bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.