bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pharmacotherapy Clinic in a Neurologic Practice
Authors: Swims Melanie P , Reed Pamala 
Published: September 2013

Background: Limited information exists on therapeutic drug monitoring of neurology patients. Although multiple reviews on anticoagulation clinics have shown good outcomes, the therapeutic endpoints achieved in patients enrolled in a pharmacotherapy clinic serving only those with a history of stroke/transient ischemic attack (TIA) have not been noted previously. Objective: To illustrate the drug therapy management role of a pharmacotherapist in a neurology clinic and provide evidence on the quality of the service by presenting data on therapeutic endpoints in the subset of patients who are on anticoagulant therapy for stroke prevention. Methods: Reported therapeutic endpoints included recurrent stroke/TIA, bleeding, time in therapeutic range (international normalized ratio [INR] range 2–3), adherence, and patient satisfaction with pharmaceutical care. Patients completed the Morisky self-report compliance questionnaire and the Pharmaceutical Care Satisfaction Questionnaire. Other information included medical history, medications, anticoagulation rationale, referring service, and therapeutic endpoints. Results: There were few adverse outcomes of bleeding or stroke. Time in therapeutic range for an INR of 2–3 was 59.67%. Of 251 INRs, 2 (0.8%) were greater than 5. Patient satisfaction with pharmaceutical care was high, as was adherence. Conclusions: The incidence of recurrent stroke/TIA and bleeding was rare, despite the inherently higher bleeding risk for stroke patients. Times in range of INRs were equivalent to those of other anticoagulation clinics. Patient satisfaction and adherence were good despite polypharmacy. Pharmacotherapists can be valuable additions to neurology clinics by helping neurologists in the management of the pharmacotherapy of their patients, including those on anticoagulation therapy for stroke/TIA.
Hospital Telepharmacy Network: Delivering Pharmacy Services to Rural Hospitals
Authors: Peterson Charles D , Rathke Ann , Skwiera John , Anderson Howard C 
Published: September 2013

Objective: To provide a detailed description of the Hospital Telepharmacy Network established in North Dakota for delivering pharmacy services to rural hospitals, including its overall purpose, goals, and how it works; and to provide valuable information for pharmacists and rural hospitals on how to successfully implement a telepharmacy program designed to serve small rural hospitals that do not have 24 hour pharmacist staffing and pharmacy services. Discussion: Seven rural hospitals (4 acute care, 3 critical access) in northern and central frontier counties of North Dakota that established a hospital telepharmacy network for delivering pharmacist staffing and pharmacy services between the institutions are described. Through use of audio, video, and computer links, rural hospitals in Rugby, Devils Lake, Harvey, Rolla, Carrington, Mandan, and Cando with an average of 32 beds (range 20–50), 11,214 doses filled per month (range 7,000–23,000), 1 staff pharmacist, and 1 pharmacy technician participated in the project. Hours of service for the pharmacies are Monday through Friday 8:00 am to 5:00 pm (3 hospitals), 8:00 am to 4:30 pm (1 hospital), 8:30 am to 4:30 pm (2 hospitals), and 8:30 am to 5:00 pm (1 hospital). Conclusions: National pharmacist shortages have made it difficult for small rural hospitals to find pharmacist relief help in covering routine hours, evenings, nights, weekends, vacations, sick time, and professional meetings. The Hospital Telepharmacy Network in North Dakota provides a convenient and affordable solution for rural hospitals to meet their pharmacist staffing needs. It also provides a mechanism for rural hospitals to satisfy the new Joint Commission on Accreditation of Healthcare Organizations' requirement of pharmacy being accessed after hours by only pharmacy personnel and provides future strategies for hospitals to address the issue of 24 hour pharmacist review of all medication orders.
Denosumab: A Novel Agent for Osteoporosis
Authors: Horning Kristin K , Hegge Karly A , Bottenberg Michelle M 
Published: September 2013

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of denosumab, a biologic antiresorptive agent for treatment of osteoporosis and other bone-related disorders. Data Sources: Primary literature and review articles were obtained via a MEDLINE search (1966–July 2008), using the following key terms: denosumab, AMG 162, and RANKL. 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. All pertinent preclinical and clinical information was included. Randomized controlled trials were evaluated to assess the efficacy of denosumab in osteoporosis, rheumatoid arthritis (RA), and breast cancer—related bone metastases. Data Synthesis: Denosumab is a humanized monoclonal antibody that neutralizes receptor activator of nuclear factor-κB-ligand, thereby decreasing osteoclast-mediated bone resorption. This agent has been compared with placebo and intravenous bisphosphonates in randomized, double-blind controlled trials. In studies involving patients with osteoporosis, RA, or breast cancer—related bone metastases, denosumab significantly improved bone mineral density and markers of bone turnover when compared with placebo. Adverse events were minimal among patients receiving denosumab, although long-term safety data are not available. Conclusions: Denosumab is a novel therapeutic agent that improved BMD and bone turnover markers in clinical studies, suggesting that it may be promising for the treatment of a variety of bone remodeling disorders. ACPE Universal Program Numbers: 407-000-09-051-H01-P (Pharmacists); 407-000-09-051-H01-T (Technicians)
Impact of a Community Pharmacist on Patient Knowledge of NPMs
Authors: Watts Amber , Castleman Landon , Phillips Beth Bryles 
Published: September 2013

Background: Nonprescription medications (NPMs) account for more than 100,000 products for approximately 450 ailments. It has been estimated that 59% of the American population self-medicates with NPMs. A recent survey found that patients are deficient in reading drug labels and identifying active ingredients and that they are exceeding the recommended daily dose of NPMs. Objective: To evaluate the impact of one-on-one pharmacist counseling sessions on patients' knowledge of NPMs, looking at specific patient populations. Methods: We conducted a randomized prospective intervention trial. Patients over the age of 18 years taking blood pressure and/or diabetes medications were randomized into control and intervention groups. All patients received baseline preintervention surveys. Patients in the intervention group completed a postintervention survey after a 20-minute NPM counseling session, while patients in the control group completed the postintervention survey without completing a counseling session. t-Test and descriptive analyses were used to evaluate results from the presurvey and postintervention survey to evaluate the impact of a community pharmacist, delineate NPM use in the past 6 months, and reflect the opinions and attitudes toward use and safety of NPMs. Results: Patient NPM knowledge improved after a counseling session with a community pharmacist. Drug facts label knowledge scores improved (4.8 vs 5.4; p = 0.02) and basic drug knowledge scores improved (3.9 vs 6.3; p = 0.02) compared with baseline analysis in the intervention group. Patients in the intervention group scored significantly higher compared with the control group on the overall knowledge postintervention survey (11.8 vs 9; p = 0.01). Conclusions: Pharmacists can significantly impact the NPM knowledge of patients by dedicating a short amount of scheduled time to educating patients about appropriate use of medications.
Comparison of Desvenlafaxine and Venlafaxine Ingestions Reported to Texas Poison Centers
Authors: Forrester Mathias B , Villarreal C Lizette 
Published: September 2013

Background: Desvenlafaxine is the major active metabolite of the serotonin norepinephrine reuptake inhibitor venlafaxine and is prescribed for the treatment of major depressive disorder. Objective: To compare desvenlafaxine and venlafaxine ingestions reported to a statewide poison center system. Methods: Cases included all desvenlafaxine and venlafaxine ingestions reported to Texas poison centers during 2008–2009. The distribution of all cases by selected demographic factors was identified. After cases that involved coingestants and/or were not followed to a final medical outcome were excluded, the distribution of the remaining cases by clinical and management factors was determined. Results: There were 144 desvenlafaxine and 777 venlafaxine ingestions. The distribution of desvenlafaxine and venlafaxine ingestions was, respectively, female patients 61.8% versus 64.2%, age 0–5 years 31.9% versus 19.3%, unintentional 47.2% versus 39.8%, and involving no coingestants 56.3% versus 46.7%. There were no coingestants and the medical outcome was known for 47 desvenlafaxine and 208 venlafaxine cases. The distribution of this subset of ingestions was, respectively, managed on site 40.4% versus 24.0%, already at or en route to a health-care facility 36.2% versus 52.9%, and referred to a health-care facility 23.4% versus 23.1%. The medical outcome was no effect 72.3% versus 56.3%, minor 14.9% versus 26.4%, moderate 10.6% versus 14.9%, and major 2.1% versus 2.4% for desvenlafaxine and venlafaxine, respectively. Conclusions: The patterns of desvenlafaxine and venlafaxine ingestions were generally similar. However, desvenlafaxine ingestions were more likely to involve young children, be unintentional, not involve coingestants, be managed on site, and involve no effect.
The Impact of an Urban Telepharmacy on Patient Medication Adherence in a Federally Qualified Health Center
Authors: Hudd Timothy R , Tataronis Gary R 
Published: September 2013

Background: New and innovative ways to efficiently and effectively deliver pharmacy services are necessary to ensure the future viability of the pharmacy profession. We believe that the practice of telepharmacy may be one potential option for some health-care institutions. Objective: To measure the impact of a satellite telepharmacy on medication adherence by making 340B medication pricing more accessible to uninsured, underserved patients in an urban setting and to assess the level of patient acceptance of pharmacy services provided through the use of a telepharmacy. Methods: A retrospective electronic review of medication claims data submitted by community pharmacies was used to ascertain medication adherence rates of patients using our telepharmacy. Using a 30-day supply, the mean number of days between refills for all prescriptions was determined for each patient at his/her respective pharmacy setting (telepharmacy, retail chain, or both). Statistical analyses were conducted to determine whether significant differences existed in the overall mean number of days between refills for each setting. Additionally, patient satisfaction surveys were distributed to patients using the telepharmacy. Results: There was no statistically significant difference in the mean (SD) number of days between refills for those using telepharmacy (37.1 [7.3]) versus retail chain (38.8 [10.3]; p = 0.610). Among patients using the telepharmacy, 95/250 (38%) completed patient satisfaction survey questionnaires; 87% indicated that the telepharmacy always made it easier to refill prescriptions, while 85% felt that speaking with the pharmacist through the videotelephone improved medication understanding. Conclusions: Similar outcomes were observed in the telepharmacy and retail chain settings. Medications were consistently refilled in both settings beyond the time in which they were actually due to be refilled. Patient assessment of the telepharmacy indicated high degrees of satisfaction with accessibility, service, and patient counseling.
Clindamycin-Associated Hyperphosphatemia in a Child with Renal Dysfunction
Authors: Ibach Bethany W , Miller Misty M , Johnson Peter N , Turman Martin A , Lewis Teresa V 
Published: September 2013

Objective: To report a case of hyperphosphatemia associated with administration of intravenous clindamycin phosphate in a child with renal dysfunction. Case Summary: We describe the case of a 12-year-old boy who developed hyperphosphatemia while receiving intravenous clindamycin phosphate. The child had a history of asthma but was otherwise healthy. He was transferred to our facility for management of methicillin-resistant Staphylococcus aureus bacteremia, periorbital cellulitis, osteomyelitis, and necrotizing pneumonia. He received intravenous vancomycin and clindamycin 930 mg administered every 8 hours. Concurrently, he developed acute kidney injury. His baseline phosphorus concentration was within the normal range but increased as high as 11.7 mg/dL while he received clindamycin. Despite receiving oral phosphate binder therapy and a low phosphorus diet, he had little reduction in serum phosphorus values. Intravenous clindamycin was suspected as a potential cause for hyperphosphatemia, and a recommendation was made to switch from intravenous to oral clindamycin solution since it contains a different salt formulation. Given the severity of the child's disseminated infection and questions of whether he could absorb the enteral formulation, the decision was made to continue intravenous clindamycin and he was ultimately transferred to a rehabilitation facility for further care on intravenous clindamycin. Discussion: Excess oral or intravenous intake of phosphorus can result in hyperphosphatemia, as the body's plasma phosphate concentration exceeds the kidney's diminished filtration capacity. In this patient, use of the Naranjo probability scale indicated a possible adverse event associated with clindamycin. Phosphate intake from intravenous clindamycin and decreased glomerular filtration rate may have contributed to the child's hyperphosphatemia. Conclusions: While intravenous clindamycin was not the sole cause for this patient's hyperphosphatemia, health care professionals should be aware of the potential for increased phosphate load when administering this drug to a patient with renal dysfunction.
Multidisciplinary Approach to Improve Venous Thromboembolism Risk Assessment and Prophylaxis Rates in Hospitalized Patients
Authors: Stark Jennifer E , Bird Matthew L , Smith Winter J , Vesta Kimi S , Rathbun Suman W 
Published: September 2013

Background: Venous thromboembolism (VTE) is a preventable disease in hospitalized patients; however, VTE prophylaxis is underutilized. Effective strategies for the assessment of individual patients' VTE risk and the provision of VTE prophylaxis are needed. Objective: To evaluate the efficacy of a multidisciplinary intervention designed to improve VTE risk assessment and prophylaxis in at-risk hospitalized patients. Methods: The multidisciplinary intervention to improve VTE risk assessment and prophylaxis consisted of 3 strategies: a broad educational effort, nursing assessment, and pharmacist follow-up. Educational programs were delivered to nursing, pharmacy, and physician staff. Upon admission, all patients were assessed for VTE risk factors by nursing staff. Pharmacists reviewed reports of patients screened to have at least 1 VTE risk factor; for patients not prescribed VTE prophylaxis, pharmacists placed a progress note and VTE prophylaxis order form in the chart. If no prophylaxis was prescribed by the following day, the pharmacist contacted the physician with a verbal recommendation. The impact of this intervention was evaluated by comparing the proportion of patients assessed for VTE risk factors on admission and the proportion of VTE prophylaxis candidates who received prophylaxis, both before and after implementation. Results: A total of 310 patients were included during the 2-month study period. An increase in patients assessed for the presence of VTE risk factors was observed after the intervention (41% vs 87%, p < 0.001). Similarly, an increase in patients prescribed prophylaxis was observed after the intervention (36% vs 63%, p < 0.001). Conclusions: This multidisciplinary approach including education, nursing assessment, and pharmacist follow-up resulted in a significant increase in the rates of VTE risk assessment and prophylaxis.
The Use of Combination Lipid Therapy in a County Health System
Authors: Pio Margaret Youngmi , Piszczor Erin Marie , Quinones Marissa Escobar , Boatright Steven Micheal , Chow Diem Hong , Hulstein Jeffrey Lynn , Moss Elizabeth , Mathew Annie Chathanatt , Budhwar Nitin 
Published: September 2013

Background: With the paucity of clinical outcomes trials and guidelines to make compelling recommendations regarding the treatment of dyslipidemia beyond statin monotherapy, we present a descriptive analysis of the combination lipid-lowering therapies being used at a large county hospital system. Objective: To provide a descriptive evaluation of the comparative effectiveness and safety of various combination lipid therapies in conjunction with a statin. Methods: Patients of a county health system who received at least 3 months of combination lipid therapy in conjunction with a statin during a 1-year period were eligible for inclusion in this retrospective chart review. The main outcome was a descriptive analysis of the comparative effectiveness among combination lipid therapies, as evidenced by fasting lipid panels. Results: A total of 834 patients were included in the analysis. Approximately 88% were on 1 additional lipid-modifying agent beyond a statin; 2 or 3 additional medications were much less common. Fish oils and fibrates were the most common nonstatin agents used, comprising approximately 85% of the combination therapies. Approximately 17% of patients had all 4 lipids at goal. A majority of patients were at goal for low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), and total cholesterol, but a large proportion were not at goal for HDL-C and triglycerides. No statistically significant differences were found among therapies for effectiveness related to lipid goals, medication adherence, or safety. The chart review did not find an appreciable number of adverse events. The overall adherence rate was subpar at 56% and varied modestly among treatments. Conclusions: This retrospective analysis found no significant differences in effectiveness, adherence, and safety among the combination lipid therapies used in a county health system. Further research is warranted to elucidate the recommended approach to using combination lipid therapies.
Effects of Smartphones on Pharmacist-Physician Clinical Communication
Authors: Wilson Charlene , Wu Robert , Lo Vivian , Wong Gary G , Fernandes Olavo A , Tomlinson George , Summa-Sorgini Claudia 
Published: September 2013

Background: Clinical pharmacist interventions are associated with improved patient outcomes and cost savings. Expanded interprofessional communication strategies may improve the efficiency and quality of the communication of these interventions. Objective: To determine the impact of smartphone device use on pharmacists' efficiency when communicating clinical interventions and to determine factors related to smartphone use that improve and impede communication. Methods: A prospective, 2-phase, observational study was completed. In phase 1, work shadowing observations involved general internal medicine (GIM) pharmacists who communicated interventions to a physician's smartphone (BlackBerry device) and multiorgan transplant (MOT) pharmacists who used traditional modes of communication (paging, phone call, face-to-face). On each ward, various aspects of the interventions were documented for a total of 20 hours. In phase 2, 10 interviews were conducted with GIM pharmacists and physicians to gain their perspectives on BlackBerry device communication. Results: In phase 1, no significant difference was found in median time to resolution (order change or drug information response given) between accepted interventions from the smartphone group (15.5 minutes) versus traditional modes of communication in the GIM group (4 minutes) and the MOT group (8.5 minutes) (p = 0.74). In phase 2, themes that emerged across the different clinical groups included perceived improvements in communication processes (efficiency, decreased wait times, and triaging of issues), concerns for potential miscommunication (use of tone in the emails), and recommendations regarding BlackBerry best practices (dealing with urgent/nonurgent issues and establishment of pharmacist-physician interprofessional relationships). Conclusions: Despite no significant difference in median time to resolution of pharmacists' interventions communicated through physician BlackBerry devices compared to traditional modes, the majority of interviewees perceived this device to be a positive communication tool resulting in improved efficiency of team communication.
Therapeutic Management of Accidental Epinephrine Injection
Authors: Cluck David B , Odle Brian , Rikhye Somi 
Published: September 2013

Objective: To review the literature regarding therapeutic options for accidental epinephrine exposure via EpiPen (Mylan Specialty Inc.) autoinjector devices and to suggest a treatment algorithm based on the most common approaches found therein. Data Sources: A literature search of MEDLINE (1950-March 2012) was conducted, using the search term accidental epinephrine injection in combination with the terms adrenaline, EpiPen, anaphylaxis, autoinjector, and treatment. Case reports, case series, and systematic reviews were evaluated for efficacy and safety data. In addition, the references of the reviewed articles were examined to identify additional reports or data. Study Selection and Data Extraction: All English-language articles describing accidental exposure to epinephrine were identified. Our search included both pediatric and adult patient populations. Articles were excluded if the exposure to epinephrine was purposeful and the EpiPen described in the report was being used as intended or the outcome was not clear. Individual case reports were described in detail whereas case series and systematic reviews were included but were not described in detail. To our knowledge, there have been no clinical trials that describe or compare therapeutic options for accidental exposure to epinephrine. Data Synthesis: Accidental exposure to epinephrine is an underreported phenomenon that could warrant medical attention. The importance of this issue has recently been emphasized with the legislative requirement of many schools to store epinephrine (EpiPen) autoinjector devices. The available therapeutic options can be divided into pharmacologic and nonpharmacologic categories. The most common pharmacologic options described in the literature include phentolamine, subcutaneous terbutaline, topical nitrates, and calcium channel blockers. Nonpharmacologic options include observation and/or warm water soaks. Treatment recommendations in our proposed algorithm were based solely on the available data that we describe in our review. Conclusions: The literature did not provide clear guidance on the most appropriate management of accidental epinephrine injection. However, if pharmacologic therapy is necessary, phentolamine appears to be considered the most effective. Guidelines may be helpful in improving the management of accidental epinephrine injection, as well as in preventing unnecessary therapy.