Utilizing Theoretical Domains Framework to Determine Barriers to Evidence-Based Recommendations in Non-Valvular Atrial Fibrillation.

Background: Implementation of evidence-based guidelines in patient care is inefficient. Only 14% of new research are routinely adopted into clinical practice. The atrial fibrillation (AF) practice guidelines recommend anticoagulation in men with a CHADS-VASc score greater than or equal to 2 and in women with a CHADS-VASc score greater than or equal to 3.

Selection of a validated scale for measuring medication adherence.

Objective: To evaluate literature describing medication adherence surveys/scales to gauge patient behaviors at the point of care.

Data Sources: Literature was identified via PubMed and Ovid (1950 to June 2009) using the search terms medication adherence, medication compliance, and medication persistence and combined with the terms questionnaire, survey, scale, or self-report.

Study Selection: All articles in English with adherence scales validated in two or more diseases and containing 30 or fewer questions were selected.

Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea.

Objectives: Our objective was to determine if use of intravenous immune globulin (IVIG) decreases the incidence of mortality, colectomies, and length of stay in the hospital in patients presenting with severe Clostridium difficile-associated diarrhea (CDAD).

Methods: A retrospective analysis was undertaken of 79 patients who had a positive C. difficile toxin titer and severe disease admitted to the University of Pittsburgh Medical Center Presbyterian between July 2001 and July 2003.

Designing a strategy to promote safe, innovative off-label use of medications.

Innovative off-label medication use (defined as prescribing with reasonable rationale for use, but insufficient evidence to allay safety, efficacy, and cost-effectiveness concerns, yet is not clinical research) is common practice and provides challenges to ensuring high-quality health care and patient safety. This article describes a strategy to promote policy and standardization of innovative off-label medication use, ensure oversight of patient safety, and prospectively assess efficacy. A multidisciplinary group developed a policy and process to regulate innovative off-label medication use that standardizes formulary review, maximizes peer expertise input, and minimizes institution liability by evaluating the effectiveness of use, promoting evidence-based practices, and ensuring ethical obligations to patients and society.

United States medical practice summary: innovative off-label medication use.

Data are limited regarding how academic medical centers (AMCs) deal with medication use that represents a departure from product labeling; has reasonable rationale for use, but insufficient evidence to allay safety, efficacy, and cost-effectiveness concerns; yet is not clinical research (defined as innovative off-label medication use). This report describes national trends in management of innovative off-label medication use. A cross-sectional survey of US AMCs was conducted.

Quality of arthritis information on the Internet.

Purpose: The quality and reliability of Internet-based arthritis information were studied.

Methods: The search terms "arthritis," "osteoarthritis," and 'rheumatoid arthritis" were entered into the AOL, MSN, Yahoo, Google, and Lycos search engines. The Web sites for the first 40 matches generated by each search engine were grouped by URL suffix and evaluated on the basis of four categories of criteria: disease and medication information content, Web-site navigability, required literacy level, and currentness of information.

Impact of nonsteroidal antiinflammatory drugs on the cardioprotective effects of aspirin.

Objective: To examine the evidence of a pharmacodynamic interaction between aspirin and nonsteroidal antiinflammatory drugs (NSAIDs); specifically, to determine whether a deleterious relationship exists with respect to the cardioprotective effects of aspirin.

Data Sources: Primary articles were identified by a MEDLINE search (1966-May 2004). Search terms included aspirin, nonsteroidal antiinflammatory drug, drug interaction, mortality, myocardial infarction, and stroke.

Role of inhaled nitric oxide in adult heart or lung transplant recipients.

Objective: To evaluate the role of inhaled nitric oxide (iNO) in adult heart or lung transplant recipients.

Data Sources: Pertinent literature was identified via a MEDLINE search (1966-July 2004).

Data Synthesis: Pulmonary hypertension leading to right ventricular failure and ischemic reperfusion injury are complications following heart or lung transplant, respectively.

Low-dose granisetron for postoperative nausea and vomiting prophylaxis.

Objective: To evaluate the use of low-dose granisetron in postoperative nausea and vomiting prophylaxis.

Data Sources: Clinical trials available through PubMed and OVID (1966-July 2003), as well as information supplied by the drug manufacturer, were accessed.

Data Synthesis: Safety concerns associated with droperidol and limited availability of other agents have created a need to restructure prophylaxis guidelines for postoperative nausea and vomiting.

Meeting the modified drug information requirements of ASHP-accredited pharmacy practice residency programs.

The current standards for meeting drug information (DI) requirements in American Society of Health-System Pharmacists (ASHP)-accredited pharmacy practice residency (PPR) programs and the impact of changes in ASHP standards for the DI requirements were studied. In September 2002 a nine-question survey was e-mailed to the directors of all ASHP-accredited PPR programs listed with an available e-mail address on ASHP's residency directory Web page as of August 2002. The program directors were asked to provide information on the demographics of their practice settings, the current methods of completing the DI requirements of their programs, whether the DI requirements had changed between the 2001-02 and 2002-03 residency years, and whether any changes in the DI requirements were anticipated.

Venlafaxine hydrochloride for the treatment of hot flashes.

Objective: To review the literature evaluating venlafaxine for the treatment of hot flashes.

Data Sources: Clinical literature accessed through MEDLINE (1966-August 2002), PubMed, Harrison's Online, and references of reviewed articles. Key terms used were venlafaxine, Effexor, hot flashes, and vasomotor symptoms.

Seizure potential of concomitant medications and radiographic contrast media agents.

Objective: To review seizure risk of concomitant medication administration and nonionic, water-soluble radiographic contrast media agents for myelography.

Data Sources: Clinical literature was identified through MEDLINE (1966-May 2003). Key search terms included metrizamide, iohexol, myelogram, myelography, seizure, and contraindications.

Adverse Drug Events Involving COX-2 Inhibitors.

Objective: To describe the types and severity of adverse drug-related events (ADEs) observed in patients receiving cyclooxygenase-2 (COX-2) inhibitors and to increase the awareness of risk factors that predispose patients to ADEs associated with COX-2 inhibitors.

Methods: A review of ADEs reported at the University of Pittsburgh Medical Center Presbyterian Hospital (UPMC-P) revealed significant events related to use of celecoxib or rofecoxib. A query of the internal ADE database was performed to identify ADEs involving COX-2 inhibitors from January 1999 to June 2002.

Hospital policies regarding herbal medicines.

The prevalence and content of herbal policies and herbal formularies in the hospital setting were studied. Drug information centers affiliated with hospital pharmacies were surveyed by telephone. Hospitals with policies on herbal products were asked to provide detailed information about the policies.