College of Pharmacy and Nutrition at the University of Saskatchewan.

Results:

An equal number of subjects expressed an outright preference for each method, but results suggested that the order of presentation of the methods might be important. Most participants indicated that if a pharmacist used pictures while advising on medications, print information would still be welcomed.

Conclusion:

Patients were satisfied with both methods, with no clear overall preference evident within the study sample.
Assisting Consumers with Their OTC Choices
Authors: Taylor Jeffrey G. , Chorney Sherilyn , Fleck Ian , Golightly Robert , Litzenberger Valdeen , Loeppky Kristen , Tait Ashley , Tulloch Joanie
Published: June 2013

Background:

The general public recognizes the important role of pharmacists in helping select over-the-counter (OTC) medicines, yet data to quantify the level of consumer demand are scarce.

Objective:

The purpose of this project was to describe consumer response to offers of assistance as a measure of consumer demand.

Method:

Six pharmacy students spent three weeks in three community pharmacies as OTC medicine advisors. Subsequent to formal offers of assistance, acceptances and refusals were tracked to gauge consumer demand for information.

Results:

On average, students had contact with 19.8 consumers per hour, leading to 11,174 interventions. Of these, 27.8% involved the exchange of clinical information, 36.9% saw the person decline assistance, 30.3% were limited to product location, while 5.0% constituted non-drug queries.

Conclusion:

Although a modest percentage, there were 3107 (27.8%) clinical intervention transactions, which is noteworthy for the short duration of the study and indicates significant consumer demand for this aspect of practice.
Bringing the Benefits of Anticoagulation Management Services to the Community
Authors: Bungard Tammy J. , Archer Stephen L. , Hamilton Peter , Ritchie Bruce , Tymchak Wayne , Tsuyuki Ross T.
Published: June 2013

Background:

While warfarin is efficacious for the prevention of thromboembolic disorders, many patients are undertreated. To optimize therapy, anticoagulation management services (AMSs) deliver a coordinated, focused approach to this care; however, AMSs are limited in their ability to impact patients outside of tertiary care settings.

Objective:

To describe the methods used to develop community-based AMSs across Alberta.

Methods:

Through a three-staged approach, this project created community-based, pharmacist-managed AMSs for patients requiring warfarin therapy. Stage I was the initiation of a central or “core” AMS, located at a quaternary referral centre. Starting with the core enabled us to develop and test the program and create an environment to serve as a training and support centre for future aspects of the program. Next, an educational program was developed and implemented (Stage II) for a diverse group of pharmacists to establish and manage a community-based or “satellite” AMS (Stage III) at their practice site. All three stages are undergoing detailed evaluation, capturing project-specific (patient outcome) data as well as system-level (integration within the health care infrastructure) data.

Conclusion:

By offering a focused, coordinated, and consistent approach to warfarin management, with ongoing collaboration with other providers, the ultimate goal of this program is to optimize patient outcomes. Utilizing pharmacists as central players within a collaborative setting will enhance the use of our current infrastructure. This program may serve as a model for other health regions and other chronic diseases.
Improving Asthma Control in the Rural Setting: The BREATHE (Better Respiratory Education and Asthma Treatment in Hinton and Edson) Study
Authors: Charrois Theresa L. , Newman Stephen C. , Senthilselvan Ambikaipakan , Tsuyuki Ross T.
Published: June 2013

Background:

Overuse of β-agonists is a risk factor for poor control of asthma. Pharmacists can identify high-risk patients through refill information and can then initiate disease-management programs for these patients.

Methods:

The Better Respiratory Education and Asthma Treatment in Hinton and Edson (BREATHE) study was a randomized, controlled trial in high-risk asthma patients. The intervention included an educational program (with focus on development of a written action plan), assessment of asthma therapy, and referral to a respiratory therapist and primary care physician. The primary objective was to determine the effect of this program (initiated by community pharmacists) on asthma control, as measured by the Asthma Control Questionnaire. Secondary objectives included determining the effect of the program on numbers of emergency department visits and hospital admissions, use of inhaled corticosteroids, courses of oral steroids, and lung function. Endpoints were measured at baseline, 2 months, and 6 months.

Results:

A total of 70 patients were randomized (34 to usual care, 36 to the intervention). At 6 months, there was no significant difference in asthma control between the usual care and inter-vention groups (change in ACQ score 0.33 and 0.43 respectively, p = 0.66). There were no significant differences in the secondary endpoints. Generally, pharmacist compliance with the intervention was poor.

Conclusions:

Although no differences were found in asthma control, this model, which uses a multidisciplinary, community-based approach, offers a unique management strategy for rural asthma patients. Can Pharm J 2006;139(4):44–50.
Community Pharmacist Practices in Hypertension Management
Authors: McLean Donna L. , Bungard Tammy J. , Hui Carolyn , Tsuyuki Ross T.
Published: June 2013

Objective:

To determine the current practices of community pharmacists in the management of hypertension.

Methods:

This was a cross-sectional, observational study of pharmacist practice using unannounced standardized patients (SPs) with hypertension visiting a random stratified sample of 101 community pharmacies in Edmonton, Alberta. Consent was not obtained from pharmacists.

Results:

Knowledge of current blood pressure guidelines and target values: Of the 101 community pharmacists who were visited by the SPs, 69% offered a general blood pressure target value (<120/80 mm Hg); only 7% stated the correct target blood pressure value for the SPs' particular scenario (<140/90 mm Hg). Only 14% requested enough patient history to properly determine target blood pressure. Review of medical history: Few pharmacists questioned the SPs about their medical history (7%), medication profile (16%), family history of cardiovascular disease (19%), previous elevated blood pressure readings (20%), or previous diagnosis of hypertension (22%). Accuracy/confirmation of blood pressure reading: 53% of pharmacists inquired about the conditions under which the blood pressure reading had been taken; 39% of pharmacists offered to retake the patient's blood pressure. Patient education: Pharmacists discussed how hypertension is diagnosed (76%), what hypertension is (46%), how to take a blood pressure reading properly (46%), and the impact of lifestyle measures on blood pressure (60%); they also gave supplemental educational materials (29%). Referral: 83% of pharmacists advised the SPs to make an appointment to see a physician.

Conclusions:

Pharmacists took reasonable steps to determine the accuracy of the blood pressure measurement, explain the diagnosis of hypertension, and refer to a physician. Major deficiencies were observed in assessment of target blood pressure and review of medical history. Pharmacists, alone or in collaboration with other health professionals, are urgently needed to play a major role in identifying, screening, and managing individuals with hypertension. Can Pharm J 2006;139(5):38–44.
Blood Pressure Awareness and Self-Monitoring Practices among Primary Care Elderly Patients
Authors: Lau Elaine , Kaczorowski Janusz , Karwalajtys Tina , Dolovich Lisa , Levine Mitchell , Chambers Larry
Published: June 2013

Background:

Seniors are perceived as relatively passive recipients of health care, and levels and predictors of blood pressure awareness and self-monitoring in these patients are poorly understood.

Objectives:

To determine the extent to which seniors are aware of their blood pressure status and targets and to examine correlates of blood pressure awareness and self-monitoring.

Methods:

We conducted a cross-sectional analysis of a 32-item baseline questionnaire that was completed by patients aged 65 years and older who were attending pharmacy-based cardiovascular health promotion sessions. The study comprised sociodemographic data, as well as data on health-related quality of life, knowledge of current blood pressure readings and targets, and treatment and monitoring of blood pressure in the previous year.

Results:

Of the 983 respondents, 379 (38.5%) recalled their most recent blood pressure reading. For one-third of these respondents (323/983), their physicians relayed blood pressure targets; of these, 26.9% (87/323) reported targets consistent with current guidelines. Overall, 47.1% (463/983) reported monitoring blood pressure in the past year. Multivariate logistic regression analysis revealed that older patients (aged 80 years and older) were less likely to know their blood pressure readings, compared with those who were younger. Patients with a postsecondary education, those who were diagnosed with high blood pressure, and those who were told their target blood pressure were more apt to know their readings, relative to those less educated, undiagnosed, or unaware of their target blood pressure. Participants who were aged 80 years and older were a negative predictor of self-monitoring in multivariate analysis, whereas living with someone, previous diagnosis of high blood pressure, and being advised of their target blood pressure were positive predictors.

Conclusion:

Seniors had a relatively poor understanding of their blood pressure readings and targets, but a subset was considerably more knowledgeable and potentially suited to be more involved in blood pressure self-management.
Pharmacotherapy of Hypertension
Authors: Campbell Norm , Semchuk William , Lewanczuk Richard
Published: June 2013

Background:

Hypertension is a leading risk factor for death and disability in Canada. Pharmacists can help to improve the treatment and control of hypertension through collaboration with physicians and patients to improve pharmacotherapy.

Objective:

To review appropriate pharmacotherapy for hypertension, as outlined in the recommendations of the Canadian Hypertension Education Program.

Methods:

The recommendations of the Canadian Hypertension Education Program were reviewed with a view to identifying gaps in the recommendations as they apply to pharmacy practice. For some of these gaps, it was determined that pharmacists could provide further care to patients with hypertension, and opportunities for pharmacist involvement are suggested here.

Results:

Initial pharmacotherapy for uncomplicated hypertension includes thiazide-type diuretics, beta-blockers for patients under 60 years of age, angiotensin-converting enzyme (ACE) inhibitors, long-acting calcium channel blockers, and angiotensin receptor blockers. For additive hypotensive action in two-drug combinations, either a diuretic or a calcium channel blocker should be combined with a beta-blocker, ACE inhibitor, or angiotensin receptor blocker. Other combinations are less effective or unproven. Areas where pharmacists must become more actively involved in the management of patients with hypertension include provision of balanced information about benefits and side effects, identification of secondary druginduced causes of hypertension or drug interactions, and suggestion of adjustments to medication dosage for patients with renal dysfunction.

Conclusions:

There are specific and unique roles for pharmacists in the management of hypertension. Pharmacists can play a greater role in improving the pharmacological management of hypertensive patients, aided in part by regular updates to the recommendations of the Canadian Hypertension Education Program.
Pharmaceutical-Related Strategies for Health Care Reform in Canada: Federal Party Principles, Priorities, and Actions 2004–2006
Authors: Al-Sukhni Mayce , Ballantyne Peri
Published: June 2013

Background:

The guiding principle of the Canada Health Act (CHA) is to provide Canadians with “medically necessary care.” We note the historic limitations of the CHA with respect to the full integration of medicines and pharmaceutical health care and point to the priority given to drugs and pharmacy-related care in 2 recent federal reports on health care reform. In The Health of Canadians — The Federal Role (Kirby 2002) and Building on Values: The Future of Health Care in Canada and its related submissions (Romanow 2002), the role of drugs and pharmacy in Canadian health care receives unprecedented emphasis.

Methods:

To determine whether the emphasis on pharmacare made by Kirby, Romanow, and others is retained in federal-level health reform planning, we conducted a content analysis of major federal party platforms and policies tabled for the spring 2004 election (as well as brief reference to those tabled for the winter 2006 election).

Results:

Recommended pharmacy-related reforms focus on potential catastrophic costs to individual patients rather than on a consideration of essential medicines as medically necessary for a growing number of Canadians. Furthermore, little consideration is given to the role pharmacists could play in minimizing the potential risks of inappropriate drug use and associated costs.

Discussion:

We consider the difficulty of reconciling the principles of the CHA and the reality of a piecemeal pharmaceutical health care system.

Conclusion:

Health reforms are needed that take into consideration the growing importance of drugs in health care and the issue of equity and access to drugs for Canadians.
Pharmacist Intervention in Risk Reduction Study in High-Risk Cardiac Patients: The Effect of 2 Methods of Pharmacist Training
Authors: Taylor Jeffrey , Semchuk William , Deschamps M. , Sulz L. , Tsuyuki Ross T. , Duffy P. , Wilson T.
Published: June 2013

Objective:

To assess the effect of intensive vs conventional training on pharmacist-suggested implementation of cardiac risk reduction efforts in community practice.

Methods:

Sixty-one volunteer pharmacists from 40 pharmacies were randomized to 1 of 2 educational groups: intensive or conventional training in cardiac risk reduction. With training complete, pharmacists identified and approached patients at high risk for coronary artery disease (CAD) at their practice sites to participate in the program. After a patient interview, pharmacists documented the relevant CAD risk factors and medication history, and then faxed this information, along with risk reduction recommendations, to the primary care physician. Patients were then encouraged to book a medical appointment for further assessment and treatment, if warranted. Follow-up occurred at 4, 16, and 24 weeks to determine if any pharmacist-suggested risk reduction measures had been implemented. Pharmacists were reimbursed $30 per patient accrued.

Results:

A total of 217 patients were enrolled in the study, and of those, 216 had follow-up data available for analysis. No significant differences were observed between the groups with respect to mean number of patients enrolled per pharmacist (4.3 vs 2.7) and the proportion of pharmacists completing at least 1 patient (17/27 vs 14/34). Feedback from pharmacists on program delivery indicated no significant difference in satisfaction with the training provided. The recommendations forwarded by pharmacists of the intensive group (35.8%) received greater acceptance by physicians than those in the conventional group (23.8%).

Conclusion:

Although results are preliminary, intensive training for pharmacists was more likely to result in improvements in cardiovascular risk reduction therapy than when conventional training was used.