Assessing pharmacy student confidence to answer patient questions regarding herbal medicines and natural product drugs.

Background And Purpose: To assess the change in confidence answering questions about herbal medicines and natural product drugs (HMNPD) in third year professional pharmacy students in an HMNPD course.

Educational Activity And Setting: A questionnaire was developed to query confidence in responding to patient questions, recommending specific products, and ability to retrieve resources regarding HMNPD. It was administered the first and last week of the semester; responses were evaluated using a Chi-squared test.

Balanitis: A Unique Presentation of Diabetes in an Elderly Male.

While diabetes is a common medical condition, the initial presentation of patients with diabetes may vary. In some cases, different types of infections or inflammatory conditions may prompt a patient to seek medical attention. Males may present to their primary care provider with a bothersome inflammation of the penis that may be the first recognition of previously undiagnosed diabetes.

Mohs Micrographic Surgery: Key Pharmacologic Considerations.

Objective: To describe Mohs micrographic surgery and evaluate whether direct oral anticoagulants should be withheld in patients with atrial fibrillation (Afib) prior to the procedure and to consider what type of antibiotic prophylaxis should be used.

Setting: A community setting in which an elderly patient is living independently at home.

Practice Description: Academic-affiliated internal medicine clinic that cares for adult patients of all ages, including elderly patients living independently in their own home.

Transition Hand-Off from Inpatient to Outpatient Treatment of Acute Pyelonephritis in an Elderly Male.

Pyelonephritis is the progression of a urinary tract infection (UTI) to the kidney. In younger patients the infection may not be as severe and may even be treated with oral antibiotics. However, in elderly males pyelonephritis can be more complex and may require hospitalization and treatment with intravenous antibiotics.

Automated alerts and reminders targeting patients: A review of the literature.

Objective: Information technology supporting patient self-management has the potential to foster shared accountability for healthcare outcomes by improving patient adherence. There is growing interest in providing alerts and reminders to patients to improve healthcare self-management. This paper describes a literature review of automated alerts and reminders directed to patients, the technology used, and their efficacy.

Pharmacist-provided diabetes management and education via a telemonitoring program.

Objective: To assess clinical outcomes (glycosylated hemoglobin [A1C], blood pressure, and lipids) and other measurements (disease state knowledge, adherence, and self-efficacy) associated with the use of approved telemonitoring devices to expand and improve chronic disease management of patients with diabetes, with or without hypertension.

Setting: Four community health centers (CHCs) in Utah.

Practice Description: Federally qualified safety net clinics that provide medical care to underserved patients.

Ginkgo and Warfarin Interaction in a Large Veterans Administration Population.

Ginkgo biloba is a widely used herbal product that could potentially have a severe interaction with warfarin, which is the most frequently prescribed anticoagulant agent in North America. Literature, however, provides conflicting evidence on the presence and severity of the interaction. In this study, we developed text processing methods to extract the ginkgo usage and combined it with prescription data on warfarin from a very large clinical data respository.

The Utah Remote Monitoring Project: improving health care one patient at a time.

Background: The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah.

Development of an Alert System to Detect Drug Interactions with Herbal Supplements using Medical Record Data.

While potential medication-to-medication interaction alerting engines exist in many clinical applications, few systems exist to automatically alert on potential medication to herbal supplement interactions. We have developed a preliminary knowledge base and rules alerting engine that detects 259 potential interactions between 9 supplements, 62 cardiac medications, and 19 drug classes. The rules engine takes into consideration 12 patient risk factors and 30 interaction warning signs to help determine which of three different alert levels to categorize each potential interaction.

Assessing and treating hepatic encephalopathy in the older patient.

Altered mental status (AMS) and confusion are common reasons older patients may be admitted to a hospital. Hepatic encephalopathy (HE) is associated with confusion and AMS. The following case describes an older male presenting with confusion.

Dietary supplements and probiotics for diabetes.

An overview of the most popular alternative therapeutic modalities.

Feasibility and potential benefit of collecting Complementary and Alternative Medicine data through a computerized patient interview.

Objective: To determine the feasibility of gathering Complementary and Alternative Medicine (CAM) data directly from the patient via a computerized patient interview.

Design: A quantitative descriptive study was utilized to determine whether patients would be willing to self-report their CAM usage and whether the self-reported data complements clinicians perceptions and medical records.

Measurements: 40 patients were recruited to test the computerized patient interview application.

Dietary supplements for women: clinician considerations.

Approximately 49% of Americans take dietary supplements and spend approximately $15 billion annually. Most patients believe that supplements are innocuous substances, and they use them for added health benefits or for certain diseases. However, problems may be associated with dietary supplement use, including potential side effects and drug interactions.

Prediabetes in a nursing facility patient with renal insufficiency.

Objectives: Prediabetes encompasses a variety of abnormalities, including impaired fasting glucose, impaired glucose tolerance, and metabolic syndrome. Prediabetes also increases the risk of developing type 2 diabetes mellitus (T2DM) by 3- to 10-fold, but the complications associated with hyperglycemia begin early in the patient's progression from normal glucose levels to diabetes. Early identification and treatment of prediabetes has the potential to reduce or delay progression to overt diabetes, to preempt related cardiovascular and microvascular disease, and to significantly improve morbidity and mortality.

Health economics and compliance of vials/syringes versus pen devices: a review of the evidence.

Background: The goal of this review was to assess the state of the published literature on health economics and compliance of vials/syringes versus pen devices.

Methods: A literature search was performed using the Embase search engine for publications that linked drug terms (insulin and insulin lispro) to disease terms (insulin-dependent diabetes mellitus, non-insulin-dependent diabetes mellitus) and other terms (accuracy, article, clinical trial, controlled clinical trial, controlled study, cost benefit analysis, drug delivery system, drug dosage form, drug dosage form comparison, drug dose comparison, drug preference, equipment design, force, glycemic control, healthcare cost, human, insulin treatment, needle, patient attitude, patient compliance, patient safety, torque) along with author keywords (Diabetes, Dose accuracy, FlexPen [Novo Nordisk, Bagsvaerd, Denmark], Insulin, Next Generation FlexPen).

Results: The search yielded 39 articles, of which five articles met our study criteria.

Caring for the underserved: exemplars in teaching.

The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received.

Curriculum recommendations of the AACP-PSSC task force on caring for the underserved.

A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy.

Evaluation of adverse events of oral antihyperglycemic monotherapy experienced by a geriatric population in a real-world setting: a retrospective cohort analysis.

Background And Objective: To evaluate and compare the risk of adverse events (AEs) associated with the use of metformin, sulfonylureas and thiazolidinediones among geriatric patients in a usual care setting.

Methods: An electronic medical record database was utilized to identify geriatric patients with type 2 diabetes mellitus aged > or =65 years from 1996 to 2005. Patients naive to oral antihyperglycemic drug (OAD) therapy were followed for 395 days post initiation of metformin, sulfonylurea or thiazolidinedione treatment.

Dietary supplements in the management of diabetes: potential risks and benefits.

A wide range of products claiming to lower blood glucose levels or prevent and treat diabetes complications and comorbidities are marketed to the public. Yet many individuals with diabetes are reluctant to inform their health care providers of complementary therapy use. As the nutrition experts on diabetes care teams, registered dietitians, in conjunction with pharmacists, are uniquely positioned to encourage patients to communicate openly about their use of dietary supplements, provide safety and efficacy information about supplements, and discourage use of dangerous or ineffective products.

Importance of cultural issues in managing a patient with diabetes.

Diabetes is highly prevalent in different ethnic groups. In the Hispanic population there are unique health care beliefs and practices that may affect diabetes care and management. It is important for pharmacists to understand these beliefs and other cultural issues in providing care to these persons with diabetes.

Botanical dietary supplements and the treatment of diabetes: what is the evidence?

With the increase in cases of diabetes, many patients are using dietary supplements in an attempt to improve diabetes control. It is estimated that one third of patients with diabetes use some type of dietary supplement or complementary and alternative medicine treatment. Dietary supplements have active pharmacologic ingredients that are not only responsible for their theorized mechanisms in lowering blood glucose, but that are also responsible for adverse effects and drug interactions.

Development of a complementary and alternative medicine (CAM) pharmacy and therapeutics (P&T) subcommittee and CAM guide for providers.

Objective: The objective was 2-fold: (1) to evaluate the feasibility and value of developing a Pharmacy and Therapeutics (P&T) subcommittee aimed at scientifically evaluating complementary and alternative medicine (CAM) products for an integrated managed care organization (IMCO) and (2) to assess provider acceptance and usefulness of a CAM guide.

Methods: Three factors drove the decision to form a CAM P&T subcommittee to evaluate current commonly used CAM products: (1) physicians, pharmacists, and dieticians expressed a desire for an easy-to-use, scientifically based mechanism for evaluating the ever-increasing number of CAM products; (2) Intermountain Health Care Health Plans (Health Plans), the insurance division of this IMCO, offers access to certain CAM products to its members at a discounted price in an effort to remain competitive with other IMCOs; and (3) this IMCO owns and operates more than a dozen community pharmacies that sell CAM products. Some IMCO clinicians believed an efficacy and safety review of the products offered through the organization was warranted.