Designing implementation strategies to improve identification, cascade testing, and management of families with familial hypercholesterolemia: An intervention mapping approach.

Introduction: Familial hypercholesterolemia (FH) is a common inherited cholesterol disorder that, without early intervention, leads to premature cardiovascular disease. Multilevel strategies that target all components of FH care including identification, cascade testing, and management are needed to address gaps that exist in FH care. We utilized intervention mapping, a systematic implementation science approach, to identify and match strategies to existing barriers and develop programs to improve FH care.

Pharmacologic therapy among patients with type 2 diabetes mellitus admitted to the cardiology service.

Aim: To review the management of diabetes control in patients with type 2 diabetes admitted to the cardiology service at Auckland City Hospital for over 48 hours; to assess how many would potentially benefit from introduction of empagliflozin under current Pharmac guidelines.

Methods: A retrospective audit of all admissions into cardiology between 1 November 2020 and 31 January 2021 prior to the availability of empagliflozin. Data collected included diagnosis and presence of type 2 diabetes, HbA1c and diabetes medications.

Opportunities and Challenges for the Development of MRCK Kinases Inhibitors as Potential Cancer Chemotherapeutics.

Cytoskeleton organization and dynamics are rapidly regulated by post-translational modifications of key target proteins. Acting downstream of the Cdc42 GTPase, the myotonic dystrophy-related Cdc42-binding kinases MRCKα, MRCKβ, and MRCKγ have recently emerged as important players in cytoskeleton regulation through the phosphorylation of proteins such as the regulatory myosin light chain proteins. Compared with the closely related Rho-associated coiled-coil kinases 1 and 2 (ROCK1 and ROCK2), the contributions of the MRCK kinases are less well characterized, one reason for this being that the discovery of potent and selective MRCK pharmacological inhibitors occurred many years after the discovery of ROCK inhibitors.

Barriers, facilitators, and solutions to familial hypercholesterolemia treatment.

Background: Familial hypercholesterolemia (FH) is an inherited lipid disorder that confers high risk for premature cardiovascular disease but remains undertreated. Causes are multifactorial and multilevel, ranging from underprescribing (at the clinician-level) to medication nonadherence (at the patient-level). We evaluated patient and clinician stakeholder barriers and facilitators for treatment of FH to explore possible solutions to the problem.

Body size and tube voltage dependent corrections for Hounsfield Unit in medical X-ray computed tomography: theory and experiments.

The purpose of this work is to present a body size and tube voltage dependent correction scheme for the Hounsfield Unit, HU, in medical X-ray Computed Tomography imaging. Boltzmann photon transport equation was employed to study X-ray interaction with bulk water in CT imaging. Experimentally measured X-ray output in body of phantoms and attenuation cross sections of water were employed in the derivation of beam intensity in X-ray imaging.

Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol.

Background: Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia.

Assessment of symptom burden and adherence to respiratory medications in individuals self-reporting a diagnosis of COPD within a community pharmacy setting.

Objectives: Data on symptom burden or medication adherence in patients with chronic obstructive pulmonary disease (COPD) within a community pharmacy setting are limited. This study assessed symptom burden and adherence to respiratory medications in individuals reporting COPD, chronic bronchitis, or emphysema diagnoses visiting community pharmacies.

Design: This cross-sectional study enrolled participants visiting 35 community pharmacies in Missouri (October 2016 to April 2017).

Implementation Science to Advance Care Delivery: A Primer for Pharmacists and Other Health Professionals.

Health care is experiencing increasing pressure to implement evidence-based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research-to-practice gap.

An Approach for Some in Advanced Pharmacy Informatics Education.

Computerization is transforming health care while the quantity and complexity of biomedical knowledge rapidly grows. Today, all clinicians use health information technology (HIT), but only some pharmacists need to be cross-trained in "all" that advanced informatics entails so they can devise new and better information systems to support the pharmacy practice of the future. We propose a dual approach to informatics education in pharmacy: incorporate fundamental informatics education into pharmacy curricula for all students; and train some students interested in becoming informatics experts to design, develop, implement, and evaluate novel HIT for pharmacy.

Dissemination and implementation sciences in pharmacy: A call to action for professional organizations.

There is a substantial gap between the generation of new knowledge and its widespread incorporation into routine clinical practice, including the medication use process. Principles of dissemination and implementation sciences, if fully embraced by clinicians and researchers, have the potential of improving healthcare effectiveness, efficiency, quality, and safety. This commentary is a call to action for member-driven professional organizations in pharmacy to serve their members and the profession by proactively and strategically leading efforts to develop pharmacist's abilities to incorporate principles of dissemination and implementation sciences into their practice.

An Approach for All in Pharmacy Informatics Education.

Computerization is transforming health care. All clinicians are users of health information technology (HIT). Understanding fundamental principles of informatics, the field focused on information needs and uses, is essential if HIT is going to support improved patient outcomes.

Prevalence of Helicobacter pylori infection in children in the Bahamas.

Objective: Helicobacter pylori (H pylori) is a common bacterial infection that is associated with significant morbidity and mortality worldwide. This bacterium causes a chronic infection that is causally related to illnesses ranging from gastritis, peptic ulcer disease to gastric cancer. It is generally considered that it is acquired in childhood but the prevalence varies considerably between countries and communities.

Improving care transitions: current practice and future opportunities for pharmacists.

During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S.

The quality of screening colonoscopies in an office-based endoscopy clinic.

Background: Wait times for hospital screening colonoscopy have increased dramatically in recent years, resulting in an increase in patient referrals to office-based endoscopy clinics. There is no formal regulation of office endoscopy, and it has been suggested that the quality of service in some office locations may be inferior to hospital procedures.

Objective: To compare the quality of office-based screening colonoscopies at a clinic in Oakville, Ontario, with published benchmarks for cecal intubation, withdrawal times, polyp detection, adenoma detection, cancer detection and patient complications.

Improving adherence to dyslipidemia medication guidelines in hospitalized diabetic patients using a technology-assisted pharmacist intervention.

We tested whether a technology-assisted pharmacist intervention improved physician adherence to guidelines for lipid-lowering therapy in diabetic patients. Computerized alerts identified diabetic patients above LDL-Cholesterol (LDL-C) goal. During Period 1 prescribing behavior was observed in both control and intervention physician groups without intervening.

Systemic antifungal therapy for tinea capitis in children.

Background: Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread.

Objectives: To assess the effects of systemic anti-fungal drugs for tinea capitis in children.

Adherence to dyslipidemia treatment guidelines in diabetic patients.

Using a previously described computer algorithm to prospectively identify diabetics, we observed the adherence to published guidelines for treatment of dyslipidemia in diabetics. Despite national guidelines, dyslipidemia remains widely under-treated. Further interventions are needed to improve lipid-lowering treatment in appropriate candidates.

Concordance between medication histories and outpatient electronic prescription claims in patients hospitalized with heart failure.

Using an electronic prescription claims database and electronic hospital records, we retrospectively compared outpatient heart failure (HF) prescriptions dispensed with reported use obtained during medication histories taken at hospital admission. We found significant disagreement between each source for all but one HF medication class.

Intervention to improve dyslipidemia screening in hospitalized diabetics.

Using an automated method to prospectively identify diabetic patients, we measured the impact of an administrative policy to perform LDL-cholesterol (LDL-c) testing on all diabetics not having the test performed within a specified time period. Automatic testing resulted in significant increases in LDL-c testing rate, and identified a greater proportion of patients who were candidates for statins. Further interventions are needed to increase prescriptions for lipid-lowering therapy.

Defining the opportunity for pharmacogenetic intervention in primary care.

Unlabelled: Pharmacogenetics (PG), the study of human genome function and its effects on drug response, represents an exciting approach for reducing adverse drug events and increasing therapeutic efficacy. However, there is no clear information of the potential impact of PG in the primary care setting. Therefore, a study was conducted to determine the frequency of use of medications under PG influence, including 16 PG adverse drug reaction (ADR)-associated medications, in the primary care setting.

Substrate specificity and novel selective inhibitors of TNF-alpha converting enzyme (TACE) from two-dimensional substrate mapping.

We report a systematic analysis of the P1' and P2' substrate specificity of TNF-alpha converting enzyme (TACE) using a peptide library and a novel analytical method, and we use the substrate specificity information to design novel reverse hydroxamate inhibitors. Initial truncation studies, using the amino acid sequence around the cleavage site in precursor-TNF-alpha, showed that good turnover was obtained with the peptide DNP-LAQAVRSS-NH2. Based on this result, 1000 different peptide substrates of the form Biotin-LAQA-P1'-P2'-SSK(DNP)-NH2 were prepared, with 50 different natural and unnatural amino acids at P1' in combination with 20 different amino acids at P2'.

Implementing a commercial rule base as a medication order safety net.

A commercial rule base (Cerner Multum) was used to identify medication orders exceeding recommended dosage limits at five hospitals within BJC HealthCare, an integrated health care system. During initial testing, clinical pharmacists determined that there was an excessive number of nuisance and clinically insignificant alerts, with an overall alert rate of 9.2%.