Principles of economics crucial to pharmacy students' understanding of the prescription drug market

Many pharmacy schools have increased the amount of economics coursework to which pharmacy students are exposed in their prepharmacy and pharmacy curriculums. Students obtain competencies aimed at understanding the basic concepts of microeconomic theory, such as supply and demand. However, pharmacy students often have trouble applying these principles to real world pharmaceuticals or healthcare markets. Our objective is to make economics more relevant for pharmacy students. Specifically, we detail and provide pharmacy-relevant examples of the effects of monopoly power, barriers to marketplace entry, regulatory environment, third party insurance, information asymmetry and unanticipated changes in the marketplace on the supply and demand for pharmaceuticals and healthcare services.     

Brief report: illness intrusiveness and adjustment among Native American and Caucasian parents of children with juvenile rheumatic diseases

OBJECTIVE: To investigate cognitive appraisal-adjustment relationships in Native American (NA) and Caucasian parents of children diagnosed with juvenile rheumatic diseases. METHODS: NA (n = 16) and Caucasian (n = 24) parents completed measures of disease status, illness intrusiveness, and adjustment; the rheumatologist provided estimates of disease severity. RESULTS: Hierarchical regression analysis revealed a moderating effect for racial group membership on the illness intrusiveness-parent adjustment relationship. Specifically, parent-perceived illness intrusiveness was more closely related to poorer adjustment among NA parents relative to Caucasian parents. Post hoc tests indicated that illness intrusiveness was significantly associated with poorer adjustment in NA parents, but was unrelated to parent adjustment in the Caucasian sample. CONCLUSIONS: Results highlight the importance of examining racial group differences in cognitive appraisal-adjustment outcome relationships. Results are discussed with respect to the need for incorporating cultural issues into pediatric chronic illness research and treatment.     

Exploratory and confirmatory factor analysis of the Child Uncertainty in Illness Scale among children with chronic illness

OBJECTIVE: To conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) of the Child Uncertainty in Illness Scale (CUIS) with a sample of children and adolescents with a chronic health condition. Developmental differences in factor structure were also examined. METHODS: A sample of 373 children aged 8-18 years with chronic conditions completed the CUIS as a part of a larger battery of measures. RESULTS: The EFA yielded a 16-item two-factor model termed Unpredictability/Ambiguity and Comprehension. The CFA yielded a 14-item two-factor model that fits the data very well, where chi2(df = 74) = 95.396, Comparative Fit Index (CFI) = .973, Tucker Lewis Index (TLI) = .967, and Root Mean Square error of approximation (RMSEA) = .038. No developmental differences were found in underlying factor structures: Deltachi2(df = 12) = 17.754, DeltaCFI = .004, DeltaTLI = -.001, and DeltaRMSEA = .000. CONCLUSIONS: The two-factor CUIS measure could be a useful tool for assessing illness uncertainty among children with chronic illness.     

Cognitive and affective features of postpolio syndrome: Illness uncertainty,attributional style,and adaptation

We examined a sample of 58 individuals with postpolio syndrome (PPS). Subjects completed measures of illness severity, perceived support from the medical community, attributional style, illness uncertainty, and general emotional adaptation. We found elevated levels of emotional distress across several parameters of emotional adaptation. Illness uncertainty and generalized negative outcome expectancies were strongly associated with poorer adaptation; disease severity and perceived support from the medical community did not relate to measures of emotional adaptation. Hierarchical multiple regression analyses revealed that illness uncertainty and both stable and global attributions for negative events contributed significant, unique variance to the prediction of psychological distress beyond the influence of illness severity and demographic parameters. In general, individuals with PPS appear to be at risk for problems in adaptation, and specific cognitive appraisal processes appear to play an influential role in the development of these problems. Our findings have general implications for clinical management of persons with PPS.     

Glomerulonephritis mediated by antibody to glomerular basement membrane. Immunological, clinical, and histopathological characteristics.

A prospective study was undertaken to establish the incidence of glomerular basement membrane (GBM) antibody-mediated glomerulonephritis and its histopathological characteristics in a clinical group of patients presenting with renal disease. Biopsies from 43 of 409 consecutive patients technically satisfactory for direct immunofluorescent (IF) examination had diffuse and generalized linear localization of host immunoglobulin (Ig); two other badly scarred kidneys tested negative to IF although GBM antibodies were eluted. Confirmatory evidence of GBM antibody-mediated disease in these patients came from whole kidney or biopsy elutions (15 patients), serologic assays for circulating GBM antibodies by indirect IF (9 of 38 patients), radioimmunoassay (26 of 34), and hemagglutination (31 of 32). Although sera were not tested from six patients, circulating antibodies were demonstrated by some test in 36 of 39 of the remainder. Histologically, half of the patients had minor and nonspecific glomerular abnormalities or mild focal proliferative glomerulonephritis. More severely involved kidneys had focal necrotizing (17%), rapidly progressive (7%), and chronic, usually sclerosing, glomerulonephritis (27%). Clinical courses of these patients comparably were quite variable, ranging from indolent microhematuria and/or gross hematuric bouts to progressive renal failure; nephrotic syndrome was observed in 11 patients. GBM antibody-mediated glomerulonephritis may be a relatively mild disease with apparently stable renal function, although 16 patients have experienced functional deterioration, and 11 have progressed to dialysis, renal transplantation, or death.     

Sensitivity of isoelectric focusing, ion exchange, and affinity chromatography to labile glycated hemoglobin

We examined the effect of labile glycated hemoglobin on measurements of glycated hemoglobin by several commercial procedures. Erythrocytes from diabetic and nondiabetic patients were incubated in vitro with various concentrations of glucose, to generate labile glycated hemoglobin, and the species of glycated and nonglycated hemoglobin in each sample were identified by isoelectric focusing. Glycated hemoglobin was then assayed by the Bio-Rad A1 column method (I), the Bio-Rad A1c column method (II), and the Pierce affinity column method (III). I was sensitive to the labile (aldimine) fraction of glycated hemoglobin, and percentages of glycated hemoglobin so determined represented the sum of the labile fraction plus hemoglobin A1c and other stable glycated species. This spurious increase in glycated hemoglobin concentration by the aldimine could be obviated by any of three wash procedures, which eliminated the labile fraction from the samples: incubating the erythrocytes (a) in phosphate-buffered saline (pH 7.4) for 18 h at 22 degrees C, (b) in 100 mmol/L citrate (pH 5.0) for 30 min at 37 degrees C, or (c) in saline containing, per liter, 30 mmol of semicarbazide and 12 mmol of aniline hydrochloride (pH 5.0) for 30 min at 37 degrees C. Methods II and III did not detect the labile fraction. However, treatments a-c decreased the concentrations of stable glycated hemoglobin as determined by all three column-chromatographic methods as compared with unwashed sample. By isoelectric focusing we determined that blood with high glucose content had concentrations of aldimine roughly proportional to the blood glucose concentration. The kinetics of formation of labile glycated hemoglobin in these cells were consistent with the reported rate constants determined by using purified hemoglobin preparations in vitro.     

Frequency and characteristics of goal attainment following BoNT-A injection for management of spasticity

Purpose: To determine which Goal Attainment Scale (GAS) goals are commonly achieved in patients with upper limb and/or lower limb spasticity following Botulinum Neurotoxin Type A (BoNT-A) injection.

Method: Adults who attended a Spasticity Management Clinic for upper and/or lower limb BoNT-A injection were included in this prospective cohort study. Goals were set by participants and/or carers in conjunction with the therapist using the GAS, prior to injection and reviewed at one month following the injection. Three out of the five categories of goals were passive. Goals were categorised into: mobility/transfers, pain/comfort, upper limb use, hygiene, and cosmesis. The number of responders for the GAS total score, and in each of the GAS categories, was calculated.

Results: Sixty-seven participants were recruited (mean age 51?±?16 years; range 18–85), 70% had a stroke. Responders for mobility and transfer goals were further post injury or disease onset than non-responders (median 5.9 vs. 1.2 years, p?=?0.03). Clients with stroke were less likely than other participants to achieve mobility and transfer goals (p?=?0.02). There was a trend for those who achieved mobility and transfer goals to be younger (mean 49 years vs. 55 years, p?=?0.06). Although active goals are more commonly identified, passive goals were more likely to be achieved.

Conclusions: Although active goals are commonly identified by people with spasticity, passive goals were more likely to be achieved following BoNT-A injection. A long duration of spasticity does not preclude patients from achieving mobility and transfer goals. Non-stroke participants were more likely to achieve mobility and transfer goals.

• Implications for Rehabilitation

• Patients with chronic spasticity should be considered for BoNT-A as clinically meaningful outcomes can be achieved.

• When spasticity is present in multiple muscles, the GAS can be an assistive tool to guide clinicians in determining which muscles are a priority for injection, because the client will be more motivated to improve those specific goals.

• Although carers and patients are more willing to set active goals, these are more difficult to achieve possibly because follow up intervention or independent practise is required.