bluuebunny/crossref_metadata_2025 huggingface dataset:
Active Communication of a Pharmacy Discharge Plan for Patients with Respiratory Diseases: A Pilot Study
Authors: Beauchesne Marie-France , Nenciu Laura M , Dinh Thanh-Ha , Tassé Michel , Fillion Anne , Labrecque Manon , Blais Lucie
Published: September 2013

Background:

Drug-related problems (DRPs) are common following hospital discharge. Active communication of a written pharmacy discharge plan may increase the number of community pharmacists' interventions.

Objective:

To assess the impact of the active communication of a written pharmacy discharge plan.

Methods:

This was a pilot study comparing 2 groups of pharmacists over a period of 6 weeks. Participating community pharmacists were assigned to either the control group (those who provided usual patient care during hospital stay and transmission of a standard written pharmacy discharge plan) or the active communication group (those who, in addition to the usual care provided in the control group and the written pharmacy discharge plan, included a list of up to 3 DRPs with proposed interventions to resolve them and a telephone call from the hospital pharmacist to the community pharmacist to facilitate the transfer of information). The patients enrolled were adults admitted to the respiratory unit of our hospital who were returning home following their discharge. Patients were assigned to the control or the active communication group based on the community pharmacy where they usually filled their prescriptions.

Results:

Overall, 36 community pharmacists were included in the study and assigned to either the active communication (n = 17) or control group (n = 19). A total of 22 patients were assigned to either the control group (n = 8) or the active communication group (n = 14). The mean number of community pharmacist interventions per patient was 4.2 in the active communication group and 0.9 in the control group (p = 0.0004). The mean number of DRPs per patient for which there was at least one intervention made by the community pharmacist was 2.8 in the active communication group and 0.6 in the control group (p = 0.0001).

Conclusions:

Results of this pilot study demonstrate that the active communication of a written discharge plan may increase the number of interventions by community pharmacists.
Pharmacists' Self-Assessments regarding Emergency Preparedness Activities in Kansas
Authors: Fromer Deborah B , Ablah Elizabeth , Schrater Suzanne R , Molgaard Craig A , Cook David J
Published: September 2013

Background:

In an emergency, the pharmacists' role lies in obtaining access to pharmaceuticals and other crucial supplies necessary to ensure that injured or ailing people are treated quickly and effectively.

Objective:

To assess pharmacist reactions regarding the emergency preparedness program, “Can it Happen in Kansas: Response to Terrorism and Emerging Infections,” before and after training.

Methods:

A terrorism preparedness questionnaire was developed to self-assess changes in participants' confidence. These were measured before, immediately after, and 3 and 10 months after training.

Results:

At pretest, pharmacists reported feeling more alert to agroterrorist attacks in Kansas, better able to describe their roles in incident response, more alert to symptoms of emerging infections, and better able to recognize radiation symptoms than at posttest (all p < 0.001). Similar statistical patterns can be found in almost all content areas covered.

Conclusions:

It is difficult to measure competencies and skills needed in emergency preparedness training. Future training will involve more objective measures. Since pharmacists are well positioned to detect emerging and unusual patterns of disease or medical conditions, it is imperative that they are included among professionals who are trained to recognize symptoms of exposure to biological, nuclear, or chemical agents.
Amantadine Therapy in Traumatic Brain Injury Patients
Authors: Villareal Carolyn L
Published: September 2013

Objective:

To review literature on amantadine therapy in patients with traumatic brain injury (TBI).

Data Sources:

MEDLINE (1966–March 2006), EMBASE (1974–March 2006), BIOSIS (1969–March 2006), and International Pharmaceutical Abstracts (1970–March 2006) were searched to identify papers on the clinical outcomes of patients with TBI treated with amantadine. A bibliographic search was also performed.

Study Selection and Data Extraction:

Papers were excluded if they were not published in English, if they included patients less than 16 years old, or if they included patients in whom the effects of multiple medications, rather than amantadine alone, were studied. Reports were categorized according to the time of initiation of amantadine following the injury.

Data Synthesis:

Reports examining early initiation of amantadine suggest a possible benefit for treatment of decreased responsiveness and functional recovery. One report examining late initiation of amantadine failed to demonstrate benefit in the treatment of motor impairment, while 2 reports suggested possible improvement of functional recovery. Finally, reports examining late initiation of amantadine in the treatment of cognitive and behavioral therapy demonstrated possible benefit.

Conclusions:

Further investigation is needed before either early or late initiation of amantadine can be recommended for treatment of decreased responsiveness and functional recovery. However, while additional research is conducted, late initiation of amantadine can be considered an option for the treatment of cognitive and behavioral impairments in patients with TBI.
Probable Elevation in International Normalized Ratio from Cranberry Juice
Authors: Welch Justin M , Forster Keith
Published: September 2013

Objective:

To report a case in which cranberry juice interacted with warfarin, resulting in an elevated international normalized ratio (INR).

Case Summary:

A 77-year-old male had maintained stable INR values for 6 months while on a warfarin maintenance dose of 24 mg/wk. On a routine follow-up examination, the INR was 5.9; one month prior to presentation, the INR had been 2.4. The patient reported several recent nosebleeds and a red mark on his left eye. He stated he had been adherent to therapy and denied any changes in medications or recent illnesses such as fever, flu, or diarrhea. His physical activity level and diet had been consistent, with no alcohol intake. The only change identified was the addition of daily cranberry juice (1–3 cups/day) for the last month. Cranberry juice was stopped, and the dose of warfarin was decreased to 22 mg/wk. Subsequently, the INR stabilized at the low end of the therapeutic range.

Discussion:

Whether cranberry juice interacts with warfarin is unclear. Three previously published case reports suggested a possible interaction. In at least 2 of these cases, confounding factors and incomplete information make assessing the influence of cranberry juice difficult. The interaction in our patient was scored as probable by the Naranjo probability scale, based on the temporal relationship, return to the therapeutic INR range after discontinuing cranberry juice, and elimination of alternative causes for the INR elevation.

Conclusions:

This case suggests that cranberry juice may interact with warfarin, leading to an elevated INR.
Long-Term Glycemic Control after a One Week Hospital Education Program for Inpatients with Type 2 Diabetes
Authors: Akabane Michiya , Konishi Hiroki , Nishio Yoshihiko , Yamaji Akira
Published: September 2013

Background:

Clinical usefulness of short-term education for long-term glycemic control has been unclear in patients with type 2 diabetes.

Objective:

To conduct a one week education program, incorporating a clinical path with group education and a team approach, for inpatients with type 2 diabetes and assess the effect of our program on short- and long-term glycemic control in these patients.

Methods:

Changes in hemoglobin A1c (A1C) values of 29 patients were serially examined for 3 years after discharge at completion of the education program, and findings were compared with those of 22 patients with diabetes who did not participate in the program.

Results:

A1C values of patients in the education group at the first and third year after discharge were maintained at lower levels than those of patients in the control group. The proportion of patients with A1C values less than 7% was greater in the education group than in the control group during the first and third years. No significant differences in the number of hospital visits were noted over 3 years, and no significant difference between the 2 groups was found in the ratio of patients receiving drug therapy to those supported by a diet/exercise regimen only.

Conclusions:

Our findings suggest that a one week in-hospital education program contributes to improvement of short- and long-term glycemic control in patients with type 2 diabetes.
Telepharmacy in Mental Health Outpatient Case Management
Authors: Nieves J Edwin , Stack Kathleen M , Cruz Martin
Published: September 2013

Objective:

To describe the use of videophones to augment community-based case management medical services, particularly for in-home pharmacy consultations.

Discussion:

Despite recent technologic advances, telepharmacy image applications, in which a patient and a pharmacist can see each other, are rather limited in number and variety. However, videophone technology can fill this role well, given its portability, low cost, reliability, privacy, ease of use, and minimal technologic requirements. Videophone deployment in our psychiatry community case-management program has improved both medical and pharmacist access to a population of seriously mentally ill patients. Specifically, the ability to reach a hospital-based pharmacist through videophone, while making home visits, has allowed clarification of medication preparation and authorization of refills as well as improving treatment adherence. In short, despite minor technical limitations, videophones provide a simple and, in our case, reliable solution for in-home care. To date, both patients and case managers have responded with satisfaction to this treatment adjunct.

Conclusions:

Despite some limitations, videophone technology can increase patient access to health care, particularly pharmacy consultations. Expanded use of this technology would allow for systematic studies to support or refute the successes documented at our institution.
The Effects of Androstenedione Supplementation on Serum Gonadal Hormones
Authors: Weber Cynthia A , Wood Heidi M , Ernst Michael E
Published: September 2013

Objective:

To review the effects of androstenedione supplementation on serum gonadal hormones.

Data Sources:

Biomedical literature was accessed via PubMed through September 2007; MeSH terms included androstenedione and gonadal hormones.

Study Selection and Data Extraction:

Studies were limited to those published in English, with the primary outcome of change in serum gonadal hormone concentrations following multiple-dose oral androstenedione supplementation. Articles that reported only effects on muscle strength were excluded because our review focuses on the biochemical, not physiological, effects of androstenedione. For studies that evaluated multiple outcomes of therapy that were published in more than one journal, only the article reporting serum gonadal levels was selected for this review.

Data Synthesis:

We reviewed 8 unique studies that evaluated the effect of oral androstenedione supplementation on serum gonadal hormone concentrations. Critical comparison of the studies is challenging due to heterogeneity in methodology and outcomes measured, small sample sizes and short durations, and lack of complete data. The timing of serum gonadal hormone measurements, which is of critical importance, is not standardized among the studies. Subjectively evaluated, these studies suggest that androstenedione supplementation may cause a small, transient increase in serum testosterone. However, this effect is very short (<24 h) and may be completely negated by conversion to estrogens and through feedback inhibition of endogenous testosterone production with long-term use (≥28 days).

Conclusions:

The findings of the studies reviewed suggest that androstenedione supplementation may cause a small, transient increase in serum testosterone levels. More importantly, estrogen-related hormones were also increased. Although androstenedione supplements are no longer available in the US without a prescription, they are available in other countries and potentially via the Internet. Clinicians should be aware of the potentially harmful effects of androstenedione on gonadal hormones in the event that they are involved in the care of a patient who may be using an androstenedione-containing product.
Evaluation of State Schedule II Controlled Substance Laws
Authors: Fass Jennifer A , Seamon Matthew J
Published: September 2013

Background:

States have the authority to mandate laws that are more stringent than federal law, which often results in important differences in prescribing and dispensing patterns throughout the country.

Objective:

To evaluate schedule II controlled substance laws in all 50 states, the District of Columbia, and Puerto Rico to identify important differences.

Methods:

The current state laws and regulations regarding controlled substances were evaluated using the following criteria: whether prescription expirations dates are mandated, whether partial fills are permitted, whether changes can be made to prescriptions after consulting with a physician, whether maximum days' supplies are mandated, and whether pharmacists can dispense emergency oral prescriptions.

Results:

Thirty-nine states and Puerto Rico (77%) mandate prescription expiration dates. Partial filling is permitted in all states, the District of Columbia, and Puerto Rico (100%). All 50 states and the District of Columbia (98%) permit pharmacists to make prescription changes after consulting with the physician. Nine states (17%) have mandated maximum days' supplies that a physician may prescribe. All 50 states, the District of Columbia, and Puerto Rico (100%) permit pharmacists to dispense drugs in an emergency situation with verbal prescription.

Conclusions:

Pharmacists should be aware that differences exist among the states, the District of Columbia, and Puerto Rico regarding Schedule II controlled substance laws. Understanding these differences is fundamental to the profession.
Assessment of Vitamin K Use in the Inpatient Treatment of Excessive Anticoagulation
Authors: Hansen Lizbeth A , Jennings Douglas L , Pallares Maria-Jose , Thompson Amy N , Garrison Kelli L , Wessell Andrea M
Published: September 2013

Background:

Guidelines from the Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy provide specific recommendations for the management of patients with supratherapeutic international normalized ratios (INRs).

Objective:

To assess the appropriateness of vitamin K administration in inpatients with excessive anticoagulation, according to existing guidelines.

Methods:

A retrospective chart review was performed for randomly selected patients on warfarin therapy who received vitamin K during hospitalization. Data were collected on patient demographics, vitamin K dose and route of administration, warfarin dose, alternative therapies, and INR values before and after vitamin K administration. The appropriateness of vitamin K use was evaluated based on indication, route, and dose.

Results:

A total of 136 patient charts were reviewed. The majority (71%, n = 97) of patients had a baseline INR of less than 5, with a mean INR of 4.4 ± 2.9 SD. Seventy-five patients had documented bleeding events on admission, 49% of which were considered major. Average time to repeat INR was 9.7 ± 6.8 SD hours. Seventy-one percent of patients had a documented appropriate indication for vitamin K, 42% received an appropriate dose, and 27% received vitamin K via the appropriate route of administration. Only 21% of patients received vitamin K for an appropriate indication, at an appropriate dose, via an appropriate route.

Conclusions:

At our institution, the current use of vitamin K for excessive anticoagulation is inconsistent and suboptimal with regard to route, dose, and monitoring parameters. Education of both medical and pharmacy staff is essential to improving compliance with ACCP recommendations.
Pharmaceutical Care: What's in a Name? A Qualitative Analysis of Patient Perceptions of Pharmacy Practice
Authors: Franic Duska M , Tucker Leslie Tootle , Haddock Sarah M
Published: September 2013

Background:

Pharmaceutical care has been integrated into the mission statement of every major pharmacy school and the profession of pharmacy in the US.

Objective:

To evaluate patients' awareness and understanding of pharmacy practice, pharmacy services, and pharmaceutical care.

Methods:

A cross-sectional study was conducted involving completion of a self-administered questionnaire by participants frequenting community pharmacies (independent, chain, discount, and grocery) in Georgia. Content analyses were performed to assess participants' knowledge and perception of available pharmacy services and pharmaceutical care.

Results:

Approximately half of the study participants were unfamiliar with pharmaceutical care despite its integration into pharmacy education. One percent described pharmaceutical care as the compounding phase of pharmacy, 2% described it as the early clinical practice model, 45.3% equated pharmaceutical care with dispensing (ie, the “professional shopkeeper”), and approximately 52% described pharmaceutical care accurately. Forty-three percent described at least one of the subcomponents of basic pharmaceutical care (ie, pharmacist commitment, definite outcomes, or process of care [eg, counseling, drug utilization review]) and 8% described true or enhanced pharmaceutical care (ie, quality of life).

Conclusions:

The practice of pharmaceutical care is not widely understood by patients. Furthermore, many patients were unaware of the cognitive and clinical services that pharmacists provide. In the future, we expect the pharmacy profession to educate not only its pharmacists, but also its patients, about pharmaceutical care. Patients may not be seeking or demanding available services from their pharmacists because they are uninformed.
Intracoronary Vasodilators for the No-Reflow Phenomenon
Authors: Montarella Kristin E , Gales Mark A
Published: September 2013

Objective:

To review the literature relating to the use of intracoronary vasodilators to prevent and/or treat the no-reflow phenomenon in patients undergoing percutaneous coronary intervention (PCI).

Data Sources:

A literature search was conducted using MEDLINE (1966–March 2008) and Science Citation Index (1945–March 2008) using the search terms vasodilators, no-reflow, and intracoronary.

Study Selection and Data Extraction:

English-language clinical trials and case series were selected from articles retrieved. References of reviewed articles were examined for additional sources. Studies relating to the use of intracoronary vasodilators in the prevention and/or treatment of no-reflow in PCI were evaluated for safety and efficacy data. Articles relating to agents not available in the US were excluded.

Data Synthesis:

Evidence of intracoronary adenosine's utility in no-reflow treatment is limited. Its use in no-reflow prevention was associated with outcomes ranging from no difference to nearly an 88% reduction in no-reflow development; the drug was generally well tolerated. No-reflow treatment with intracoronary verapamil improved flow in 87–100% of cases. Preventive trials with verapamil failed to demonstrate efficacy. Atrioventricular block requiring treatment was the most commonly reported adverse event with intracoronary verapamil. Literature on intracoronary diltiazem and intracoronary nicardipine is limited. Both agents produced greater than 95% efficacy in no-reflow treatment, while prevention studies found no-reflow developing in less than 4% of patients. Although adverse event reporting was limited, hemodynamic instability was noted in patients receiving diltiazem. Response rates ranged from 73% to 100% when intracoronary nitroprusside was studied as treatment for no-reflow associated with acute myocardial infarction (AMI). Systemic hypotension was noted with nitroprusside administration.

Conclusions:

The available data are predominately from case series and retrospective reviews. Prevention of no-reflow with intracoronary vasodilators in elective PCI is not warranted. Nitroprusside should be considered first-line treatment in no-reflow associated with AMI.
Safety of Proton Pump Inhibitors in Community-Dwelling Older Adults
Authors: Lindblad Adrienne J , Sadowski Cheryl A
Published: September 2013

Objective:

To describe proton pump inhibitor (PPI)–related adverse effects in community-dwelling older adults.

Data Sources:

Articles were identified via PubMed (1966–March 2008) using the terms proton pump inhibitor, adverse drug effects, safety, pneumonia, fractures, Clostridium difficile, and vitamin B12. Clinical trials, meta-analyses, and drug evaluations published in English were selected. Articles excluding patients over 65 years of age or those involving solely institutionalized patients were excluded.

Study Selection and Data Extraction:

Twelve studies were selected, 10 of which were case–control or population-based studies. Three of 4 studies investigating the association of PPI use with C. difficile infection found a positive association. Many participants in these studies had no history of antibiotic exposure prior to infection. Three studies found a significant relationship between community-acquired pneumonia and PPI therapy, with a possible dose–response relationship. Two studies found an increased risk of fracture with PPI use, with a possible dose–response relationship. Two of 3 included studies found an association between vitamin B12 deficiency and PPI therapy.

Data Synthesis:

The majority of studies found significant associations between PPI use and the development of C. difficile infection, pneumonia, fractures, and vitamin B12 deficiency, all of which are plausible based on the mechanisms of action of PPIs. With a lack of randomized controlled trials, the underlying causes of these adverse effects remain controversial.

Conclusions:

Cause and effect between PPI use and C. difficile infection, pneumonia, fractures, and vitamin B12 deficiency has not been established. Well-designed, prospective, randomized studies are required to confirm whether there are risks associated with long-term PPI use. Until the results of such studies become available, PPI use should be reviewed for appropriateness at regular intervals in individual patients, as the consequences of these complications in the elderly could be devastating.
Evaluation of INR Monitoring Frequency and Time in Therapeutic Range
Authors: Snyder Christin M , Helms Bethany E , Hall Deanne L
Published: September 2013

Background:

Although anticoagulant therapy has been used for more than 50 years, the optimal interval between international normalized ratio (INR) measurements in patients who demonstrate a stable dose response remains unsettled. Based on the results of observational studies, the American College of Chest Physicians currently recommends that patients receiving a stable dose of warfarin undergo INR testing at least once every 4 weeks.1

Objective:

To determine whether an increased frequency of INR monitoring impacts time in therapeutic range (TTR) among patients receiving maintenance warfarin therapy managed by an anticoagulation clinic.

Methods:

A total of 2,222 INR results belonging to more than 700 adults who were followed by the anticoagulation service at the University of Pittsburgh Medical Center and who were receiving maintenance warfarin therapy between April 1, 2006, and September 30, 2006, were retrospectively reviewed. INR measurements were categorized as having been determined fewer than 21 days or 21 or more days after the previous measurement, and the percentage of INRs within the therapeutic range was calculated for each interval.

Results:

During the evaluation period, INRs measured within 21 days of the preceding test were within the therapeutic range 75.1% of the time, whereas INRs obtained at least 21 days after the antecedent INR test were within the therapeutic range 79.9% of the time (p < 0.001). Additionally, the proportion of INRs below 1.5 or above 5.0 was not significantly different between the 2 groups, representing only 0.04% of all results at either interval (p > 0.05).

Conclusions:

Our evaluation suggests that more frequent INR monitoring among patients receiving maintenance warfarin does not impact TTR to a clinically meaningful extent. Moreover, these findings support the reevaluation of the anticoagulation service management algorithm to reduce the frequency of INR measurements among patients within the maintenance phase of therapy.
Pharmacy Technicians and Medication Therapy Management
Authors: Powers Mary F , Bright David R
Published: September 2013

Background:

Although cognitive services have become more widely accepted among pharmacists since Medicare Part D provided a benefit to allow for billing of services, not all pharmacists have incorporated services into their practices.

Objective:

To identify opportunities for pharmacy technicians to aid pharmacists in medication therapy management (MTM).

Methods:

Articles were identified through searches of MEDLINE/PubMed (1950–July 2008) and review of MTM resources from the American Pharmacists Association. Articles describing medication therapy management and pharmacy technicians were included.

Results:

As the pharmacy profession embraces extensive patient counseling in the form of MTM, many aspects of the practice of pharmacy need to evolve to ensure MTM program success. Time constraints limit the ability of pharmacists to handle administrative tasks and represent a major barrier to MTM program implementation. Technicians can do some of the work to reduce this barrier. With proper training, technicians can assist pharmacists in the tasks that do not require the professional judgment of a pharmacist, freeing pharmacists to focus on clinical activities and enabling an MTM program to be more sustainable. For example, technicians can help in areas such as scheduling and patient reminders through phone calls. Medication histories and health histories can also be documented by technicians, as can chart construction, filing, and the documentation of release forms and health histories. Additional steps can be taken to further increase efficiency in the MTM process and include creation of a flow map and cross training of all pharmacy staff.

Conclusions:

Through developing new roles, technicians can help pharmacists provide pharmaceutical care and develop a successful MTM program.
2006 North Dakota Pharmacists' Wage and Workload Assessment
Authors: Scott David M
Published: September 2013

Background:

While literature on workforce studies is growing, there are no studies that collect accurate information concerning wages and workload issues of North Dakota pharmacists.

Objective:

To evaluate the wages and workload issues of pharmacists in North Dakota.

Methods:

A survey was modified based on the Wage and Benefit Survey for pharmacists used in the Upper Midwest Pharmacists Workforce Study and the 2004 National Pharmacist Workforce Study. A survey was mailed to the 689 pharmacists practicing in North Dakota.

Results:

Overall, 424 of 689 completed surveys (61.5% response rate) were analyzed. Pharmacists (n = 377) reported that they worked in a primary employment setting an average of 39.3 hours per week at an average hourly rate of $41.03, and the gross 2005 salary (excluding benefits) was $80,525. Chains had the highest average hourly pay rate ($43.92/hour), followed by hospitals ($41.89) and independents ($38.71). Commonly reported benefits included paid vacation (88.6%), employee health insurance (84.1%), sick leave (62.9%), and tax-sheltered plans (70.6%). Pharmacists spent the majority (50.8%) of their time in medication dispensing activities, followed by consultation (18.5%), business management (16.7%), and drug use management (12.5%). Ideally, pharmacists would like to spend less time in medication dispensing (36.1%) and business management (12.8%) and more time in consultation (28.7%) and drug use management (19.7%).

Conclusions:

The North Dakota study revealed that pharmacists want to spend more time in consultation and drug use management activities and less time in medication dispensing. These results are similar to those of the 2004 National study. While pharmacist average hourly pay rates and benefits are reflective of North Dakota practice settings, the respondents' rates are lower when compared with those in Minnesota.
Effects of β-Blocker Titration on Glucose Homeostasis in Heart Failure
Authors: Vardeny Orly , Zebrack James , Gilbert Edward M , Cheang Kai I
Published: September 2013

Background:

Abnormal glucose metabolism and insulin resistance have been associated with heart failure (HF) incidence, severity, and mortality. Metabolic parameters such as hepatic glucose production may be altered by β-adrenoceptor antagonists in patients with HF.

Objective:

To evaluate the effects of metoprolol succinate or carvedilol up-titration on fasting glucose, insulin resistance, and β2-mediated glucose production in patients with chronic HF.

Methods:

This was a prospective, randomized, active comparator study in 15 patients with American Heart Association/American College of Cardiology Stage C systolic dysfunction HF that was stabilized with medical therapy. Participants were randomized to receive metoprolol succinate 25 mg daily or carvedilol 3.125 mg twice daily. Metoprolol was titrated to a target of 200 mg daily, and carvedilol was titrated to 25 mg twice daily over 8 weeks. Insulin resistance as assessed by the homeostatic model and terbutaline-induced glucose production (area under the curve from 0 to 180 … [AUC0–180]) were assessed at baseline and at 4 subsequent β-blocker titration visits over 8 weeks.

Results:

In all 15 patients, terbutaline-induced glucose AUC0–180 decreased (p = 0.001) as β-blocker doses increased. A significant reduction in glucose AUC0–180 compared with baseline was noted only in patients taking metoprolol 100 mg daily (–2424.6 mg/dL•min; 95% CI 372.6 to −4478.4) and 200 mg daily (–2437.2 mg/dL•min; 95% CI −15.1 to −4604.4) and was not observed in those taking carvedilol. After β-blocker titration, fasting glucose concentrations for the metoprolol and carvedilol groups were 86.9 mg/dL (95% CI 89.8 to 101.6) and 95.7 mg/dL (95% CI 89.8 to 101.6), respectively (p = 0.027), adjusted for baseline values. There was no significant difference between the effect of metoprolol and carvedilol on insulin resistance.

Conclusions:

Increasing doses of β-blockers are associated with decreased β2-mediated glucose production in HF. Metoprolol succinate, but not carvedilol, decreases hepatic glucose production at doses commonly used in HF.
Pharmacists' Attitudes toward Technician Certification: A Qualitative Study
Authors: Schmitt Michael R , Desselle Shane P
Published: September 2013

Background:

Pharmacy technicians have become increasingly important in the delivery of pharmacy care. As pharmacy technicians continue to advance their roles, it is important to understand facets of their training and education that could enhance their contributions to effective pharmacy operations.

Objective:

To explore pharmacists' attitudes toward technician certification. Specifically, to describe (1) pharmacists' experiences in working with technicians who are certified and those who are not certified, (2) pharmacists' perceptions of the association between certification and technicians' competence and professional demeanor, and (3) strengths and opportunities for improvement in technician certification.

Methods:

An exploratory, qualitative approach using focus groups was employed. Sixteen pharmacists were enrolled across 2 focus groups, with each session lasting approximately 90 minutes. Digitally recorded and transcribed transcripts were content analyzed in an iterative process. A phenomenologic perspective was employed to capture the essence of participants' perspectives.

Results:

A content analysis of the transcripts revealed 3 main themes: benefits of technician certification, pharmacist reliance on support staff, and barriers to certification. The general perception was that certification benefits the profession; however, pharmacists would like to see more standardized criteria in education and training for technicians prior to them sitting for the certification examination.

Conclusions:

The benefits of certification are likely to be observed on a daily basis in practice. Further research is needed to more critically evaluate how certification contributes to improving organizational effectiveness and improving patient care.
Rifaximin for Hepatic Encephalopathy
Authors: Moye Pamela M , Yunker Nancy S
Published: September 2013

Objective:

To evaluate the efficacy of rifaximin for the treatment of hepatic encephalopathy (HE).

Data Sources:

All articles were accessed via PubMed (January 1960–December 2008), Cochrane Library, and Iowa Drug Information Service (1966–December 2008) using the terms rifaximin and hepatic encephalopathy. In addition, reference citations from publications identified were reviewed.

Study Selection and Data Extraction:

All articles in English identified from the data sources were evaluated. Fifteen studies that evaluated the efficacy, safety, and/or cost-effectiveness of rifaximin for the treatment of HE are reviewed in this article.

Data Synthesis:

HE is a neuropsychiatric syndrome that develops in patients with acute or chronic liver failure. There are a number of accepted theories explaining the pathophysiology of HE. Currently, pharmacologic therapies include nonabsorbable disaccharides (lactulose) and antibiotics (neomycin and metronidazole). Recent studies have shown a possible benefit with a newer, nonabsorbable rifamycin derivative, rifaximin. It has a broad spectrum of activity against aerobic and anaerobic gram-positive and gram-negative organism. Clinical trials have compared rifaximin with lactulose, neomycin, or metronidazole for the treatment of HE. There have also been review articles addressing the cost-effectiveness of rifaximin compared with lactulose, including the cost of hospitalization. To date there have been no randomized, placebo-controlled studies that have assessed the efficacy and long-term safety outcomes of rifaximin in the treatment of HE; however, rifaximin has demonstrated similar efficacy and better safety profiles compared with other therapies, in particular, neomycin and lactulose.

Conclusions:

Patients with HE who are refractory to lactulose therapy or who have decreased tolerability to lactulose therapy may benefit from rifaximin as either adjunct therapy or salvage therapy.

ACPE Universal Program Numbers:

407-000-09-053-H01-P (Pharmacists); 407-000-09-053-H01-T (Technicians)
Suppository Preparation: Density Factor Determination for Some Over-the-Counter Analgesic Products
Authors: Al-Achi Antoine , Patel Sapana , Cherukuri Krishna , Gandhi Dinal
Published: September 2013

Background:

The formulation of analgesic suppositories by the compounding pharmacist may offer an alternative to patients who cannot take medications orally.

Objective:

To determine the density factor (DF) for 9 nonprescription nonsteroidal antiinflammatory drugs, aspirin, and acetaminophen for use in compounding suppositories.

Methods:

Nine nonprescription analgesic products were purchased from local stores in North Carolina. All products were solid dosage forms (ie, tablets, caplets, or geltabs). The solid units were pulverized with a porcelain mortar and pestle and then incorporated into a cocoa butter base for formulating the suppository. The DF estimation was evaluated according to the Paddock method.

Results:

The highest DF value (mean ± SD) among the products tested was for St. Joseph Aspirin (1.45 ± 0.78); the lowest value was for Motrin IB (ibuprofen) (1.06 ± 0.23). Overall, 11.1% (40/360) of all compounded suppositories had some sort of defect. The most often encountered defect was chipping (3.6%; 13/360); the least encountered was sticking to molds (0.83%; 3/360).

Conclusions:

A practical method for preparing compounded suppositories provides a viable alternative for patients who require analgesic medications but cannot take them orally.
Adverse Consequences of Internet Purchase of Pharmacologic Agents or Dietary Supplements
Authors: Kwan Della , Beyene Joseph , Shah Prakesh S
Published: September 2013

Background:

The Internet is commonly used to advertise and sell medications and dietary supplements directly to consumers. Prescriptions are often not needed, and consumers may engage in unmonitored and risky health practices. No systematic attempt has been made to evaluate reported cases of adverse events following such purchases.

Objective:

To systematically identify and examine reported cases of adverse events associated with the purchase of medications and dietary supplements from the Internet.

Methods:

MEDLINE (1990-June 2009), EMBASE (1990-June 2009), IBIDS (to June 2009), TOXNET (to June 2009), bibliographies of identified articles, and Web sites of relevant health ministries and professional associations in the US and Canada were reviewed to identify eligible articles that describe adverse events associated with the purchase of medications or dietary supplements from the Internet.

Results:

Thirty-two reports of 41 cases of adverse consequences of pharmaceutical products (n = 31) or dietary supplements (n = 10) were identified. Purchases were made by people in the 30- to 50-year-old age group in 36% of cases. Prescription medications were implicated in 27% of cases and narcotic and controlled drugs were implicated in 49% of cases. Drug abuse was responsible for harm in 73% of cases, whereas adverse drug reactions occurred in 27% of cases. Nine (22%) patients died as a result of adverse consequences following such purchases. The remaining patients suffered serious adverse events such as seizures, liver damage, and hallucinations.

Conclusions:

An unexpectedly large number of case reports were identified from the literature; however, these reports do not fully illustrate the magnitude of the problem. Life-endangering adverse consequences signify a need for increased regulation and control of Internet Web sites and a need for healthcare provider involvement. Pharmacists should know where their patients obtain medications, how to verify the validity of the sources of prescriptions, and how to report adverse consequences.
PTEC Introduces Executive Director
Authors: Mohr Mary E
Published: September 2013

The education and training requirements for pharmacy technicians is a topic that has elicited much discussion in the past few years. The profession seems to be gravitating toward a consensus that some standards must be established, but there is still disagreement about the exact framework that should be mandated. The Pharmacy Technician Educators Council (PTEC) is committed to providing quality educational experiences to produce an ample supply of skilled, qualified pharmacy technicians to meet the needs of the profession. PTEC has appointed Gail Askew PharmD to the position of executive director to bring an educator's perspective to the discussions about future requirements for pharmacy technicians. Gail brings many years of experience as a pharmacist and technician educator and a unique understanding of the challenges facing the profession and has developed some strategies to begin formulating solutions.
Candida Guilliermondii Fungemia in a Critically III Trauma Patient
Authors: Lockwood Alissa M , Wyatt Katleen N , Abraham Prasad , Montgomery Sean P , Macleod Jana
Published: September 2013

Objective:

To report a case of fungemia caused by Candida guilliermondii in a non-neutropenic 17-year-old critically ill trauma patient.

Case Summary:

Few case reports and small surveys have reported invasive infection caused by C. guilliermondii, most of which has occurred in immunocompromised populations. We present the case of a 17-year-old trauma patient who developed fungemia with C. guilliermondii during his intensive care unit stay. While he had multiple risk factors for the development of candidemia, this was an atypical finding, considering that this patient was not neutropenic. Due to the variable resistance patterns with this species of Candida, mean inhibitory concentration testing was requested, which demonstrated susceptibility to fluconazole. The patient was thus treated with fluconazole and his fungemia resolved without relapse.

Discussion:

C. guilliermondii accounts for 1–5% of cases of non- albicans Candida. While C. guilliermondii typically does not cause invasive infection, it has been associated with severe, life-threatening candidiasis in immunocompromised patients. Due to its low incidence, guidelines for the management of C. guilliermondii infections have not been well established and specific risk factors have not been identified. While risk factors specific to C. guilliermondii may mimic established risk factors for candidal fungemia in general, an important aspect to consider in the treatment of this fungus is its unique resistance profile compared with other non- albicans species.

Conclusions:

This case illustrates the development of an uncommon fungal pathogen in a non-immunocompromised host, compared with previously published cases series. Susceptibility testing is recommended to prevent therapeutic failures due to varying resistance patterns with C. guilliermondii.
The Impact of a Computerized Potassium Alert on Adverse Drug Events and Pharmacists' Interventions
Authors: Mansour Hanine , Dilkhush Dimple , Lannigan Jeffry , Whalen Karen L
Published: September 2013

Background:

Hyperkalemia is one of the most common drug-related electrolyte abnormalities resulting in adverse drug events (ADEs) at our institution.

Objective:

To determine the effect of a computerized pharmacy alert on the number of adverse events related to hyperkalemia in a hospital setting and to study the impact of guidelines and education on pharmacist response to high potassium levels.

Methods:

An alert was built into the pharmacy computer system, which warned pharmacists about a potassium level greater than 5.1 mEq/L when processing an order that could increase potassium. The alert was linked to a trigger medication list. After the alert was implemented, the number of ADEs due to hyperkalemia was compared for the 3 months pre- and postalert. Due to a lack of consistency in pharmacist interventions after implementation of the alert, hyperkalemia management guidelines were developed by the pharmacy department. The staff pharmacists received training on how to address hyperkalemia when processing prescriptions. After the education component was completed, the types of pharmacist interventions made pre- and posttraining were also compared.

Results:

Building an automated pop-up alert resulted in a decreased number of ADEs related to hyperkalemia (p < 0.001) and reduced the utilization of medications needed to treat hyperkalemia (p = 0.019).

Conclusions:

Implementation of a computerized pharmacy alert resulted in a statistically significant decrease in adverse drug events related to hyperkalemia in our institution. Educating pharmacists about hyperkalemia and developing guidelines for its management provided consistency among responses to the high potassium computerized alert. Further studies are needed to evaluate the impact of guideline development and pharmacist education on the trend of drug-induced hyperkalemia in an inpatient pharmacy setting.
Ranolazine's Role in the Treatment of Chronic Stable Angina
Authors: Marrs Joel C , Kramer Wiyanna T
Published: September 2013

Objective:

To evaluate the role of ranolazine as an effective and safe first-line treatment option for the management of chronic stable angina (CSA).

Data Sources:

A literature search was conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane database (publications archived until August 2009) using the terms chronic stable angina and ranolazine. In addition, reference citations from publications identified were reviewed.

Study Selection and Data Extraction:

English-language, randomized, controlled trials evaluating ranolazine extended release (ER) for the treatment of CSA in humans were selected for review. Four randomized controlled trials were identified. Findings pertaining to efficacy and safety were extracted.

Data Synthesis:

Three randomized, placebo-controlled CSA studies (N = 191, N = 823, N = 565) and 1 non-ST-segment elevation acute coronary syndrome (ACS) study (N = 6560) were identified that evaluated ranolazine ER. The 3 CSA studies showed that ranolazine ER treatment resulted in statistically significant improvements in exercise tolerance, time to angina onset, and time to 1-mm ST-segment depression. Two of the 3 CSA studies showed statistically significant reductions in angina episodes per week and nitroglycerin use per week compared to placebo. No significant reduction in cardiovascular events was seen in the non-ST-segment elevation ACS study following 1 year of treatment with ranolazine ER. Evidence has demonstrated that monotherapy with ranolazine ER is effective in increasing exercise tolerance in patients with CSA. Ranolazine ER therapy added to traditional antianginal therapy has shown efficacy in increasing exercise tolerance and minimally decreasing angina frequency in clinical trials.

Conclusions:

Ranolazine ER should be used judiciously in the management of CSA and should not be used as a first-line agent routinely unless traditional therapy is contraindicated.
Investigation of the Potential Effects of Registration Requirements on Florida Pharmacy Technician Credentials
Authors: Wilson Debbie L , Kimberlin Carole L , Brushwood David B , Segal Richard
Published: September 2013

Background:

On June 23, 2008, Florida adopted regulations mandating credentialing requirements for pharmacy technicians.

Objective:

To investigate the Pharmacy Technician Certification Board (PTCB) certified pharmacy technician self-report and pharmacist report of work experience, education, training, and non-PTCB certification credentials of Florida community pharmacy technicians prior to the adoption of registration requirements in that state and to predict the effects of the requirements on Florida pharmacy technicians.

Methods:

A self-administered questionnaire was mailed to 2000 Florida pharmacists and 2000 Florida PTCB Certified Pharmacy Technicians (CPhTs) in 2004.

Results:

Of the 1230 returned questionnaires, 571 (46%) were from pharmacists and 659 (54%) were from technicians. Most of the pharmacists in the sample reported that they had supervised a CPhT, while few had supervised a technician with an AA in Pharmacy Technician Sciences. Most of the technicians sampled reported having some higher education. Less than half reported having formal technician training. Few reported having non-PTCB pharmacy technician certificates.

Conclusions:

Florida pharmacy technicians had some higher education or technician training credentialing, despite its not being mandatory. Pharmacists may not always be aware of the education and credentials of the technicians they supervise. The new registration requirements will most likely have little effect on existing Florida pharmacy technicians who register before January 1, 2011. Those who are CPhTs will have to complete types of continuing education that are different from those that they were required to complete for certification. Those who are not CPhTs will have to complete continuing education programs.