bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.