bluuebunny/crossref_metadata_2025 huggingface dataset:
CCP Pharmacy Technician Credentialing Framework: Commentary
Authors: Stuhan Mary Ann
Published: September 2013

The Council on Credentialing in Pharmacy (CCP) has formulated and published a Pharmacy Technician Credentialing Framework that offers a clear and detailed plan for a uniform national system of regulating pharmacy technician registration, training, and competency assessment in the US. Based on standardizing currently available instruments, including a task analysis, model curriculum, training program accreditation, and adoption of a psychometrically sound competency examination, the framework is a proposal endorsed by a broad range of pharmacy groups and practice areas and represents a consensus model on which progressive future measures can be based if it is widely accepted and adopted.
Establishing a Central Order Entry System for Delivering Telepharmacy Services to Remote Rural Hospitals
Authors: Peterson Charles D , Scott David M , Rathke Ann , Killingsworth Patricia , Hill George
Published: September 2013

Background:

Smaller, critical access hospitals continue to be challenged in finding sufficient pharmacist staffing to deliver quality pharmacy services. Innovative solutions are being explored, including use of technology, to address the problem of access to pharmacy services in remote rural areas.

Objective:

To describe a new telepharmacy model that is being developed in North Dakota; the model establishes a central order entry site (COE site) that provides 24-hour pharmacist staffing and telepharmacy services to rural critical access hospitals within the state.

Methods:

Nine rural hospitals in North Dakota established a contractual agreement with a pharmacist-staffed COE site in Fargo to obtain pharmacist staffing and pharmacy services via telepharmacy delivery.

Results:

All 9 rural hospitals receiving telepharmacy services from the Catholic Health Initiatives (CHI) COE site are critical access hospitals with 25 beds or less and an average of 6625 community population (range 470–16,010); 9986 doses filled per month (range <100–21,000); 1.8 full-time equivalent staff (FTE) pharmacists (range 0–4.6); 1.5 FTE technicians (range 0–3.0); and 0700 hours-1700 hours Monday through Friday service (range consultant pharmacist by phone 24/7 to 0700 hours-2000 hours Monday through Friday, and 0800 hours-1700 hours weekends and holidays). Six are CHI affiliates and 3 are non-CHI hospitals; 4 are Joint Commission accredited. The telepharmacy technology costs at each rural hospital were $25,300.

Conclusions:

A telepharmacy model that involves a COE site that provides 24-hour pharmacist staffing with pharmacists who are highly trained and skilled in use of telepharmacy technology and dedicate their full-time jobs to delivery of telepharmacy services to remote rural hospitals is an affordable means of delivering pharmacy services to these hospitals.
Description of a Medication Disposal Event in a Managed Care Setting
Authors: Pervanas Helen C , Cooper Maryann R , Lenza Robert
Published: September 2013

Background:

Consumers are often unaware of the best means of disposing of unwanted medications. The White House Office of National Drug Control Policy (ONDCP) recommends that unwanted medications be removed from the original container, mixed with an undesirable material, and disposed of in the trash. If followed, these guidelines should minimize environmental contamination, poisonings, and diversion that can result from improper medication disposal. ONDCP also recommends that consumers take advantage of medication collection programs in their communities.

Objective:

To describe the steps involved in implementing a medication disposal event in a managed care setting, report collection results, and describe lessons learned.

Methods:

A medication disposal event was organized and implemented at a health plan facility on Earth Day, April 22, 2009, to give consumers an opportunity to dispose of their expired or unused medications in a safe and environmentally appropriate manner. During the event, consumers were directed to drive to the facility and dispose of their medications without exiting their vehicles. Pharmacists, student pharmacists, health plan employees, and local police collaborated to collect and properly dispose of the medications after they were categorized and documented as controlled substances, noncontrolled substances, or hazardous waste pharmaceuticals. Educational materials explaining the proper and safe disposal of medications were distributed to all consumers.

Results:

The event resulted in the collection of a total of 41,601 units of medications weighing approximately 100 lbs. Of those medications, 96% were noncontrolled substances, 3% were controlled substances, and 1% were classified as hazardous waste pharmaceuticals.

Conclusions:

A medication disposal event can be implemented by pharmacists in collaboration with outside agencies to allow for appropriate disposal of medications, aiding in the prevention of drug diversion and environmental contamination. A stepwise approach was outlined allowing for the event to be replicated in a community setting.
The Role of Antioxidants on Oxidative Stress in Diabetes Mellitus
Authors: Bennett Lunawati L , Seefeldt Teresa
Published: September 2013

Objective:

To evaluate the literature on the role of oxidative stress in diabetes mellitus and search sources of promising antioxidants: pharmaceutical, dietary supplements, or investigational compounds.

Data Sources:

A preliminary literature search of PubMed (1966-June 2010) was performed, using the MeSH database when possible, with the terms antioxidants, oxidative stress, antioxidants and diabetes, insulin resistance, and antioxidants and diabetic neuropathy. Bibliographies of all articles retrieved were also reviewed.

Study Selection and Data Extraction:

All studies published in English with data describing the role of antioxidants and oxidative stress in humans or animals were included.

Data Synthesis:

Oxidative stress plays a significant role in the pathogenesis of diabetes and insulin resistance. α-Lipoic acid (ALA) and N-acetylcysteine (NAC) were shown to be potent antioxidants in several clinical trials, including the SYDNEY trial, SYDNEY 2 trial, and ALADIN III study, in diabetes with albuminuria, and in women with polycystic ovarian syndrome.

Conclusions:

ALA and NAC supplementations, along with a well-balanced diet rich in fruits and vegetables containing antioxidants, provide a potential approach in the treatment of diabetes associated with oxidative stress.
Focus on Methylnaltrexone: A Selective Mu-Opioid Receptor Antagonist for the Treatment of Opioid-Induced Constipation
Authors: Ndefo Uche Anadu , Erowele Goldina Ikezuagu
Published: September 2013

Objective:

To review the literature available on the use of methylnaltrexone, a peripherally acting quaternary opioid antagonist, approved for the treatment of opioid-induced constipation (OIC) in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient.

Data Sources:

Primary literature and review articles were obtained via a MEDLINE search (1992–2009), using the key term methylnaltrexone. Additional articles were identified from the bibliographies of reviewed literature.

Study Selection and Data Extraction:

English-language articles identified from the data sources were reviewed. Randomized controlled trials were evaluated to assess the efficacy of methylnaltrexone.

Data Synthesis:

Opioids are the cornerstone of therapy for moderate-to-severe pain in patients with serious illness. The prevalence of OIC approaches 90% of patients with advanced illness. The symptoms associated with constipation include abdominal pain and distention, nausea and vomiting, and anorexia. For patients, this can become a significant source of distress and pain. Complications associated with fecal impaction, such as incontinence and confusion, may occur. OIC is currently managed with a variety of commercially available laxatives, stool softeners, suppositories, or enemas; however, they may be compromised by poor response, adverse effects such as bloating or cramping, or other outcomes that may impair quality of life, such as pill burden or unpredictable timing of laxation. Naloxone, an opioid antagonist, has been considered for the treatment of refractory OIC. It has low oral bioavailability but the relatively high doses required and variations in individual sensitivity to the drug may result in enough systemic absorption to reverse analgesia or induce central nervous system opioid withdrawal. To avoid these centrally mediated effects, new compounds that have little ability to cross the blood-brain barrier have been developed. Methylnaltrexone is a peripherally acting quaternary opioid antagonist approved for the treatment of OIC. It does not cross the blood-brain barrier in humans and offers the therapeutic potential to reverse adverse effects of opioid pain medications mediated by receptors peripherally located (eg, in the gastrointestinal tract). This effect is critical because it spares the opioid effects mediated at receptors in the central nervous system, most importantly analgesia, and has been proven to be effective in the treatment of OIC.

Conclusions:

Methylnaltrexone appears to be an effective treatment option for OIC.
Pharmacists' Assessment of Facets of Health Literacy in Pharmacy Practice Settings
Authors: Bradley-Baker Lynette R , Mullins C Daniel , Baquet Claudia R
Published: September 2013

Background:

There is limited research on the scope of health literacy practices employed by front-line providers such as pharmacies. Given the challenge of health literacy aspects in today's society, an analysis of health literacy practices provided in pharmacy settings is warranted.

Objective:

To investigate how pharmacists assess their primary practice setting for attributes related to health literacy.

Methods:

An invitation to complete an online survey was sent to a random sample of 1,000 pharmacists practicing in ambulatory-based practice settings in Maryland. A follow-up reminder postcard was sent a month after the initial invitation. The online survey was available for 3 months. The survey instrument was based on the Agency for Healthcare Research and Quality (AHRQ) Pharmacy Health Literacy Assessment Tool. The health literacy areas explored in this study include print materials, verbal communication techniques, and sensitivity to health literacy-related issues.

Results:

Of the 1000 pharmacists sent the survey, 160 responded to the survey invitation; 113 were able to complete the entire survey. Most (56%) of the respondents were older than 40 years and 68% worked in community pharmacy settings. Pharmacists who completed formal health literacy training and those in community pharmacy practice appeared to provide greater access to easy-to-read printed materials in their health-care settings and were willing to provide competent verbal consultation about medications. Such services are specifically amenable to patients with limited health literacy. This study is limited by the low response rate and by not being generalizable to ambulatory pharmacy settings throughout the US.

Conclusions:

This study provides insight into the potential for health literacy issues to impact care provided in ambulatory pharmacy practice settings. Pharmacists need additional training regarding health literacy, such as methods to improve communication with patients who have limited health literacy.
Drug Diversion and Abuse by Health-Care Staff: Facing the Hushed Epidemic
Authors: Meyer Meagan L , Meyer Tricia A
Published: September 2013

Objective:

To increase pharmacy technician awareness of substance abuse and diversion in the health-care setting.

Data Sources:

A literature review of PubMed (September 2004-present) was performed. The 2008 Texas State Board of Pharmacy Annual Report was also reviewed.

Study Selection and Data Extraction:

There was a limited number of articles available, with most being from nursing and physician literature.

Data Synthesis:

The abuse and diversion of controlled substances by health-care professionals is a growing problem. With over 13% of the employed population having substance abuse problems, and higher rates seen with health-care professionals, the problem has become a quiet epidemic. Most impaired health-care workers exhibit typical behaviors, such as volunteering to work with controlled substances; having unwitnessed medication losses, waste, or spills and requesting to work less supervised shifts. Health-care workers should know the signs and symptoms of drug abuse in order to alert management to the possible problem. State and federal agencies outline requirements for reporting diversion. Substance abuse is a complex disease that chemically alters the function of the brain. Treatment of the substance abuser involves stopping the drug, maintaining a drug-free state, and rebuilding a life without drugs.

Conclusions:

Coworkers frequently observe substance abuse behaviors and can alert management in helping to prevent the problem from escalating and harming patients. Addicted staff members who are not helped can harm themselves, patients, the workplace, and their profession.
Point-of-Sale: A Review of Home Blood Glucose Meters
Authors: Vo Ty , Foeppel Melanie Petilla , Flynn Devon
Published: September 2013

Objective:

To provide pharmacy technicians with a review of selected home blood glucose meters, enabling them to be more effective in aiding patients at the point-of-sale.

Data Source:

Primary literature and review articles were identified by searching MEDLINE (1950–September 2010) and Google Scholar, using the key terms glucometers, glucose meters, home glucose meters, blood glucose meters, blood glucose monitoring, and self-monitoring of blood glucose. Additional articles were identified from the bibliographies of obtained literature. User manuals were obtained from the manufacturers' Web sites to determine specific characteristics for each blood glucose meter.

Study Selection and Data Extraction:

Reviewed literature was restricted to English-language articles. Blood glucose meter reviews have mostly compared standard meter functions. Eleven meters were selected for review and identified as currently marketed by their manufacturers and commonly sold in community pharmacies.

Data Synthesis:

Eleven home blood glucose meters, by Abbott, Bayer, LifeScan, and Roche, were selected for review. The selected meters have a wide range of features. They are mostly differentiated by meter size and shape, blood sample size, second blood drop allowed, coding, memory capacity, and advanced features that allow patients to customize the settings.

Conclusions:

There is a variety of home blood glucose meters on the market. When aiding patients with blood glucose meter selection, the best meter should include all of the features that address their monitoring needs.
Medication Repurposing: New Uses for Old Drugs
Authors: Hong Irene Seunghyun , Ipema Heather J , Gabay Michael P , Lodolce Amy E
Published: September 2013

Background:

Medication repurposing, the practice of using old drugs in new ways, is becoming more common. Old drugs that had previously fallen out of favor due to safety concerns, lack of efficacy, or development of more desirable therapeutic alternatives have been resurfacing in the literature and on pharmacy shelves. Developing new uses for old drugs may provide patients with access to helpful therapies but may also present challenges and risks.

Objective:

To explore the rationale for, and historical context of, the developing trend of recycling existing drugs for new, innovative uses, and to provide pharmacy practitioners with information about how to find clinical evidence regarding these new uses.

Data Synthesis:

The process of obtaining marketing approval for new drugs can take an average of over 10 years and exceed $1 billion. Repurposing old drugs (both approved and unapproved) for new uses requires considerably fewer resources since information about production needs, pharmacology, and pharmacokinetics is already known. Other advantages of using old drugs include faster availability for patient use and known safety concerns for the original indication. Disadvantages of new uses for old drugs may include lack of clinical evidence, unknown safety for the new clinical context, limited availability of information about new uses, and liability or legal concerns. Several methods of identifying potential new uses exist, including the observance of previously unknown desirable pharmacologic effects during clinical use, new knowledge of a mechanism of action leading to exploration of innovative therapeutic areas, or screening compound libraries for targeted clinical activity.

Conclusions:

There are many examples of recycling existing medications for new purposes. Pharmacy practitioners should be aware of this developing trend and know how to find information about utilizing old drugs in new ways.
Cefepime Neurotoxicity in an Adolescent Cystic Fibrosis Patient with Aminoglycoside-Induced Acute Kidney Injury
Authors: Nichols Kristen R , Brown Danielle M , Knoderer Chad A , Andreoli Sharon P
Published: September 2013

Objective:

To describe a case of cefepime neurotoxicity in an adolescent with cystic fibrosis and aminoglycoside-associated acute kidney injury (AKI).

Case Summary:

A 15-year-old, 46-kg male with cystic fibrosis (CF) and chronic sinusitis was admitted to the hospital for CF exacerbation. The patient was subsequently discharged to complete home antibiotic therapy with intravenous gentamicin and cefepime. Thirteen days after discharge, while still receiving intravenous antibiotics, the patient presented to an outside hospital complaining of vomiting, fatigue, decreased appetite, and decreased urine output. The patient was diagnosed with AKI and was transferred to our institution, where he displayed signs and symptoms consistent with encephalopathy. Encephalopathy was thought to be consistent with cefepime-associated neurotoxicity. After 2 hemodialysis sessions, the encephalopathy resolved. Over the course of admission, the patient's renal function improved.

Discussion:

This patient experienced neurotoxicity thought to be secondary to cefepime in the setting of AKI. Aminoglycoside therapy most likely led to the AKI. We believe that our patient represents the fourth pediatric patient with cefepime-associated encephalopathy described in the literature and the second without chronic renal dysfunction.

Conclusions:

Children receiving cefepime should be monitored for AKI. In the presence of AKI, cefepime doses may need to be adjusted and the patient should be monitored for signs and symptoms of neurotoxicity.
Attendance and Academic Success: High School Seniors Concurrently Enrolled in an Allied Health Program on a College Campus
Authors: Liles Janet M
Published: September 2013

Background:

Achieving academic success in a college environment invokes different meanings among faculty, administrators, and students. Within this study, academic success is defined as adherence to the college's established attendance policy and didactic grades equal to 2.0 (70%) or above on a 4-point scale. The impact of attendance on academic success is observed through an examination of motivation in a cohort of high school seniors concurrently enrolled in an allied health program.

Objective:

To determine the correlation, if any, of attendance on final grades in a cohort of high school seniors concurrently enrolled in an allied health program. An analysis of motivation was included to give perspective to the behavior of students in this program.

Methods:

Grades and attendance for each student were recorded and analyzed using the correlation analysis tool within Microsoft Excel. High school students concurrently enrolled in an allied health program were given the Academic Motivation Scale (AMS), benchmarking motivation, during the initial class meeting of the 2009–2010 academic year to further understand students' behavior. Data from the AMS were collected and analyzed by members of the institutional research group at the participating university, using Microsoft Excel.

Results:

During the 2009–2010 academic year, the mean rate of absence for the cohort was 4.55 and the mean grade point average was 2.17. The Pearson r correlation between absences and grades was −0.80 and the coefficient of determination was 0.64. Students within this cohort were academically successful, achieving grade point averages of 2.0 and above. The highest marks on the AMS were in the categories of Identified Regulation (knowing that outcomes are under your control and are determined by hard work, personal attributes, and good decisions) and External Regulation (understanding that outcomes are outside of your control and are independent of hard work and good decisions). This cohort ranked the category Amotivation lowest.

Conclusions:

Motivation appears to have supported academic success in this group of students. However, the attrition rate and small sample size in this study do not yield rich data that may be generally applied to high school students concurrently enrolled in an allied health program.
Outcomes of a Comprehensive, Pharmacist-Managed Injectable Anticoagulation Discharge Program for the Prophylaxis and Treatment of Venous Thromboembolism
Authors: Reger Melissa A , Chapman Jamie L , Lutomski Dave M , Mueller Eric W
Published: September 2013

Background:

Safe and effective transition of patients receiving injectable anticoagulation, from an inpatient to an outpatient setting, requires patient education, prescription coordination, and appropriate follow-up.

Objective:

To evaluate a long-standing, hospital-wide, pharmacist-managed injectable anticoagulation discharge program at an urban academic medical center.

Methods:

This observational study included adults discharged on an injectable anticoagulant between December 1, 2008, and February 28, 2009. The primary endpoint was program adherence, defined as percent of discharged patients whose anticoagulation therapy was coordinated by a pharmacist. Secondary endpoints included duration of patient counseling and medication procurement (including confirmation of current home supply or need for complete procurement of a full/new prescription); length of hospital stay for patients with a primary diagnosis of venous thromboembolism (VTE); and VTE recurrence and bleeding rates at 3 months. Descriptive statistics were used and are presented as proportions and mean (SD).

Results:

A total of 207 patients discharged on an injectable anticoagulant (3.2 discharges/day) were included. Pharmacist coordination was documented for 180 (87%) patients. Overall, pharmacists spent 37.6 (25.5) minutes per patient, including 19.4 (9.6) minutes for counseling and 19.7 (19.7) minutes for medication procurement; 150 (83%) patients required complete medication procurement lasting 21.4 (19.6) minutes. The length of hospital stay for patients with a primary diagnosis of VTE was 3.2 (2.4) days. At 3 months, 5.3% and 1.4% of assessable patients had recurrent VTE or major bleeding events, respectively. Patients with major bleeding experienced intracranial hemorrhage (n = 2) and gastrointestinal bleeding (n = 1), all beyond the first 2 weeks after discharge.

Conclusions:

The pharmacist-managed injectable anticoagulation discharge program was completed in a large proportion of patients. Patient education and medication procurement require the majority of time-related resources. Continual process improvement is crucial for hospitals to ensure that all patients discharged with injectable anticoagulation are assessed and receive anticoagulation education.
Controlled Substance Prescriptions after the New e-Prescription Regulations
Authors: Schneider Kent N , Schneider Trudy E
Published: September 2013

The Drug Enforcement Administration (DEA) issued regulations authorizing electronic prescriptions (e-prescriptions) for controlled substances; the regulations first became effective on June 1, 2010. Overshadowed by the health care reform legislation enacted by Congress earlier that year, these groundbreaking regulations have been overlooked by many in the health care community. To focus attention on these new regulations, this article first describes e-prescribing costs and benefits that are expected to accrue, not only to the pharmacist, but also to the DEA, prescribers, and the general public. This information will allow independent pharmacy owners and supervising pharmacists at institutions to make more informed decisions as to whether to implement e-prescriptions for controlled substances. In addition, this article explains how the new e-prescription rules are integrated into the preexisting controlled substance regulations, providing a comprehensive overview of the pharmacist's obligations when presented with any type of controlled substance prescription. This approach is intended to make these new regulations more accessible to all pharmacists, but especially to those who are new to the profession.
Aliskiren Alone or in Combination for the Treatment of Mild-to-Moderate Hypertension: Current Role and Future Perspectives
Authors: Lillyblad Matthew P , Knutson Alison R , Philbrick Ann M , Westberg Sarah M
Published: September 2013

Objective:

To evaluate the current role of aliskiren, a direct renin inhibitor, in the pharmacologic treatment of essential hypertension.

Data Sources:

A literature search of OVID MEDLINE and PubMed (both from 1950 through November 1, 2011) using the terms aliskiren and efficacy was conducted. In addition, reference citations from publications identified were reviewed.

Study Selection and Data Extraction:

All articles in English comparing aliskiren or an aliskiren-based regimen with another antihypertensive pharmacotherapy regimen in humans were identified. Articles were selected if they were on randomized controlled trials with blood pressure reduction as their primary objective. Trials included over 100 patients with mild-to-moderate essential hypertension.

Data Synthesis:

Aliskiren has been studied against or in combination with hydrochlorothiazide, amlodipine, ramipril, losartan, irbesartan, valsartan, and atenolol. It is statistically superior to hydrochlorothiazide and ramipril at lowering blood pressure, and equally as effective as losartan, irbesartan, and atenolol, with a similar safety profile. Aliskiren is an effective add-on agent to valsartan, amlodipine, and atenolol therapy. Although aliskiren is beneficial, alternative agents exist that can be used with similar efficacy for lower cost.

Conclusions:

Aliskiren is an effective antihypertensive agent, used either as monotherapy or in combination with other antihypertensive medications. The lack of evidence for long-term morbidity and mortality benefits makes it difficult to consider aliskiren a primary agent for the treatment of hypertension. The completion of the ASPIRE HIGHER program, a collection of trials whose aim is to demonstrate short- and long-term benefits of aliskiren on end-organ damage, is needed to justify the use of aliskiren other than as a last-line antihypertensive agent.
Severe Hypoglycemia from Patient Misuse of Insulin Glargine Pen
Authors: Pham Antony Q , Borno Lana T , Pham Diane A
Published: September 2013

Objective:

To report a case of severe hypoglycemia resulting from a patient's misuse of an insulin glargine pen.

Case Summary:

A 61-year-old male with a history of diabetes mellitus type 2 (T2DM), obesity, hypertension, end-stage renal disease, and systolic heart failure was admitted to the emergency department (ED) for severe hypoglycemia. The patient's treatment was recently switched from insulin glargine to an insulin glargine pen and had mistakenly injected the entire insulin pen. He was found lethargic and unresponsive at home and was brought into the ED with an initial blood glucose level of 11 mg/dL. He was given 6 ampules of dextrose 50% in the ED, started on a dextrose 10% infusion and was subsequently transferred to the medical intensive care unit (MICU). Throughout his stay in the MICU, the patient received a dextrose 20% infusion and a total of 11 ampules of dextrose 50% to keep his blood glucose level above 100 mg/dL. After a 6-day hospital course, the patient was stabilized and was discharged on sitagliptin.

Discussion:

The concern for hypoglycemia is present for any patient receiving insulin therapy. A MEDLINE search revealed the rates of hypoglycemia from insulin glargine but we found no previously described cases of severe hypoglycemia due to patient misuse of an insulin glargine pen. Our patient mistakenly injected the entire contents of the pen and became unresponsive and severely hypoglycemic. The long duration properties of insulin glargine likely prolonged the patient's hospital course. According to the Naranjo scale, the adverse reaction experienced by our patient was highly probable.

Conclusions:

Medication changes can be confusing for patients, and pharmacists have a unique opportunity to counsel and educate patients on the proper use of their medications, thus helping to prevent adverse events such as hypoglycemia from improper use of an insulin glargine pen.
Health Perception Changes of State Employees following a Health Screening Event
Authors: Pervanas Helen C , Silva Matthew A , Willett Kristine C , Cooper Maryann R , Durand Cheryl , Belliveau Paul , Abel Cheryl
Published: September 2013

Background:

Health screenings can identify patients at risk for chronic medical conditions. Additionally, screenings may influence behavior changes as depicted by the Health Belief Model.

Objective:

To examine the perceptions of state employees regarding their health and risk for medical conditions, assess whether unexpected or abnormal screening results will impact perceptions, and identify barriers to scheduling an annual physical examination.

Methods:

State employees participated in screenings for diabetes, dyslipidemia, and osteoporosis. Participants were asked to complete a pre- and post-survey. Pre-survey questions gathered information on demographics, chronic medical conditions, perception of overall health, and willingness to have an annual physical examination. The post-survey assessed self-health perceptions based on screening results, their risk for chronic medical conditions, and the likelihood that the screening results would encourage scheduling a provider appointment.

Results:

One hundred twenty-six of 128 (98.4%) employees completed the survey. Thirty-five percent of employees had cholesterol levels >200 mg/dL and 23% had T-scores less than or equal to −1.0. When asked about preexisting medical conditions, 40% of those with elevated cholesterol levels reported that they had high cholesterol, and 5% with low T-scores stated that they had osteoporosis. Following the screenings 54% and 55% responded that they were at risk for high cholesterol (p = 0.02) and osteoporosis (p < 0.001), respectively. Participants who reported having had no annual physical examination but who planned to schedule a visit as a result of their screening had a higher total cholesterol level than those who reported annual physical examinations prior to the screening (207 ± 42.6 mg/dL vs 189 ± 33.2 mg/dL; p = 0.03).

Conclusions:

Health screenings increased awareness of dyslipidemia and osteoporosis among state employees. Higher than normal cholesterol results influenced health perceptions and encouraged respondents to schedule a provider visit.
Comparing Medication Adherence Methods in Lipid-Modifying Therapy
Authors: Lafleur Joanne , McAdam-Marx Carrie , White George L , Lyon Joseph L , Oderda Gary M
Published: September 2013

Background:

Investigators have employed a number of different methods to calculate adherence estimates for patients taking lipid-modifying therapy (LMT), including measures with different numerator and denominator options. Although at least one method is known to correlate well with cardiovascular outcomes, most have not been evaluated in outcomes studies.

Objectives:

To evaluate different methods for measuring adherence, using LMT as a case example, and to determine whether estimates for adherence differ statistically and/or whether different methods can lead to different conclusions about patient adherence.

Methods:

Adherence ratios were calculated using 8 different methods for 12,448 patients who were in a managed-care system and were considered new starts with statin therapy. The calculated measures were compared and tested for differences. Patients were categorized as adherent by each method, using a threshold of 0.8, and the proportions of patients categorized as adherent were compared for differences between adherence calculation methods.

Results:

Adherence ratios calculated with like observation intervals did not vary substantially, regardless of which method for measuring medication availability was used. Those calculated with different observation intervals had substantial variability. Mean adherence ratios ranged between 0.777 and 0.798 for difference in days' observation intervals; they ranged between 0.618 and 0.630 for the predefined interval. Differences between ratios calculated using these different denominators were statistically significant (p < 0.008). Correlations between ratios were statistically significant for all comparisons (p < 0.001). Correlation coefficients ( r) were 0.64 for comparisons between ratios with different denominators versus 1.0 for comparisons with like denominators. Categorization as adherent or nonadherent differed between the methods for about 20% of patients.

Conclusions:

Significant differences were found to be based on observation period but not on medication availability. Studies of adherence should be interpreted with caution depending on which method is used, and particular interest should be paid to whether the choice of methods is consistent with study objectives and to the observation interval, as different methods may lead to different conclusions about patient adherence. Further research in LMT and other therapeutic areas is needed to determine which methods correlate best with positive patient outcomes, such as reductions in low-density lipoprotein cholesterol and cardiovascular events.
Identifying Physical Assessment Skills and Their Relative Importance in Faculty-Based Pharmacy Practice Settings within the Same Region
Authors: Mistry Amee D , Machado Matthew R
Published: September 2013

Background:

As pharmacy educators, it is the responsibility of the faculty to prepare student pharmacists, through education, for the variety of opportunities that will be available to them after graduation. This education can be provided by incorporating standards set forth by the Accreditation Council on Pharmacy Education (ACPE), as well as by working with fellow educators at other schools of pharmacy within the region or across the country. This article summarizes data collected regarding physical assessment skills from pharmacy practice faculty within the Northeast region.

Objective:

To identify how often physical assessment skills are applied and their importance to pharmacy practice faculty practicing in various pharmacy settings, to use the data collected from pharmacy practice faculty to standardize which physical assessment skills should be used for training student pharmacists, and to use the collected data to assist in the development of guidelines that highlight core competencies in physical assessment that are in accordance with ACPE Accreditation Standards and Guidelines and that student pharmacists should be able to perform upon graduation.

Methods:

A physical assessment survey was mailed to pharmacy practice faculty at schools of pharmacy in the Northeast region. The survey asked faculty members to rate 2 parameters for each skill: how often a skill is used at their own practice site, and the importance of that skill to teach student pharmacists to use in the future.

Results:

A total of 238 surveys were mailed to pharmacy practice faculty in the Northeast region; 81 surveys were returned to the primary investigator. The data collected indicated a wide spread of opinions among faculty members regarding physical assessment.

Conclusions:

Although physical assessment skill is a required competency set forth by the ACPE Accreditation Standards and Guidelines, there is a wide variety of skills that pharmacy practice faculty feel are important to teach student pharmacists.
Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study
Authors: Lee David Sh , De Rekeneire Nathalie , Hanlon Joseph T , Gill Thomas M , Bauer Douglas C , Meibohm Bernd , Harris Tamara B , Jeffery Sean M
Published: September 2013

Background:

Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity.

Objective:

To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications.

Methods:

In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing.

Results:

The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0–66). The median OTC mMRCI score was 4 (range 0–71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment.

Conclusions:

In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
Increased Warfarin Requirements during Concurrent Dicloxacillin Therapy
Authors: Kohman Kelsey N , Dunn Rebecca L , Smith Winter J
Published: September 2013

Objective:

To report on a patient who required increased dosages of warfarin to achieve therapeutic anticoagulation while taking dicloxacillin.

Case Summary:

A 60-year-old woman was hospitalized for an infected lymphocele and cellulitis. Based on microbiology results, dicloxacillin 500 mg by mouth 4 times daily was initiated to complete 14 days of treatment. Concurrently, a deep vein thrombosis was diagnosed by computed tomography angiography. Enoxaparin 100 mg subcutaneously twice daily and warfarin 5 mg by mouth daily were initiated with an international normalized ratio (INR) goal of 2–3. The patient had a history of a supratherapeutic INR while on warfarin 5 mg daily. Throughout the 20-day hospitalization, her warfarin dose was steadily increased in an attempt to achieve a therapeutic INR. Required doses ranged from 7.5 to 15 mg daily. Two days after discontinuation of dicloxacillin and with administration of a 15-mg warfarin boost, the INR was therapeutic at 2.3. Enoxaparin was discontinued and the patient was discharged on warfarin 7.5 mg daily. Upon clinic follow-up 5 days after discharge, the INR was supratherapeutic at 3.3 and the warfarin dose was decreased. The patient was then lost to follow-up.

Discussion:

This interaction between warfarin and dicloxacillin has been described in the literature; however, the mechanism responsible remains unknown. In all cases reported, increased warfarin requirements appeared after several days of dicloxacillin therapy and slowly disappeared after dicloxacillin discontinuation. This case differs from previously reported cases because it demonstrates warfarin resistance associated with dicloxacillin and a subsequent new initiation of warfarin therapy. The Naranjo probability scale and the Horn Drug Interaction Probability Scale both rate this interaction as probable.

Conclusions:

Patients taking dicloxacillin who are initiated on warfarin may require a longer duration of concurrent low-molecular-weight heparin therapy, as well as higher doses of warfarin, and may take longer to achieve a therapeutic INR.
Docetaxel-Associated Paroxysmal Atrial Fibrillation in a Patient Receiving Docetaxel Plus Cyclophosphamide (TC) Therapy
Authors: Myers Leslie J , Ho Yuan Yuan G
Published: September 2013

Objective:

To report a case of paroxysmal atrial fibrillation in a patient who was receiving a chemotherapy regimen including docetaxel plus cyclophosphamide (TC).

Case Report:

A 67-year-old woman was receiving TC therapy for stage IIB breast cancer. She developed symptomatic paroxysmal atrial fibrillation following chemotherapy administration. The patient presented with tachycardia-palpitations, a shaking sensation inside her body, shortness of breath, and tightness in her chest that did not radiate. Propafenone treatment was replaced with sotalol. Cycle 2 of chemotherapy was administered and symptoms of atrial fibrillation returned. Sotalol was switched to dronedarone monotherapy and the symptoms resolved.

Discussion:

Based on the Naranjo probability scale, chemotherapy was the probable cause of the patient's episodes of paroxysmal atrial fibrillation.

Conclusions:

As single agents, taxanes have minimal cardiac toxicity, although cardiac toxicity may be higher with precipitating factors. Clinicians caring for patients receiving taxane chemotherapy should be aware of the potential for docetaxel-induced paroxysmal atrial fibrillation.
Risk of Spontaneous Bruising with Concomitant Use of Nonsteroidal Antiinflammatory Drugs and Citalopram
Authors: Desilets Alicia , Willett Kristine C , Waller Dustin , Barry Ann
Published: September 2013

Objective:

To report a case of spontaneous bruising with concomitant use of nonsteroidal antiinflammatory drugs (NSAIDs) and citalopram.

Case Summary:

A 34-year-old white woman with a history of chronic thrombocytopenia (baseline platelet count 120–130 × 103/μL) presented to the emergency department (ED) after noticing an increase in bruising on her upper and lower extremities. When the patient was interviewed, it was found that her dose of citalopram had been recently increased from 20 to 40 mg/day and she had started ibuprofen (dose unknown) on her own to manage rib pain approximately 1 month after the citalopram dosage increase. The patient was advised to discontinue ibuprofen and was discharged. Shortly thereafter, she was started on oxaprozin 600 mg twice daily for management of trochanteric bursitis. She returned to the ED stating that bruising occurred 1 week after she was given oxaprozin. At this visit, the patient was told to discontinue oxaprozin and naproxen 440 mg twice daily was prescribed. One week later, the patient again returned to the ED with complaints of spontaneous bruising. At this point citalopram and naproxen were discontinued and she was started on acetaminophen (dose not documented) and buspirone 10 mg twice daily. No other episodes of ecchymosis have occurred in the 8 months since this change to her drug regimen.

Discussion:

Medications that increase the risk of bleeding should be carefully administered in patients who have a low platelet count. This patient experienced bruising when her dose of citalopram was increased and an increase in bruising when she combined an NSAID with citalopram. Selective serotonin reuptake inhibitors (SSRIs) may increase antiplatelet activity of NSAIDs and could therefore increase the risk of bruising. Use of the Horn Drug Interaction Probability Scale indicated a possible interaction with concomitant use of NSAIDs and citalopram.

Conclusions:

Patients who experience NSAID- and/or SSRI-related bruising should consult their providers and alternative treatments should be considered.
Urban and Suburban Community Pharmacists' Experiences with Part D—A Focus Group Study
Authors: Khan Shamima
Published: September 2013

Background:

With the enactment of Medicare Part D, the provision of drug coverage for senior citizens in the US has changed permanently. Not much is currently known about the impact of Part D on urban and suburban pharmacies.

Objective:

To explore community pharmacists' experiences with Medicare Part D in urban and suburban areas of New York City and adjacent Long Island.

Methods:

Seven focus groups were held between January 2010 and December 2010, 6 of which were held on St. John's University campus. A convenience sample of pharmacists practicing in chain and independent settings participated in the study. Participation was voluntary and anonymous.

Results:

Thirty pharmacists participated in the study. They reported that patients are facing challenges in reference to Part D, even 4 years after implementation of the program. Patients are often limited by their lack of computer skills, language skills, or level of education. Pharmacists also reported facing financial challenges because of “slow and low” reimbursement. Pharmacists were also dispensing more prescriptions, dealing with multiple plans, a variety of formularies, different copayments, and various prior authorization procedures.

Conclusions:

With regard to Medicare Part D, the challenges faced by pharmacists practicing in some of the urban and suburban areas of New York State are somewhat comparable to those faced by pharmacists practicing in rural areas. Although the financial impact has been more detrimental to independently owned pharmacies, pharmacists practicing in chain settings expressed concerns.
Tigecycline-Induced Acute Pancreatitis with Rechallenge: A Case Report
Authors: De Mesa Charles , Dajoyag-Mejia Maria A , Issac Regina , Darouiche Rabih O
Published: September 2013

Objective:

To report a case of tigecycline-induced acute pancreatitis.

Case Summary:

A 50-year-old African American man with spinal cord injury was hospitalized on 2 occasions for recurrence of an infected pressure ulcer requiring systemic antibiotic therapy. Bone and tissue cultures from his initial hospitalization grew multidrug resistant (MDR) Acinetobacter baumanii sensitive to tigecycline. He was treated with intravenous tigecycline on these 2 occasions (50-mg infusions every 12 hours), each of which resulted in significant elevation in serum amylase (to 615 U/L and 715 U/L) and lipase (to 325 U/L and 616 U/L) levels. On each occasion, the pancreatic enzymes became normal after discontinuing tigecycline.

Discussion:

Tigecycline is the first FDA-approved drug in the class of antibiotics called glycylcyclines, which are developed from tetracyclines to afford broad coverage against certain resistant gram-positive and gramnegative bacteria. It is recommended for patients at least 18 years of age for treatment of complicated intraabdominal infections, community-acquired bacterial pneumonia and complicated skin and skin structure infections caused by susceptible organisms. Tigecycline-induced pancreatitis is a rare adverse event. Review of the literature yielded only 6 prior documented cases (5 adult and 1 pediatric cases). Although the pediatric case demonstrated rechallenge, the patient concurrently received other antibiotics that are known to cause pancreatitis.

Conclusions:

This is the first report, to our knowledge, of pancreatitis associated with monotherapy with tigecycline, and this relationship was confirmed upon rechallenging our patient with tigecycline. An objective causality assessment revealed that the adverse-drug-associated event was definite.