Clinical impact of a pharmacist + health coach chronic disease management program in a rural free clinic

ObjectivesRecent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia.MethodsAfter an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program’s impact on A1c, blood pressure, and cholesterol outcomes.ResultsA total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040).ConclusionA protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.     

Pharmacokinetics and clinical studies on aztreonam in neonates and premature infants (the first report). Study on effectiveness and safety in mono-therapy with aztreonam. A study of aztreonam in the Perinatal Co-research Group

Pharmacokinetics and clinical study of aztreonam (AZT) in neonates and premature infants were conducted with the following results: 1. Pharmacokinetics (1) Serum concentrations of AZT at 30 minutes after one-shot intravenous injection of 10 mg/kg and 20 mg/kg to neonates including premature infants were 20.6-26.6 micrograms/ml and 38.5-46.4 micrograms/ml, respectively, and decreased thereafter. A dose response was observed in the serum concentrations with administration of AZT 10 mg/kg and 20 mg/kg. (2) Serum half-lives (T1/2) tended to be shorter in both mature and premature infants as their day-ages increased and T1/2 tended to be prolonged in premature infants compared with mature infants. (3) Changes in serum concentration upon one-hour intravenous drip infusion of AZT 20 mg/kg were very similar to those upon one-shot intravenous injection. (4) Urinary excretions in the first 6 hours after one-shot intravenous injection of AZT 10 mg/kg or 20 mg/kg tended to increase in mature infants as they grew and showed excretion rate of 26.2-54.3% but those in premature infants did not show any specific tendency with rate of 17.5-45.1%. Urinary excretions upon intravenous drip-infusion showed a tendency very similar to those upon intravenous injection. 2. Clinical studies (1) Clinically evaluable cases of AZT treatment were 88 cases (91 diseases), in which pathogenic organisms were identified in 56 cases (Group A), i.e., sepsis 9, purulent meningitis 2, pneumonia 8, urinary tract infection (UTI) 33 and others. Total efficacy rate was 98.2% including "excellent" (39), "good" (16) and "fair" (1). Number of cases in which pathogenic organisms were unknown (Group B) was 11, i.e., suspected sepsis (4), pneumonia (3) and intrauterine infection (4) and the efficacy rate was 100% with "excellent" (4) and "good" (7). Thus, both group A and B showed excellent results. AZT was also given to 24 cases for prophylaxis and all the cases showed prophylactic effect of AZT.4+ Bacteriologically AZT was deemed effective in 53 cases out of 56 (Group A) with identified pathogens "eradicated" and "unchanged" (2), thus the bacterial eradication rate was 96.2%. (3) A minor degree of loose feces was observed in 1 (1.3%) of 80 cases as a side effect. Abnormal laboratory test values found were eosinophilia (3 cases), elevation of GOT and GPT (2), platelet-increase (1), elevation of GOT (1), and thrombocytopenia.elevation of GOT.GPT.LDH (1). Every one of these was of a minor degree and transient. From the above pharmacokinetics and clinical results, standard dosage of AZT to neonates and premature infants should be in a unit dose of 20 mg/kg, twice daily to those with ages between 0 and 3 days, and 2 to 3 times daily to those with ages 4 days and above, by intravenous injection or intravenous drip infusion.     

Prevention of postoperative venous thromboembolism in Japanese patients undergoing total hip or knee arthroplasty: two randomized, double-blind, placebo-controlled studies with three dosage regimens of enoxaparin

BACKGROUND: Enoxaparin is a low-molecular-weight heparin indicated in Europe and North America for the prevention of venous thromboembolism (VTE) in patients undergoing major orthopedic surgery. Registration trials of enoxaparin have been conducted primarily in Caucasian populations, and the efficacy and safety of enoxaparin in Japanese patients have not been demonstrated. We evaluated three dosage regimens of postoperative enoxaparin in Japanese patients undergoing elective total hip or knee arthroplasty. METHODS: Two multicenter, randomized, double-blind studies enrolled 436 and 396 Japanese adults undergoing total hip or knee arthroplasty, respectively. The dosage regimens of enoxaparin were 20 mg once daily (qd), 40 mg qd, 20 mg twice daily (bid), or placebo for 14 consecutive days. The primary efficacy endpoint was the incidence of VTE in the modified intention-to-treat (mITT) population up to 15 days after surgery. VTE was defined as a composite of deep vein thrombosis (determined by venography) and symptomatic pulmonary embolism (confirmed by appropriate objective methods). Patients were also followed up at 90 days for VTE events. The primary safety outcome was the incidence of any bleeding during treatment and the follow-up period. RESULTS: In the mITT populations, the incidence of VTE was 41.9% and 60.8% in the placebo groups after hip or knee arthroplasty, respectively, 25.9% and 44.9% in the enoxaparin 20 mg qd groups, 33.8% and 35.1% in the enoxaparin 40 mg qd groups, and 20.0% and 29.8% in the enoxaparin 20 mg bid groups. Only enoxaparin 20 mg bid significantly lowered the risk of VTE relative to placebo (by 52.2% and 51.0% after hip and knee arthroplasty, respectively). At the 90-day follow-up, no further cases of VTE were reported. In both the hip and knee studies, the four treatment groups did not differ significantly regarding the incidence of patients with any bleeding. CONCLUSIONS: Our findings support the use of enoxaparin (20 mg bid daily, commencing 24-36 h postoperatively) in Japanese patients undergoing total hip or knee arthroplasty.     

Research skills training for the Doctor of Pharmacy in US Schools of Pharmacy: A descriptive study

Objectives As the practice of pharmacy grows increasingly complex, graduates are expected to possess a comprehensive set of skills enabling them to provide optimal patient care. Thus, research skills are becoming increasingly valuable and a necessary part of pharmacist training globally. However, training opportunities for improving research skills have not been well explored in the literature. This study examines how research skills are currently being offered in various Doctor of Pharmacy curricula in US Schools of Pharmacy. Methods A five‐question survey was e‐mailed to key individuals at 95 Colleges of Pharmacy in the USA and Puerto Rico. Responses were aggregated and then stratified by research project requirements, as well as by school type (public or private; Carnegie Foundation classification). Key findings Seventy‐nine respondents provided usable surveys for an 83% response rate. Respondents encompassed a representative population of school types. Although most schools do not require completion of a research project (75%), the majority of research skills listed were taught in various forms in over half of the responding institutions. There did not appear to be a significant distinction in research skills training provided based upon school type. However, schools requiring students to complete a research project in order to graduate provided the most comprehensive research skills training. Conclusions Research skills training has greatly increased over the past 10 years. However, more study needs to be done in a number of areas, including determining the most effective way to offer research skills training, determining its post‐graduate impact and determining its overall effect on the profession of pharmacy.     

An Online Health Informatics Elective Course for Doctor of Pharmacy Students

Objective. To describe the development and assessment of an online elective health informatics course and determine its potential for universal integration into doctor of pharmacy (PharmD) curricula.Design. A 2-credit hour online elective course was developed and offered to all PharmD students; voiced-over Powerpoint lectures were used to deliver content.Assessment. Assessment of student performance was measured using quantitative metrics via discussion questions, quizzes, written papers, and examinations. Qualitative findings were measured through discussion questions, a goal-setting classroom assessment technique, and an end-of-course reflection. Students report finding value in the course and recognizing how the knowledge gained could impact their future practice as pharmacists. Conclusion. An online course in health informatics can be an effective way to deliver content and provide a blueprint for continued integration of the content into curricula.     

Effect of interferon α, γ, and tumor necrosis factor α on the HLA-A,B, C expression of cell lines derived from human liver

ABSTRACT— Our study was undertaken to determine whether human recombinant interferon α(rIFNα), γ(rIFNγ), and tumor necrosis factor α(rTNFα) exert an effect on the HLA-A, B, C expression of human liver cell lines. The HLA-A, B, C expression was assayed by immunoperoxidase staining and enzyme-linked immunosorbent assay. rIFNα and γ enhanced the HLA-A, B, C expression of the three cell lines tested, Chang cells, SK-Hep-1, and PLC/PRF/5. The activity of rIFNγ proved more than 8000 times more potent than that of rIFNα in Chang cells, 30 times in SK-Hep-1, and 20 times in PLC/PRF/5, respectively. rTNFα also enhanced the HLA-A, B, C expression of the three cell lines. The enhancement of HLA-A, B, C expression by rIFNα and γ reached a peak on day 3, and that by rTNFα on day 5. These findings suggest that IFNα, IFNγ, and TNFα may play similar roles in enhancement of HLA-A, B, C expression of hepatocytes in hepatitis and hepatoma cells.