The effect of an interprofessional pain service on nonmalignant pain control.
chronic pain; pain management; pharmacist; medication therapy management; opioid
PURPOSE: The primary objective of this project is to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives include determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. METHODS: Baseline data was obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3-14 days after the initial education class, the patient's pain score was assessed along with his/her medication use and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via phone to complete a survey. The survey questions assess patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. RESULTS: Patients reported an average pre-enrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist recommended interventions ranges from 80%-92% depending on the pre designated disease state category. CONCLUSION: An interprofessional, nonmalignant pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population.
Coffey Cory P; Ulbrich Timothy R; Baughman Kristin R; Awad Magdi H
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2019
2019-03
<a href="http://doi.org/10.1093/ajhp/zxy084" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxy084</a>
Evaluation of dextromethorphan with select antidepressant therapy for the treatment of depression in the acute care psychiatric setting.
depression; NMDA; fluoxetine; bupropion; CYP2D6 inhibitor; dextromethorphan; paroxetine
Introduction: Dextromethorphan (DXM), an N-methyl-D-aspartate receptor antagonist, may have ketamine-like antidepressant effects. Dextromethorphan is extensively metabolized via cytochrome P450 (CYP) 2D6, and its half-life in extensive metabolizers is 2 to 4 hours. The purpose of this study was to evaluate the effects of DXM in combination with a moderate-to-strong CYP2D6 inhibitor antidepressant on depression in an acute care psychiatric setting. Methods: This was a single-center, retrospective chart review of adult patients with a depressive disorder diagnosis. Patients who received select antidepressant therapy with or without scheduled DXM were included. The primary outcome was the difference in time to improvement of depressive symptoms, which was an average composite of physician documentation, nurse documentation, and first time to 24 hours without as-needed anxiolytics or antipsychotics. The study group consisted of patients who received DXM with select antidepressant therapy, whereas the control group included those who received only select antidepressant therapy. Results: A total of 40 patients were included. The median time to clinical improvement was 3.00 days and 2.83 days for the study group and control group, respectively (P = .986). The incidence of perceptual disturbances and delusions was higher in the study group as compared with the control group (55% and 35% vs 30% and 25%, respectively). Discussion: Dextromethorphan was not associated with a rapid antidepressant effect. The commonly used dose of 30 mg daily may have been too low to have an effect; additionally, the most frequently utilized select antidepressant, bupropion, has moderately less CYP2D6 inhibition than fluoxetine and paroxetine.
Nofziger Jill L; Paxos Chris; Emshoff Jessica; Mullen Chanda
The mental health clinician
2019
2019-03
<a href="http://doi.org/10.9740/mhc.2019.03.076" target="_blank" rel="noreferrer noopener">10.9740/mhc.2019.03.076</a>
Efficacy of Tramadol for Pain Management in Patients Receiving Strong Cytochrome P450 2D6 Inhibitors
CYP2D6; cytochrome P450; drug interaction; pain control; tramadol
STUDY OBJECTIVE: Tramadol is metabolized by cytochrome P450 (CYP) 2D6 to form an active metabolite that exhibits its analgesic effect. Medications that inhibit this enzyme are used often in practice, yet the clinical impact of this interaction on the analgesic effects of tramadol has yet to be fully described. The objective was to determine whether a clinically relevant decrease in pain control is observed in patients taking scheduled tramadol concomitantly with a strong CYP2D6 inhibitor. DESIGN: Retrospective cohort study. SETTING: Large health care system. PATIENTS: One hundred fifty-two adult inpatients who received scheduled tramadol for at least 24 hours with (76 patients) or without (76 patients) a strong CYP2D6 inhibitor between January 1, 2012, and February 28, 2017, were included in the analysis. Patients hospitalized for opioid use disorder or those receiving substandard dosing of tramadol were excluded. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mean breakthrough opiate consumption in the presence and absence of CYP2D6 inhibitors. Secondary outcomes included mean pain scores, length of hospital stay, tramadol discontinuation rates, and prespecified subgroup analyses based on patient sex, race, and specific CYP2D6 inhibitor administered. Patients receiving concurrent CYP2D6 inhibitors required significantly more breakthrough morphine milligram equivalents per day compared with patients receiving scheduled tramadol without CYP2D6 inhibitors (geometric mean ± SD 18.2 ± 6.3 vs 5.7 ± 6.7 mg morphine milligram equivalents, p<0.001). No significant differences existed between cohorts for mean pain score, length of hospital stay, or tramadol discontinuation rate. CONCLUSION: This study demonstrated a clinically relevant decrease in the efficacy of tramadol when used for pain control in patients receiving a strong CYP2D6 inhibitor. These results should encourage clinicians to review medication lists for this interaction and adjust regimens accordingly to ensure adequate pain control.
Frost Derek A; Soric Mate M; Kaiser Ricky; Neugebauer Rachel E
Pharmacotherapy
2019
2019-06
<a href="http://doi.org/10.1002/phar.2269" target="_blank" rel="noreferrer noopener">10.1002/phar.2269</a>
Addressing clozapine under-prescribing and barriers to initiation: a psychiatrist, advanced practice provider, and trainee survey
Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers' perception and knowledge of clozapine. A survey was distributed to advanced practice providers, psychiatrists, and trainees (i.e. residents and fellows) at 10 medical centers within the US and Canada. The survey asked respondents about their perception of clozapine use and assessed their pharmacotherapeutic knowledge of clozapine. Two hundred eleven individual submitted completed surveys of a possible 1152; a response rate of 18.3%. There were no statistically significant differences between the advanced practice provider plus psychiatrist groups and the trainee group for most perception (eight of nine) and knowledge (eight of nine) questions. The knowledge questions with the lowest scores pertained to clozapine reinitiation and myocarditis. The majority of all respondents (144, 68.2%) felt that clozapine prescribing was a burden. Findings of this study support the need for continued clozapine education regardless of a prescriber's age/experience. Future studies to assess barriers to clozapine prescribing should extend beyond academic centers.
Leung Jonathan G; Cusimano Joseph; Gannon Jessica M; Milgrom Olga; Valcourt Stephanie C; Stoklosa Joseph B; Kemp Michael; Olsufka William; Vickery P Brittany; Nichols Stephanie D; Crouse Ericka L; Paxos Chris; Johnson Emily K; Palmer Brian A
International Clinical Psychopharmacology
2019
2019-05
<a href="http://doi.org/10.1097/YIC.0000000000000269" target="_blank" rel="noreferrer noopener">10.1097/YIC.0000000000000269</a>
Prevalence and Predictors of Benzodiazepine Monotherapy in Patients With Depression: A National Cross-Sectional Study
OBJECTIVE: Depression guidelines discourage benzodiazepine monotherapy and limit use to short-term adjunctive therapy with antidepressants; however, patients with depression continue to receive benzodiazepine monotherapy. The prevalence and predictors of this prescribing pattern have not been described previously and are warranted to assist clinicians in identifying patients at highest risk of receiving benzodiazepine monotherapy. METHODS: A national, cross-sectional analysis of the National Ambulatory Medical Care Survey from 2012 to 2015 was performed for adults treated for depression. Depression was identified using a survey item specifically assessing the presence of depression. Office visits involving patients with bipolar disorder, schizoaffective disorder, or pregnancy were identified by ICD-9 code or specific survey item and were excluded. The primary endpoint was benzodiazepine monotherapy prescribing rate defined as initiation or continuation of a benzodiazepine in the absence of any antidepressant agent. A multivariate logistic regression model was created to identify variables associated with benzodiazepine monotherapy. RESULTS: In total, 9,426 unweighted visits were eligible for inclusion. Benzodiazepine monotherapy was identified in 9.3% of patients treated for depression (95% CI, 8.2%-10.6%). Predictors of benzodiazepine monotherapy included age of 45-64 years (OR = 1.39; 95% CI, 1.01-1.91), epilepsy-related office visit (OR = 5.34; 95% CI, 1.39-20.44), anxiety-related office visit (OR = 1.67; 95% CI, 1.23-2.27), underlying pulmonary disease (OR = 1.43; 95% CI, 1.09-1.87), and concomitant opiate prescribing (OR = 2.86; 95% CI, 2.01-4.06). Psychiatrists were less likely to prescribe benzodiazepine monotherapy than were other providers (OR = 0.42; 95% CI, 0.29-0.61). CONCLUSIONS: Benzodiazepine monotherapy is utilized in nearly 1 in 10 patients treated for depression. Adults aged 45 to 65 years, patients prescribed opioids, patients seen by primary care providers, and those with underlying anxiety, epilepsy, or pulmonary disorders are at highest risk.
Soric Mate M; Paxos Chris; Dugan Sara E; Fosnight Susan M; Turosky Jodie Z; Sadana Prabodh; Emshoff Jessica B; Everly Lukas; Snyder Brittany M; Mistry Bhavin K; Bhat Shubha; Unruh Amy E; Safi Ismail M
The Journal of Clinical Psychiatry
2019
2019-05
<a href="http://doi.org/10.4088/JCP.18m12588" target="_blank" rel="noreferrer noopener">10.4088/JCP.18m12588</a>
effect of an interprofessional pain service on nonmalignant pain control.
chronic pain; chronic pain; DISCHARGE planning; HEALTH literacy; HEALTH occupations students; INTERDISCIPLINARY education; LENGTH of stay in hospitals; MEDICAL appointments & schedules; MEDICAL care; MEDICAL personnel & patient; MEDICAL protocols; MEDICAL records; MEDICAL referrals; MEDICALLY underserved persons; medication therapy management; MORPHINE; opioid; pain management; pain management; PAIN measurement; PATIENT education; PATIENT satisfaction; pharmacist; pharmacists; RETROSPECTIVE studies; SUBSTANCE abuse; SURVEYS; TELEPHONES; THERAPEUTIC use of narcotics
Purpose The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. Methods Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3–14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. Results Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. Conclusion An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population. [ABSTRACT FROM AUTHOR]
Coffey Cory P; Ulbrich Timothy R; Baughman Kristin R; Awad Magdi H
American Journal of Health-System Pharmacy
2019
2019-06
<a href="http://doi.org/10.1093/ajhp/zxy084" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxy084</a>
An interprofessional case study competition addressing community healthcare needs and the opioid crisis
DeBoth Kelle K; Stoddard-Dare Patricia; Bruce Susan; Niederriter Joan
Journal of Interprofessional Education & Practice
2019
2019-06
<a class="doi" href="https://doi.org/10.1016/j.xjep.2019.03.007" target="_blank" title="Persistent link using digital object identifier" rel="noreferrer noopener">https://doi.org/10.1016/j.xjep.2019.03.007</a>
Pharmacists' role in glycemic management in the inpatient setting: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy.
Diabetes Mellitus; hyperglycemia; hypoglycemia; inpatients; pharmacists
The objective of this opinion paper was to identify and describe the role of pharmacists in ensuring safe and optimal management of patients with glycemic excursions in the inpatient setting. The role of the pharmacist includes involvement in admission medication history and reconciliation, formulary management of glucose‐lowering medications and devices, individual patient medication management, discharge transition of care, and interprofessional collaboration with other health care providers. Recommendations are based on review of published guidelines and literature focusing on the management of patients with hypo‐ and hyperglycemia in the hospital as well as during the time of transition to and from the inpatient setting. [ABSTRACT FROM AUTHOR]
Donihi Amy C; Moorman John M; Abla Alicia; Hanania Raja; Carneal Dustin; MacMaster Heidemarie Windham
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-04
<a href="http://doi.org/10.1002/jac5.1041" target="_blank" rel="noreferrer noopener">10.1002/jac5.1041</a>
Grade point average is an inappropriate measure of a residency candidate's knowledge and skills.
Education; screening; students
Accreditation standards set forth by the American Society of Health‐System Pharmacists note that postgraduate year one programs should have a formal process in place to screen candidates based upon predetermined criteria to ensure applicants have the appropriate qualifications to complete residency training. This standard encourages programs to have a set of consistent criteria and an objective approach to evaluate each applicant. As a result, many programs rely heavily on accessible metrics, such as grade point average (GPA), to quickly compare candidates. The GPA has many flaws that, if utilized by residency programs, could result in screening out highly qualified candidates early in the application review process who possess the skills that residency program directors covet, such as work ethic, passion, adaptability, leadership, research experience, communication skills, professionalism, cultural competency, and personality fit. To identify qualified candidates for postgraduate residency training, the application review process must be reexamined to promote a more holistic approach, going beyond the student's ability in the classroom. Further discussion is needed regarding the pros and cons of utilization of standardized and consistent assessments of residency applicants' knowledge, skills, behaviors, and attitudes to complete a holistic review of candidates as discussed in this article. Further research is needed to identify the factors defining a successful resident and tools to predict those factors. [ABSTRACT FROM AUTHOR]
Soric Mate M; Robinson Jennifer D; Ulbrich Timothy R
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-04
<a href="http://doi.org/10.1002/jac5.1076" target="_blank" rel="noreferrer noopener">10.1002/jac5.1076</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic.
Adrenergic Beta-Antagonists -- Therapeutic Use; Adult; Ambulatory Care Facilities; Chi Square Test; Descriptive Statistics; Diabetes Mellitus; Education; Essential Hypertension -- Drug Therapy; Fisher's Exact Test; Human; Hyperlipidemia -- Drug Therapy; Medically Underserved Area; Metformin -- Therapeutic Use; Non-Traditional; Outcomes of Education; Pharmacy Service; Physicians -- Education; Prescribing Patterns -- Education; Statins -- Therapeutic Use; Type 2 -- Drug Therapy
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of β-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's χ2 and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and β-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad Magdi H; Ulbrich Timothy R; Furdich Kenneth M; Schneider Stacy R; Gothard M David
Journal of Pharmacy Technology
2019
2019-04
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
Interprofessional Education for Team-Based Geriatric Care
Geriatrics & Gerontology
Presentation A161 at the American Geriatrics Society 2019 Annual Meeting
Brown D K; Drost J; Fosnight S; Morgan A; Hazelett S
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.15898" target="_blank" rel="noreferrer noopener">10.1111/jgs.15898</a>
Adaption of Geriatric Education Model Across Sites: Does Group Size Matter?
Geriatrics & Gerontology
2019 Annual Scientific Meeting of the American-Geriatrics-Society (AGS)
Drost J; Brown D K; Joan N; Sanders M; Fosnight S; Hazelett S; Kropp D
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
n/a
Consensus Clinical Decision-Making Factors Driving Anticoagulation in Atrial Fibrillation
Guideline-recommended anticoagulation is frequently omitted in high-risk patients with atrial fibrillation (AF) for reasons not fully understood, which may result in suboptimal care. A nationally representative, expert group of physicians (cardiology, neurology, and general medicine), and clinical pharmacists participated in a consensus-seeking, modified Delphi method to identify key clinical decision-making factors driving anticoagulant prescribing in real-world AF patients. Representing >2,500 anticoagulation-related patient encounters per month, 27 of 30 participants completed the study (90% overall response rate). In Round-1, experts rated their level of agreement with factors and suggested modifications or additional factors. Of 66 factors entering Round-1, 21 met and 4 partially met consensus, 41 did not meet consensus, and 7 were newly suggested. Of 32 factors advanced for scoring in Round-2, 16 met consensus criteria. In Round-3, experts were given the option to rescue up to 2 of the 16 nonconsensus factors from Round-2. Including a concomitant need for dual antiplatelet therapy, no factor was successfully rescued into consensus. The most important factors related to risk of infarction rather than bleeding risk or other patient-specific considerations. Among factors not independently addressed in current guidelines, these included baseline hematologic indicators of potential bleeding risk, previous bleeding episodes by specific type, other risk factors for bleeding, and adherence. In conclusion, when determining anticoagulation strategies in AF, there is a need for further research on the clinical implications of these emerging factors as well as the reasons behind divergent opinions toward nonconsensus factors.
King Philip K; Fosnight Susan M; Bishop Jeffrey R
The American Journal of Cardiology
2019
2019-07
<a href="http://doi.org/10.1016/j.amjcard.2019.07.006" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.07.006</a>
National Trends in Statin Medication Prescribing in Patients With a History of Stroke or Transient Ischemic Attack
statin; stroke; transient ischemic attack
BACKGROUND: Guidelines support statin therapy post-stroke or transient ischemic attack (TIA); however, previously reported utilization rates are suboptimal. OBJECTIVE: This study investigates the incidence of statin usage in patients with a documented stroke or TIA while identifying predictors of statin use. METHODS: A retrospective, cross-sectional study utilizing data from the National Ambulatory Medical Care Survey. RESULTS: A total of 2963 unweighted visits were included in the analysis, representing a total of 52 645 000 office visits when weighted. Statin therapy was initiated or continued in 35.7% (95% confidence interval [CI]: 32.4-39.0%) of office visits. Upon multivariate analysis, positive predictors of statin therapy included a diagnosis of hyperlipidemia (odds ratio [OR]: 3.60; 95% CI: 2.40-5.41), angiotensin-converting enzyme inhibitor (ACE-I) therapy (OR: 2.52; 95% CI: 1.69-3.76), aspirin therapy (OR: 2.02; 95% CI: 1.40-2.93), and clopidogrel therapy (OR: 2.60; 95% CI: 1.69-4.02). Negative predictors of statin therapy included office visits with neurologists when compared to visits with primary care practitioners (OR: 0.55; 95% CI: 0.33-0.90) and office visits in rural areas when compared to office visits in urban areas (OR: 0.64; 95% CI: 0.41-0.99). CONCLUSION: Various factors impact statin therapy use with overall utilization being suboptimal, highlighting an opportunity for medication optimization.
Snyder Brittany M; Soric Mate M
Journal of Pharmacy Practice
2019
2019-07
<a href="http://doi.org/10.1177/0897190019865147" target="_blank" rel="noreferrer noopener">10.1177/0897190019865147</a>
AMPK‐SIRT1‐independent inhibition of ANGPTL3 gene expression is a potential lipid‐lowering mechanism of metformin.
angiopoietin‐like 3; diabetes; dyslipidaemia; lipoprotein lipase; metformin
Objectives: Hypertriglyceridaemia enhances cardiovascular disease risk in patients with diabetes. Lipoprotein lipase (LPL) regulates plasma triglyceride levels by hydrolysing chylomicrons and very‐low‐density lipoprotein (VLDL). Metformin, an antidiabetic drug, improves plasma lipids including triglycerides. We examined metformin's regulation of angiopoietin‐like 3 (ANGPTL3), a liver‐derived secretory protein with LPL inhibitory property. Methods: Using HepG2 cells, a human hepatocyte cell line, the effects of metformin on ANGPTL3 gene and protein expression were determined. The role of AMPK‐SIRT1 pathway in metformin regulation of ANGPTL3 was determined using pharmacological, RNAi and reporter assays. Metformin regulation of ANGPTL3 expression was also examined in sodium palmitate‐induced insulin resistance. Key findings: Metformin and pharmacological activators of AMPK and SIRT1 inhibited the expression of ANGPTL3 in HepG2 cells. Pharmacological or RNAi‐based antagonism of AMPK or SIRT1 failed to affect metformin inhibition of ANGPTL3. AMPK‐SIRT1 activators and metformin exhibited distinct effects on the expression of ANGPTL3 gene luciferase reporter. Sodium palmitate‐induced insulin resistance in cells resulted in increased ANGPTL3 gene expression which was suppressed by pretreatment with metformin. Conclusions: Metformin inhibits ANGPTL3 expression in the liver in an AMPK‐SIRT1‐independent manner as a potential mechanism to regulate LPL and lower plasma lipids. [ABSTRACT FROM AUTHOR]
Lin Li; Burke Jamie; Venkatesh Sahana; Sadana Prabodh
Journal of Pharmacy & Pharmacology
2019
2019-09
<a href="http://doi.org/10.1111/jphp.13138" target="_blank" rel="noreferrer noopener">10.1111/jphp.13138</a>
A need for a holistic residency application review process.
Soric Mate M; Robinson Jennifer D; Ulbrich Timothy R
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-06
<a href="http://doi.org/10.1002/jac5.1119" target="_blank" rel="noreferrer noopener">10.1002/jac5.1119</a>
Enteral and parenteral nutrition considerations in pediatric patients
compounding; enteral; neonatal; nutrition; parenteral; pediatric; stability
October 2019 Update
PURPOSE: Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. SUMMARY: The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. CONCLUSION: The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.
Cober Mary Petrea; Gura Kathleen M
American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists
2019
2019-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ajhp/zxz174" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxz174</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic
medical education; clinical; medications; pharmacy; interventions; Pharmacology & Pharmacy; impact; academic detailing; ambulatory care; community practice; prescribing patterns; prior authorization
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of beta-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's chi(2) and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and beta-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad M H; Ulbrich T R; Furdich K M; Schneider S R; Gothard M D
Journal of Pharmacy Technology
2019
2019-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
Calculation of the Protein Turnover Rate Using the Number of Incorporated 2H Atoms and Proteomics Analysis of a Single Labeled Sample
Rate constant estimation with heavy water requires a long-term experiment with data collection at multiple time points (3-4 weeks for mitochondrial proteome dynamics in mice and much longer in other species). When tissue proteins are analyzed, this approach requires euthanizing animals at each time point or multiple tissue biopsies in humans. Although short-term protocols are available, they require knowledge of the maximum number of isotope labels (N) and accurate quantification of observed 2H-enrichment in the peptide. The high-resolution accurate mass spectrometers used for proteome dynamics studies are characterized by a systematic spectral error that compromises these measurements. To circumvent these issues, we developed a simple algorithm for the rate constant calculation based on a single labeled sample and comparable unlabeled (time 0) sample. The algorithm determines N for all proteogenic amino acids from a long-term experiment to calculate the predicted plateau 2H-labeling of peptides for a short-term protocol and estimates the rate constant based on the measured baseline and the predicted plateau 2H-labeling of peptides. The method was validated based on the rate constant estimation in a long-term experiment in mice and dogs. The improved 2 time-point method enables the rate constant calculation with less than 10% relative error compared to the bench-marked multi-point method in mice and dogs and allows us to detect diet-induced subtle changes in ApoAI turnover in mice. In conclusion, we have developed and validated a new algorithm for protein rate constant calculation based on 2-time point measurements that could also be applied to other biomolecules.
Ilchenko Serguei; Haddad Andrew; Sadana Prabodh; Recchia Fabio A; Sadygov Rovshan G; Kasumov Takhar
Analytical Chemistry
2019
2019-11-19
Journal Article
<a href="http://doi.org/10.1021/acs.analchem.9b02757" target="_blank" rel="noreferrer noopener">10.1021/acs.analchem.9b02757</a>
PMID: 31638786
Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease
INTRODUCTION: Pharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA1c) control (≤9%) and 3) blood pressure control (<140/90 mm Hg). METHODS: We evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers. RESULTS: Facilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA1c ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg. CONCLUSION: Through this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.
Rodis Jennifer L; Capesius Traci R; Rainey Julie T; Awad Magdi H; Fox Carrie Hornbeck
Preventing Chronic Disease
2019
2019-11-21
Journal Article
<a href="http://doi.org/10.5888/pcd16.190163" target="_blank" rel="noreferrer noopener">10.5888/pcd16.190163</a>
PMID: 31753083 PMCID: PMC6880917
Impact of cardiac MRI imaging on detection rates of myocarditis
Morgenstern A; Mikolich B; Morgenstern D; Mikolich J R
European Heart Journal
2019
2019-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/eurheartj/ehz748.0565" target="_blank" rel="noreferrer noopener">10.1093/eurheartj/ehz748.0565</a>